What Sexual Side Effects Are Possible After Robotic And Laparoscopic Prostate Surgery
Laparoscopic and robotic prostate surgery are highly precise in their ability to spare the nerve bundle responsible for erections. The degree of sexual function after radical prostatectomy is determined by many factors. These include the man’s age, how sexually active he was before the procedure. Most men experience at least temporary erectile problems after a radical prostatectomy. Our recently demonstrated 82% potency rate at 1 year following “energy-free” laparoscopic radical prostatectomy in patients with excellent preoperative erections is amongst the best in the literature.
Getting Ready For Surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if youre not sure.
- I take a blood thinner, such as:
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these problems, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
- Be honest with your healthcare providers about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- For information about being a health care agent, read How to Be a Health Care Agent.
- If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.
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Types Of Prostate Surgery
There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.
Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.
The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.
Keyhole surgery
Keyhole surgery .
- Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
- Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.
Open surgery
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Urinary Control After Robotic Prostatectomy
Following proper prostatectomy recovery guidelines, patients who experienced normal continence prior to surgery should regain function within 12-13 months.
Loss of bladder control, or urinary incontinence, is a potential side effect of prostate removal surgery. Because the prostate sits just below the bladder and encircles the urethra, the urinary tract can be damaged during a radical prostatectomy. In the hands of an experienced robotic surgeon like Dr. Samadi, preservation of the urinary sphincter and competent rebuilding of the urinary tract can eliminate the risk of long-term incontinence. Uniquely, Dr. Samadi does not sever the endopelvic fascia and cuts the bladder neck very narrowly during robotic prostatectomy.
Urinary incontinence is far more common after open prostatectomy, as is risk of infection.
Changes In Your Sex Life
Most men experience some decline in erectile function after their prostate is removed, but this can be managed. It can take six months or even up to a year for the affected nerves to recover from surgery. But with proper therapy and treatment, most patients can have good erectile function again, says Dr. Fam.
Treatment options include:
Work with your doctor to find a treatment that is right for you.
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What Are Laparoscopic And Robotic Surgery
Laparoscopic and robotic prostate surgery are minimally invasive techniques for performing surgery. Both these procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive surgery with advanced robotic technology.
Histology Results And Follow
You will have an appointment at 4 weeks post-operation. Between your operation and this date, your prostate will have been sent to a laboratory where it is thoroughly inspected to produce a final report on the precise details of your cancer. This is called a histology report. During this appointment you will be given the histology results, detailing the final Gleason grade and stage of tumour, which is very important in determining your prognosis and the probability of the need for additional treatment, such as radiotherapy.
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Anatomical Mechanisms Of Male Urinary Continence
Although we still cannot claim to fully understand the mechanisms of urinary continence in males, alongside advances in radical prostatectomy techniques and increased numbers of operations, a large amount of related anatomical knowledge has been accumulated. In the 1980s, on the basis of the classical anatomical theory, the urogenital diaphragm, lying flat below the prostate gland, was thought to be a key structure in urinary continence by acting as the urethral sphincter however, at the end of the 1990s, human and cadaver studies showed that the structure previously identified as the urogenital diaphragm did not exist .
In terms of our present understanding of the mechanisms of male urinary continence, a review published in European Urology in 2010 provides a representative collection of results, and this review was updated in 2016 with the latest research .
Currently, male urinary continence is understood to be achieved by the combined actions of multiple anatomical structures surrounding the prostate gland below, we summarize the major constituent muscular structures in this urethral sphincter complex and their roles.
What Are The Benefits To Patients Who Have Laparoscopic And Robotic Prostate Cancer Surgery
The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise the risk of incontinence is low and the surgical technique is continuously refined to improve potency.
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Outcomes And Clinical Benefits Include:
- Same cancer cure rate as traditional surgery
- Shortened physical recovery
- Highest cure rates compared to other treatments
- Improved functional recovery of bladder control and sexual function
- Best possible way to know the full extent of the cancer
- Assessment of local/regional lymph nodes to check for cancer spread
What Makes The Robotic Prostatectomy A Superior Prostate Cancer Treatment
The da Vinci robotic prostate cancer surgery system is able to provide superior clinical prostate cancer treatment results when compared to non-robotic traditional and scope-assisted procedures.
This is because the da Vinci systems Surgeon Console is equipped to provide the surgeon with a revolutionary, three-dimensional, multi-level magnification spectrum.
More traditional scope-assisted surgery typically provides a much lower resolution image, and a far more limited field of vision. Furthermore, the da Vinci systems sensitive electronics and one-centimeter diameter surgical arms allow the surgeon to make highly precise movements inside the incision during robotic prostate cancer surgery. This means that the malignant tissue can be removed with efficiency and ease unheard of prior to the era of robotic surgery. This greater precision reduces the likelihood of relapse due to missed cancerous tissue.
The precision of the da Vinci system also allows the prostate surgeon to avoid damaging healthy prostate tissue, which improves clinical results, reduces scar tissue build-up, and contributes to an overall shorter recovery period after robotic prostatectomy.
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Why Is There Less Blood Loss With Robotic
The use of the robotic equipment in surgery means a more precise and less disruptive dissection, which helps control potential sources of bleeding. Blood loss is also reduced because of the pressure generated by the gas used in inflate the abdomen during surgery, which provides surgeons with a better and more expansive view of the operating area around the prostate.
What Are The Advantages Of Cleveland Clinic’s Prostate Surgery Program
These procedures are performed through small key-hole incisions that do not cut muscle. Laparoscopic and robotic prostatectomy offer surgeons unparalleled visualization of the area, thus permitting precise removal of the prostate. Patients also experience significantly less blood loss. Additionally, patients benefit from:
- Reduced hospital stay after surgery and faster healing
- Less postoperative pain and virtually no need for pain medication
- Earlier removal of catheter
- Shorter recovery time
- Quicker return to normal activity and work
- Smaller “Band-aid” incisions and less scarring
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Urologic Cancer Treatment Begins With Your Primary Physician
In most cases, once you have been diagnosed with a urologic cancer, either prostate, kidney or bladder, your primary care physician and/or urologist will assist you with the necessary test required before your surgery. This should be done approximately four weeks before surgery. If you have any questions regarding pre-op tests, please call us at .
Prostate Cancer Can Change The Way You Feel About Yourself
Itâs OK to talk about challenges youâre facing, including sex and confidence in yourself. You deserve support, whether itâs from a partner, friends, family, your doctor or a counselor. Opening up about your needs, thoughts and concerns â even when uncomfortable â shows real courage.
In a lot of ways, men are brought up to be macho â you donât complain, you donât have things wrong with you. But prostate cancer isnât something you can just spit on, rub dirt on, walk off, you have to deal with it.
During and after treatment, youmight experience changes to your:
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What Measures Should Be Taken After Discharge
Patients should take medications as directed by your doctor while avoiding products with aspirin. Patients are advised to drink plenty of fluids and avoid vigorous exercises for six weeks. Also, the patient should gently wash the incision with mild soap and water. Furthermore, patients should keep their legs elevated when resting in bed and should avoid consuming alcohol, caffeinated drinks and spicy foods.
Days Before Your Surgery
Follow Your Healthcare Providers Instructions for Taking Aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare providers instructions. Do not stop taking aspirin unless they tell you to.
For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.
Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary Supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding.
If your healthcare provider gives you other instructions, follow those instead.
For more information, read Herbal Remedies and Cancer Treatment.
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Should I Still Have My Kidney Removed If My Cancer Has Spread
While some evidence suggests that removing the primary cancer in the kidney can extend the life of patients with metastatic kidney cancer, an evaluation needs to be made to determine how risky the surgery would be. If possible, it may be best to have a minimally invasive removal to limit recovery times.
What Is The Recovery Time After Radical Prostatectomy
You may feel tired for a few weeks after surgery. Light exercise such as walking can help with the healing process. You should avoid heavy lifting for several weeks.
You may have urinary incontinence or leakage for weeks to months after the surgery, although most people recover continence after surgery. Recovery of sexual function is expected to take months. Your doctor may start you on a medication to help with recovery of erections.
Youll need regular follow-ups with your healthcare provider to monitor for evidence of cancer recurrence and manage effects from the surgery. They can work with you to improve any problems with erectile dysfunction or bladder control.
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Recovery After Greenlight Laser Surgery
Please note that these recommendations apply to patients who undergo Greenlight Laser prostatectomy at New York Urology Specialists. Other surgeons may have different recommendations. Please contact your surgeon for instructions.
Patients can have a regular diet after the Greenlight laser of the prostate. For patients who undergo Greenlight laser prostatectomy at New York Urology Specialists, you may drink alcohol socially within reason once youre not taking medications.
You also may engage in regular nonstrenuous activities such as walking. Men should avoid sexual activity for 3-4 weeks after the Greenlight laser procedure to allow the prostate to heal. Similarly, biking and strenuous running should be avoided for 3-4 weeks after the procedure as it may provoke bleeding.
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What Are The Warning Signs Of Prostate Cancer
Risk factors for prostate cancer include age, family history, race, and obesity. You may be at higher risk for prostate cancer if you are over age 50, have a family history of prostate cancer, are overweight, or if you are a Black man. See your doctor if you have any of these symptoms:
- Trouble passing urine
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Frequency And Limitations Of Assessment
In recent reports, the second leading cause of the low recovery rate from erectile dysfunction is that unlike urinary incontinence, preoperative function cannot easily be assessed postoperatively in all patients. In other words, age, preoperative function measured with the IIEF-5, and the extent of intraoperative NVB sparing are well-proven independent factors that directly affect recovery of erectile function. However, because these variables differ among individuals, consistent postoperative improvements are difficult to identify. Thus, to control for these variables, most reports on erectile dysfunction have only included a subset of patients such as those aged < 60 years those with normal preoperative erectile function, defined as an IEF-5 score of at least 22 and those with complete bilateral preservation of the NVB during surgery. However, the patients satisfying these conditions typically only account for < 10% of all patients .
About Your Prostate Surgery
A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body.
A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision , which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.
Open prostatectomy
In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button . Theyll remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.
Figure 2. Open prostatectomy incisions
Laparoscopic or robotic-assisted prostatectomy
During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen . Theyll insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to assist with this procedure.
Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions
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Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
What To Expect During And After Prostate Cancer Surgery
At the time of surgery, patients will have a urinary foley catheter placed in the urethra. Upon hospital discharge, patients will keep the urinary catheter with them for one week. Urine drains into a small bag that is strapped to the upper leg. There is a valve at the bottom of the bag to empty it from time to time. It will be necessary to drain the bag as it fills.
After the surgery and while still in the hospital, patients will begin digesting clear liquids. This will be followed by solid food based on the surgeons recommendations. The first bowel movement occurs three to four days later, which is normal. In order to make the first bowel movement as easy as possible, we recommend drinking prune juice daily, while taking a stool softener and laxative. These are highly important to consider because patients should minimize straining and pushing during a bowel movement after treatment.
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