Transurethral Resection Of Bladder Tumor
A transurethral resection of bladder tumor or a transurethral resection is often used to find out if someone has bladder cancer and, if so, whether the cancer has spread into the muscle layer of the bladder wall.
TURBT is also the most common treatment for early-stage or superficial bladder cancers. Most patients have superficial cancer when they’re first diagnosed, so this is usually their first treatment. Sometimes, a second, more extensive TURBT is done to better ensure that all the cancer has been removed. The goal is to take out the cancer cells and nearby tissues down to the muscle layer of the bladder wall.
Prostatectomy: What To Expect During Surgery And Recovery
If youve been diagnosed withprostate cancer, your doctor will consider many factors before recommending the besttreatment. For many men, that may mean a prostatectomy. In this surgery,doctors remove the entire prostate.
The Johns Hopkins Hospital performs more of these procedures than almostanywhere else in the world. One of the most common questions they hear frompatients: What should I expect after surgery?
Johns Hopkins urologistMohamad Allaf, M.D., explains the surgery and recovery.
Sexual Effects Of Urostomy
Its normal people to be concerned about having a sex life with a urostomy. Having your ostomy pouch fit correctly and emptying it before sex reduces the chances of a major leak. A pouch cover or small ostomy pouch can be worn with a sash to keep the pouch out of the way. Wearing a snug fitting shirt may be more comfortable. Choose sexual positions that keep your partners weight from rubbing against the pouch. For more tips, see Urostomy Guide.
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Why The Procedure Is Performed
Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. This is called localized prostate cancer.
Your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your doctor may talk with you about other treatments that could be good for your cancer. These treatments may be used instead of surgery or after surgery has been performed.
Factors to consider when choosing a type of surgery include your age and other medical problems. This surgery is often done on healthy men who are expected to live for 10 or more years after the procedure.
Neobladder And Urinary Diversion
If the bladder is removed through a radical cystectomy, our surgeons may be able to create a new bladder, called a neobladder. If thats not possible, we will create a new way for the urine to leave the body. This is called urinary diversion. Which best procedure is best depends on your prior medical history, the location of the cancer, and your personal preferences.
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What Are Pelvic Floor Exercises And Can Improve Erection Quality
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
Can I Shower Bathe And Swim With A Urostomy
A stoma is a one-way door, so waterâs not a problem. You can shower and bathe with or without your pouch. But itâs best not to use bath oils or soaps with moisturizer.
Swimming isnât a problem, either. It helps to:
- Wear a smaller bag or a waterproof cover when you swim.
- Wear your pouch, but empty it before you get into the water.
- Use waterproof tape around the edges of the pouch.
- Wait a few hours after you put on a new pouch before you swim.
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Improve Bladder Control Regain Your Continence Sooner After A Robotic Prostatectomy
Kegel exercise strengthens the group of muscles called the pelvic floor muscles These muscles contract and relax around the bladder and the bladder opening at your command. When these muscles are weak, urine leakage may result. You can exercise these muscles just like any other muscle in your body, and building them up may help reduce your symptoms. It is important that you perform these exercises correctly and consistently to gain maximum benefit after prostate cancer surgery.
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What Should I Expect From Cystectomy
Your surgeon may remove part of your bladder or the entire bladder .
- Partial cystectomy: Only a part of the bladder is removed. Usually, nearby lymph nodes are removed as well to determine whether any cancer has spread beyond the bladder. Lymph nodes are small bundles of tissue that filter your bodys lymph fluid and produce immune system cells. The remaining bladder is repaired and stays in the body.
- Radical cystectomy: Surgeons remove the entire bladder and nearby lymph nodes. In men, surgeons almost always cut the vas deferens and remove the prostate and seminal vesicles . In women, doctors often also remove the uterus, fallopian tubes, ovaries, cervix and occasionally part of the vaginal wall.
Surgeons perform bladder removal surgery using one of two different surgical approaches:
If radical cystectomy is performed, your surgeon will reconstruct the urinary tract in one of three ways so that the urine you produce can be eliminated from your body. These methods include:
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Urinary Dysfunction After Prostate Cancer Treatment
The term urinary dysfunction includes:
-
Urinary incontinence, which can range from some leaking to complete loss of bladder control
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Irritative voiding symptoms or urinary bother, including increased urinary frequency, urgency, and pain upon urination
Bladder obstruction caused by an enlarged prostate is the typical reason for these symptoms initially. However, after therapy, they are typically caused by damage to the nerves and muscles used in urinary control.
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What Causes Frequent Urination After Prostate Surgery
Q: Is frequent urination normal after a radical prostatectomy? A: Yes, but its usually only a matter of time before urination returns to normal. Bladder capacity is usually reduced somewhat by the surgery, but the main cause is that, after surgery the bladder wall is swollen and thickened and irritable.
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Oab And Urgency Incontinence
In the context of management of post-rPR OAB syndrome, it is important to understand its underlying pathophysiological mechanism . Since OAB is multifactorial , the exact role of prostate surgery in the development of OAB is still under debate as, after rPR, there are several variables that could contribute to detrusor overactivity.
Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery . However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described.
It has been demonstrated that urethral afferents are activated by urethral perfusion and they could modulate the micturition reflex via pudendal and pelvic afferent and efferent signals, causing bladder contraction. This has been described as urethrovesical mechanism .
In a recent study, Mastukawa et al. identified that low maximum urethral closure pressure at baseline and its decrease postoperatively were strong predictors of de novo post-rPR OAB underlying the role of the intrinsic sphincter deficiency on the pathophysiology of OAB .
In contrast, detrusor underactivity may cause OAB syndrome as well, which seems contradictory at the first glance. Bladder underactivity may affect up to 40% of patients after radical prostatectomy mostly due to denervation .
Sexual Effects Of Radical Cystectomy In Men
After surgery, many men have nerve damage that affects their ability to have erections. In some men this may improve over time. For the most part, the younger a man is, the more likely he is to regain the ability to have full erections. If this issue is important to you, discuss it with your doctor before surgery. Newer surgical techniques may help lower the chance of erection problems.
For more on sexual issues and ways to cope with them, see Sex and the Man With Cancer.
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Continuous Irrigation Of The Bladder After Prostatectomy
Prostatectomy is one of the most common surgical procedures performed in the prostate. It can be suprapubic prostatectomy or transurethral resection. It is a common procedure in cases of prostate cancer and benign prostatic hyperplasia.
You might need CBI in this case and other surgical procedures concerning the prostate. Remember that the male prostate is located in the bladder neck. By accessing to the prostate, other surrounding tissues will likely be affected. This is the prostatic fossa.
The manipulation of the prostate may also cause mild tearing in the bladder. Thus, continuous irrigation of the bladder is recommended in many cases. It is actually considered a routine post-operative procedure for some doctors. Still, if your doctor does not consider CBI necessary, he may have valid reasons, too .
We mentioned above the reasons why we typically advocate CBI after prostate surgery. In the case of prostatectomy, patients will already have a catheter placed after surgery. An additional reason in this particular case is to avoid collapsing the lumen of the catheter.
But if your doctor decided not to perform continuous irrigation, heres a list of possible reasons :
For all of the above, your doctor may or may not consider CBI in your case. If he does not use CBI, it is probably because your surgery had some bleeding. But if youre a candidate for CBI, rest assured it is for your sake.
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Quality Of Life After Surgery
Since bladder removal surgery involves restructuring the way urine exits the body, a person may initially experience a decrease in their quality of life. However, managing urine secretion usually becomes easier as time goes on.
Immediately following surgery, doctors usually restrict what the person can do. This restriction, though temporary, may feel frustrating.
It is common for the new urinary system, such as urinary sacks or stomas, to feel uncomfortable at first. If the person has trouble adjusting, they may want to discuss their concerns and feelings with a doctor, social worker, or counselor. Joining a support group can also help.
The person should be able to return to all their normal life activities within 46 weeks following surgery.
During recovery, the person will be able to get used to their new means of urinating. As their familiarity with the new urinary system grows, any inconvenient symptoms should lessen.
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How Do You Retrain Your Bladder After A Catheter Is Removed
Gradually increase the amount of time between bathroom breaks. Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom.
Bleeding After Prostate Surgery
Bleeding after prostate surgery is among the most common problems. To prevent the problem, a drain system is installed in the surgical area, and in addition to this system, some treatments are also performed to prevent bleeding. Although bleeding after prostate surgery is not a sign of important problems, you should definitely contact your physician if the condition has become chronic.
There is a number of risks that can occur after prostate surgery. These risks may include urination problems, urinary incontinence, bleeding, and sexual dysfunction. In this article, we will talk about the bleeding problem faced after prostate surgery.
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What Kinds Of Surgeries Treat Urinary Incontinence After Your Prostate Is Removed
There are two types of surgery for urinary incontinence: the urethral sling and the artificial urinary sphincter. Usually, the incontinence needs to last for about one year after the prostatectomy to be sure there is not going to be further improvement before your healthcare provider suggests this type of therapy.
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Who Performs Prostate Surgery
A urologist performs prostate surgery. Some specialists use the term urologic surgeon, but board certification in urology requires extensive training in surgery, including prostate surgery. If you require prostate surgery for cancer, look for a surgeon who specializes in prostate cancer surgery. This doctor may be a urologist, urologic surgeon, or surgical oncologist.
Urologists specialize in surgical procedures in the urinary tract system and the male reproductive system, including the prostate. Surgical oncologists specialize in cancer surgery. All of these providers may specialize further in the surgical approach, such as laparoscopic surgery or robotic prostate surgery.
Regardless of the specialty, be sure your surgeon performs a high volume of surgeries per year of the exact procedure you are having, and at a hospital with a record of high qualitya low rate of complications. This expertise and experience will improve your chances of a successful operation and recovery. Check hospital quality at healthgrades.com.
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Why Does Incontinence Occur After Prostate Cancer Surgery
There are two sphincter muscles that keep men continent before radical prostatectomy , the internal urethral sphincter and the external urethral sphincter. The internal sphincter is not under your control and is found at the bottom of the bladder, called the âbladder neck,â and in the prostate. This is removed during your surgery because the prostate cannot be taken out without removing this sphincter. You control your external sphincter, which is the muscle you can use to stop your urine stream and the one you can strengthen with pelvic floor muscle exercises. Normally, a healthy external sphincter is sufficient to provide continence. However, after RP, there can be some damage or dysfunction of the external sphincter, which can prevent you from recovering your bladder control. This may be due to damage to the nerves, blood supply, supporting structures, or the muscle itself as the external sphincter is located at the apex of the prostate gland.
What Are The Types Of Radical Prostatectomy
Your surgeon will choose among several types of radical prostatectomy:
- Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
- Robot radical prostatectomy: Your surgeon makes several small incisions or one single incision across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.
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How Common Is Urinary Incontinence After Prostate Surgery
If you have a radical prostatectomy, a tube called a catheter will be placed inside your bladder to allow urine to drain. When the catheter is removed, most men will have some difficulty controlling their urine flow.
For most men, the urinary leakage will improve in the months following surgery. In an NHS trial, 46% of men needed to use absorbent pads six months after having a radical prostatectomy. But, one year on from having the procedure, this figure had improved to 17%.
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Holmium Laser Enucleation Of The Prostate
In a high-tech procedure known as holmium laser enucleation of the prostate, your NYU Langone surgeon uses a laser to remove the prostate tissue that is blocking urine flow, without damaging the surrounding tissue. Performed under general anesthesia in the hospital, this procedure involves removing, or enucleating, prostate tissue that is blocking urine flow by cutting, or morcellating, it into small, easily removable pieces using a laser.
Men who undergo this procedure can expect to recuperate at home and return to work in less than a week. Temporary side effectsincluding blood and burning with urination, an increase in the frequency and urgency of urination, and mild urine leakagecan last for up to four weeks.
During recovery, you can perform most of your usual activities, except for sexual or strenuous activities.
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Surgery For Male Urinary Dysfunction
At NYU Langone, doctors often recommend surgery for men with certain types of male urinary dysfunction, including benign prostatic hyperplasia and stress incontinence thats caused by prostate surgery. Rarely, surgery is required to treat neurogenic voiding dysfunction.
The goal of surgery is to improve bladder function. There are several types of prostate surgery, and the one thats best for you often depends on your symptoms and the size of the prostate.
How Is Postoperative Bleeding Diagnosed
Your healthcare provider will look for the source of your bleeding. He will ask about your health, and if you or anyone in your family has a bleeding disorder. He will ask what medicines you take, including over-the-counter medicines, and vitamin or herbal supplements. You may also need any of the following:
- Blood tests may be done to show how well your blood clots.
- Procedures such as endoscopy and angiography may be used to find the source of your bleeding, or to control it. An endoscope is a long, bendable tube with a light on the end of it. An angiogram is a picture of your arteries. You may be given a dye to help the blood vessels show up better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.
- Surgery may be done in the same area to pinpoint where the blood is coming from.
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