Enlarged Prostate Surgery: The Real Risks And Side Effects
Enlarged prostate surgery unfortunately has real risks and side effects that are often downplayed or minimized by urologists making you the guinea pig with very possible impotence and incontinence as a result.
Furthermore, you will often have to repeat the operation later on as your prostate continues to grow because the real causes of this prostate disease have not been addressed by radical surgeries.
Also known as a TURP surgery or BPH surgery, this is the gold standard of prostate surgeries for enlarged prostate symptoms.
TURP stands for Transurethral Resection of the Prostate. The surgery consists of passing a flexible instrument up your penis and into the prostate gland to shave off pieces of the prostate.
The bloody pieces are removed allowing more space for the urethra tube to pass urine from your bladder.
The operation is done under anesthesia and you will usually spend a couple of days recovering. You will have to wear a catheter for some time while you heal, and then it can be removed.
It would be great if that was all there was to it. Yet, its not so simple
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During Surgery For Bph
The vast majority of BPH surgeries are performed using a transurethral technique, of which there are several types. With each, a tube-like instrument called a cystoscope or resectoscope reaches the prostate gland via the urethra.
Some transurethral techniques include:
- Transurethral resection of the prostate : An electrified wire loop is used to remove prostate tissue. This is the most common surgery used to treat BPH.
- Transurethral electrovaporization of the prostate : Electrical energy applied through an electrode is used to heat and vaporize an area of enlarged prostate tissue.
- Transurethral incision of the prostate : No prostate tissue is removed, but two deep cuts are made starting in the bladder neck . The purpose of these cuts is to widen the urethra in order to improve urine flow.
- Laser energy is used to vaporize prostate tissue.
- Laser enucleation of the prostate: A holium or thulium laser is used to remove large chunks of excess prostate tissue that is blocking urine flow.
- Prostate urethral lift: Implants are placed in the prostate to lift the prostate and keep the urethra open.
- Prostate water vapor therapy: Targeted, controlled doses of stored thermal energy in water vapor are used to decrease prostate tissue.
What Happens During Surgery
Your surgeon will put a small needle just below your belly button, into your abdominal cavity. The needle is connected to a small tube that passes carbon dioxide into the belly. This lifts the abdominal wall to give the surgeon a better view once the laparoscope is in place.
Next, a small cut will be made near your belly button. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.
Before the surgery, the surgeon will take a thorough look at your abdominal cavity to make sure the laparoscopy procedure will be safe for you. If the surgeon sees scar tissue, infection, or abdominal disease, the procedure will not be continued.
If the surgeon decides the surgery can be safely performed, more small cuts will be made, giving them access to the abdominal cavity. If necessary, one of these small incisions may be enlarged to remove the pelvic lymph nodes.
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Radical Prostatectomy Retropubic Or Suprapubic Approach
You’ll be positioned on the operating table, lying on your back.
An incision will be made from below the navel to the pubic region.
The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.
The prostate gland will be removed.
A drain will be inserted, usually in the right lower area of the incision.
The Different Types Of Prostate Surgery
The term prostatectomy is used to describe a number of different surgical procedures to remove either part or all of the prostate gland. This may be required to treat prostate cancer or BPH.
When only a part of the prostate is removed, this is called a simple prostatectomy. This process involves enucleating it from its capsule to trim away excess tissue, but where the sphincter muscle and nerves remain intact. It is usually used to treat BPH, which is a benign condition, meaning there is no risk of malignant cells having moved on to surrounding tissue.
When the entire prostate gland, capsule , the surrounding lymph nodes and neighbouring tissue is removed, this is known as a radical prostatectomy. This is usually a treatment for men with localised prostate cancer and there a number of techniques used:
Open Surgery This is where the prostate is removed via a large single incision in the lower abdomen, or the perineum .
Laparoscopic Radical Prostatectomy This is where the prostate is removed via several small incisions in the lower abdomen using small surgical instruments. This process is much less invasive than open surgery.
Robotic-assisted radical prostatectomy Much like laparoscopic radical prostatectomy, the prostate is removed via small incisions in the lower abdomen. Robotic-assisted instruments are inserted through the incisions and controlled by a surgeon.
Holmium Laser Enucleation of the Prostate
Transurethral Resection of the Prostate
What Are The Benefits Of Prostatectomy
Prostatectomy is most commonly performed to treat prostate cancer, in conjunction with other therapies such as radiation therapy, chemotherapy, hormone therapy, etc. It is also performed for BPH patients to provide permanent relief from urinary symptoms caused due to an enlarged prostate gland.
Benefits of prostatectomy inlcude:
- Permanently removes cancer cells from the body by removing all the prostate tissue and its surrounding structures
- Long-term relief from urinary symptoms of BPH, such as:
- Frequent urinary urge
- Difficulty in starting and maintaining urinary stream
- Increased urinary urge at night
- Feeling of bladder fullness even after urinating
- Frequent urinary tract infections, etc.
What Do They Do To Remove Your Prostate
The removal of the entire prostate gland and the urethra that runs through the prostate and the attached seminal vesicles is referred to as a radical prostatectomy. A variety of approaches are available for performing this procedure. The type of approach may vary with your surgeon’s preference, your physique, and medical conditions. Traditionally, radical prostatectomy was performed through an incision that extended from below the belly button down to the pubic bone or through an incision underneath the scrotum . In an effort to decrease the chance of complications or bad outcomes from the procedure, laparoscopic approaches to performing a radical prostatectomy were developed. The use of the robot to perform the laparoscopic radical prostatectomy, robotic-assisted radical prostatectomy, is currently the most common method to perform a radical prostatectomy. Compared to open radical prostatectomy, robot-assisted laparoscopic radical prostatectomy is associated with less postoperative discomfort and sooner return to full activity, as well as less intraoperative blood loss with comparable outcomes regarding urinary continence and erectile function. Radical prostatectomy is an appropriate treatment option for those individuals with clinically localized prostate cancer that can be removed completely surgically and who have a life expectancy of 10 or more years and have no medical contraindications to surgery.
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Psa Doubling Time Is More Accurate Than Gleason Score
Detecting recurrence with PSA at the earliest possible stage creates an opportunity to determine the seriousness of the relapse. With repeated, sequential testing of PSAsay with monthly blood drawsthe rate of PSA increase can be accurately determined. How quickly the PSA doubles reveals the grade of relapse. This information is very important because low-grade relapses are treated very differently than high-grade relapses.
Most people are familiar with the Gleason grading system, the most popular methodology for cancer grading in newly diagnosed men, that is, prior to relapse. With the Gleason system, the cancer cells are graded by a special doctor called a pathologist. The pathologist views the biopsy specimen under a microscope and assigns a grade to cancer. The Gleason system is the most powerful prognostic indicator for grading newly-diagnosed prostate cancer and has a very important role in determining optimal treatment for newly diagnosed men. However, in relapsed prostate cancer, the PSA doubling time easily supersedes the accuracy of the Gleason score. Knowledge of the cancers growth rate is the most accurate way to grade the cancers aggressiveness, and, luckily, the PSA determines this with unparalleled exactitude.
Once the PSA doubling time reveals the severity of the relapse, a treatment strategy is implemented. Treatment varies drastically depending on the grade of relapse, so the optimal type of treatment for each grade of relapse is discussed below.
What Are The Risks Of Prostate Cancer Surgery
If your prostate cancer treatment plan includes surgery, you might be wondering about the risks associated with your procedure. The oncologists in the Urologic Oncology Program at Moffitt Cancer Center can provide some general information for you to consider. We encourage you to review this information prior to having an in-depth discussion about your individual risk profile with your treatment team, which is always your best source of advice and support.
The most commonly recommended type of surgery for prostate cancer is a radical prostatectomy. This procedure involves the removal of the entire prostate gland and some surrounding tissues, including the seminal vesicles. Like all forms of surgery, a radical prostatectomy has some inherent risks, which can vary widely from patient to patient.
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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.
Those muscles are the core of how your body maintains blood flow to the penis and therefore keeps erections strong.
They put pressure on the veins in your penis, preventing blood from flowing back into the rest of your body. If they arent strong enough then even if you can get an erection, you wont be able to keep it.
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.
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Minimally Invasive Surgical Options
In minimally invasive surgical procedures, we make several small incisions in your abdomen. We then insert a tiny, lighted telescopic camera called a laparoscope, along with specially designed surgical instruments that a surgeon uses to perform the operation.
When you have minimally invasive surgery, youre likely to have less discomfort after the procedure and more likely to recover faster than with a traditional open surgery, in which incisions are larger and more extensive. Many men who have their prostates removed in a minimally invasive operation are able to return home the following day.
We offer two types of minimally invasive surgery.
Many of our surgeons perform robot-assisted laparoscopic prostatectomy. This sophisticated tool offers much finer precision than any other surgical technique.
Using a device called the da Vinci® Surgical System, a surgeon performs the operation while seated at a console that has a viewing screen as well as hand, finger, and foot controls. The screen projects a three-dimensional image, magnified tenfold, of the prostate and the surrounding area. This allows the surgeon to view the surgical site in great detail. The robot then translates the surgeons hand, wrist, and finger movements into real-time movements of the instruments inside the patient.
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Surgery May Be Required To Treat A Range Of Conditions That Affect The Prostate Here We Take A Look At The Three Most Common Types Of Prostate Surgery
In the case of cancer, these procedures are performed to stop the spread of malignant cells. For BPH, surgery may be required to relieve symptoms that are making it difficult to urinate, which can have a significant impact on quality of life.
Help Managing Cancer Treatment Side Effects
The team at Compass Oncology is experienced in helping patients treat prostate cancer and manage the side effects of treatment. If you live in the Portland-Vancouver area, have more questions about the side effects of prostate cancer treatment, or need help managing your side effects, request an appointment at one of our locations that’s convenient for you. We’re here with you every step of the way.
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Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
Other Possible Side Effects
Anorgasmia is the inability to achieve orgasm regardless of the level of stimulation.
2) Penile shrinkage
Removal of the prostate seems to initiate a phase of penile shrinkage that varies between 2 to 3 cm. For men with large organs, this may have little effect. But a man that starts on the small side might be very dismayed about it.
3) Urine leakage or pain during intercourse
4) Urine leakage at orgasm
5) Pain or discomfort at orgasm
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Where Does Prostate Cancer Spread
The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other organs.
A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.
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Types Of Prostatectomy Procedures
- A simple prostatectomy removes all or part of the prostate gland with an incision in the lower belly. This surgery is usually chosen for an enlarged prostate.
- A radical prostatectomy removes all of the prostate gland and tissue around it. This surgery is usually chosen to treat prostate cancer.
The Urology Specialists of Maryland offer patients expertise in minimally invasive laparoscopic surgery and robotic surgery for prostatectomies.
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When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety
Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.
The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.
For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.
You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.
Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
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How Turp Is Performed
TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts need to be made in your skin.
The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.
General or spinal anaesthesia is used during the procedure so you don’t feel any pain while it’s carried out.