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.
Sperm banking
Male Sexual and Reproductive Medicine Program
Exercise
How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasnt spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
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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What To Expect After Prostate Laser Surgery
Laser surgery is an increasingly widely-used technique in men who were diagnosed with benign prostatic hyperplasia, an enlargement of the prostate that occurs in most men, to some degree, with age. Compared to traditional prostate surgery methods, prostate laser surgery has some distinct advantages. They include a lower risk of serious post-surgery bleeding, a much shorter hospital stay or the possibility of being treated on an outpatient basis, a significantly reduced need for a urinary catheter, and a much quicker recovery.
Nonetheless, prostate laser surgery, though delivered through concentrated beams of light that either vaporize or cut off excess prostate tissue rather than with a scalpel, is surgery. All forms of surgery carry some degree of risk, and all forms of surgery depend on you the patient to follow the appropriate aftercare guidelines delivered by your surgeon to the letter.
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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Sex After Prostate Surgery
When first diagnosed with prostate cancer, its common for men to wonder what the future will hold. Certainly, a prostate cancer cure is a top priority, but then what?
Dr. David Samadi understands that men want to know:
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Will I have sex after prostate cancer?
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How will sex after prostate cancer be different?
For many men, prostate cancer treatment choice determines these answers.
If you select robotic prostate surgery your chances of enjoying sex after prostate surgery are very high. Robotic prostatectomy is a minimally invasive prostate removal. It is considered one of the best treatment options for prostate cancer due to its success rate and fast recovery rate.
The da Vinci robotic prostate cancer surgery system enables the surgeon to make precise movements. This ensures cancer-removal efficiency and sparing of the nerves and muscles that are responsible for the sexual function.
However, it is absolutely critical to choose a robotic surgeon with a high case volume and extensive prostate surgery experience. The robot does not perform the surgery and technology is no guarantee of success. Enjoying sex after prostate surgery is only possible if the procedure was performed by an experienced, highly-trained robotic surgeon.
Dr. Samadi explains how the preservation of sexual function is possible:
How Long Does Urinary Incontinence After Prostate Surgery Last
It’s impossible to say exactly how long it lasts. The chances of you having urinary problems may be influenced by your age, weight and the physical characteristics of your urethra .
However, a majority of men are eventually continent after a radical prostatectomy. In many cases, men are able to go safely without any kind of incontinence product after about three months. This is especially true of men who are healthy overall and fall into the age range of 40 to 60 years. If you are having persistent problems, its important to know that there are ways to treat urinary incontinence after prostate surgery.
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Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
Too Close For Comfort: The Effects Of Radical Prostatectomy On Intimacy
Dr Charles Mooney,CopyrightTrop proches pour être bien: les effets de la prostatectomie radicale sur lintimité
The personal effects of prostatectomy on intimacy and sexual satisfaction as seen through the eyes of a professional couple have not previously been expressed in the literature. We believe that because of our unique situation we can provide a few concrete recommendations for family physicians as they relate to patients and their spouses before and after surgery.
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Difficulty Getting An Erection
Impotence is more likely to happen if you are older. Nerve sparing surgery and robotic surgery may reduce the risk for some men. Speak to your doctor before you have surgery to get an idea of your risk of problems afterwards.
How Do Doctors Perform Prostate Removal
During prostate removal the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. A prostatectomy takes about two hours and is performed under general anesthesia.
There are two approaches used for a prostatectomy:
- Robotic surgery
- Minimally invasive procedure with faster recovery time
- Uses smaller incisions and robotic technology
The surgical process is as follows:
- The doctor will make a small incision to gain access to the prostate
- The prostate is removed
- The bladder is reconnected to the urethra
- A catheter is connected to the bladder to allow urine to drain while the area heals
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Life After Treatment: Alan Weiners Story
When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.
The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.
Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.
I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.
Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.
What If You Have Metastatic Hormone
If your doctor tells you that you have this type of metastatic prostate cancer, it means your cancer responds to hormone therapy
Most prostate cancer cells need male sex hormones, including androgens like testosterone, to grow. A type of hormone therapy like androgen deprivation therapy could slow the growth of mHSPC by lowering the level of these hormones.
You could also ask your doctor if youââ¬â¢re eligible for any clinical trials.
Still, some people with mHSPC prefer to avoid or delay getting treatment with an option called active surveillance. Thatââ¬â¢s when your doctor keeps close tabs on your health but doesnââ¬â¢t give you treatment unless test results show your cancer is getting worse.
You could ask your doctor if watchful waiting is an option for you.
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Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
Three Common Prostate Problems
Growing older increases the danger of prostate problems. The three most common problems in the prostate gland are prostatitis, benign prostatic hypertrophy, and prostate cancer.
One change does not prompt another. For instance, having prostatitis or benign prostatic hypertrophy does not raise your risk of prostate cancer. Also, you can have more than one issue simultaneously.
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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:
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Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when its half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
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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.
Does Incontinence Go Away On Its Own After Prostate Surgery
For most men, urinary incontinence will go away within about 1 year. The time frame varies depending on how severe your incontinence is, and what types of treatments youre using to manage it. Some men may recover from leaks within weeks, whereas others will take months for the bladder leaks to subside. Performing pelvic floor exercises, also known as Kegels, which help strengthen the muscles that are located in the base of the pelvis between the pubic bone may help to speed the recovery process along.
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Urinary Incontinence After Prostate Surgery: Everything You Need To Know
Undergoing a prostatectomy can be difficult. And for many men, finding that they are incontinent post surgery may come as a shock.
But rest assured that there are many treatments available to manage incontinence treatment after surgery. Read below for some of the most common questions we receive about incontinence after prostate surgery.
Can You Have Sex After Prostate Removal
The good news is that sex after prostate removal is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.
Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.
Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.
So, prostate surgery does affect you sexually, but not in the ways you are thinking of.
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What Happens During My Operation
A general anaesthetic will be used you will be asleep throughout the procedure. During surgery, you will be given antibiotics by injection.
Robotic-Assisted Laparoscopic Prostatectomy
Robotic surgery is performed via keyhole incisions and uses sophisticated mini-instruments which are under the control of the surgeon. The robot mimics and assists the surgeons movements it does not do the operation. The technique is now widely used because of its high degree of surgical accuracy, and because your recovery is faster than it is for open surgery.
Six small incisions are made into the abdomen through which the robotic instruments are inserted. The robot is placed beside you in the operating theatre. The robot has four arms three for instruments and one for a high magnification 3-D camera to allow the surgeon to see inside your abdomen. The robotic instruments are small approximately 7mm in width. The surgeon sits in the same rooms but away from the patient and with the robotic technology is able to carry out more controlled and precise movements in a small space within the body.
The muscle fibres and nerves that control continence are preserved.
The skin is closed with absorbable sutures which are located under the skin and are not visible and the outside is sealed with skin glue.
Blood loss is usually less than 200mL and the risk of a blood transfusion is < 2%.
Open Prostatectomy
Blood loss is usually around 500mL. The risk of a blood transfusion in my hands is < 2%.