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Prostate surgery essentially entails two major types of surgery, a transurethral resection of the prostate for noncancerous enlargement of the prostate, and radical prostatectomy, usually done for cancer of the prostate. Surgery for prostate cancer is done when it is believed that the prostate cancer has not spread beyond the gland itself.
Traditionally, the prostate is removed in an open approach. One approach is called the radical retro-pubic approach, in which there is an inverted T incision in the lower abdomen. The prostate and surrounding lymph nodes are removed under general or spinal anaesthesia. The surgeon may not proceed with the surgery if the lymph nodes come back positive for cancer during the surgery. The doctor will try to spare the nerves on either side of the prostate gland so the patient can have spontaneous erections again.
In a perineal approach, the incision is made between the anus and scrotum. It is not a popular procedure because it does not easily spare the nerves causing erection and it cannot get at the lymph nodes. It is a shorter procedure so some people opt for that if the nerves and lymph nodes aren’t important. The recovery is easier from this type of surgery.
The prostate can be removed entirely using a laparoscope. Small incisions are made in the abdomen and a lighted camera helps the surgeon use small instruments to remove the prostate in its entirety. The advantage of this procedure is that the recovery time is much shorter than with the other procedures although the patient will still need a catheter after the procedure.
Robotic-assisted laparoscopic radical prostatectomy is a newer procedure that uses a computer and a robotic arm that controls the instruments used. There is less bleeding, pain and a shorter recovery time with this type of procedure. There is no difference in side effects of erectile dysfunction when comparing robotic-assisted surgery and open surgery.
There are a number of side effects and risks of having a radical prostatectomy. The first is a surgical risk of having an infection, excessive bleeding, heart attack, stroke or deep vein thrombosis in the leg that can travel to the lungs. If the lymph nodes are removed, a lymphocele, a collection of fluid, can form and need to be drained. There are a lot of blood vessels involved in this surgery so heavy bleeding and blood transfusions are a possibility. A puncture of the intestines can happen, leading to peritonitis and sepsis.
Urinary incontinence can be a complication of a radical prostatectomy. There are different degrees of incontinence and three types of incontinence: A) stress incontinence, in which you void whenever you laugh, exercise or sneeze. B) overflow incontinence, in which the bladder has little force and there is a blockage of the urethra secondary to scar tissue. C) urge incontinence, in which the patient has the sudden urge to void with little time to make it to the bathroom. Some men have no ability to control their urinary flow whatsoever and have continuous incontinence, requiring a catheter.Another side effect of a radical prostatectomy is impotence or erectile dysfunction. It happens when the bundles of nerves on either side of the prostate are disrupted. Impotence can happen even when the nerves are just handled and then the impotence will come back in a few months or a year. Erectile dysfunction post operatively depends on one’s age and on the ability to get an erection prior to the operation and whether the nerves were damaged. Younger men do better than older men in getting erectile dysfunction back. Some men get a dry orgasm without any fluid passed through the urethra. Medications can be used to treat the erectile dysfunction, which are identical to the medications used to treat other cases of erectile dysfunction. Some men will have a less intense or absent orgasm after the surgery and lose their fertility completely.
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