Removal of the prostate (radical prostatectomy )
Urology / / August 12, 2017
prostate cancer, prostatectomy prostate video
Radical prostatectomy - a surgical procedure to remove the prostate gland and some tissue around it.This procedure is carried out to remove prostate cancer or advanced stage of prostate adenoma, if it can not be disinfected using other methods.
Radical prostatectomy is performed if:
- Cancer has not spread beyond the prostate gland (stage I and II) and no metastases to regional lymph nodes;
- To eliminate the obstruction (urinary outlet obstructions) of the urinary tract in men with stage III prostate cancer;
- advanced forms of prostate adenoma does not respond to other treatment (rarely).
Today, modern medicine has the following types of surgery to remove the prostate:
- Open surgery (retropubic and perineal)
- Laparoscopic prostatectomy
- Robotic laparoscopic radical prostatectomy.
main objective of an open or laparoscopic surgery to remove all of the cancer.Sometimes this means
However, the surgeon can not know before the operation about the possibility of nerve-sparing approach, it depends on whether the cancer invades the nerves.
When choosing a method of prostatectomy, take into account your personal wishes, age, overall health, comorbidity, stage and grade of cancer, and PSA level.
your age and general state of health is very important to how treatment may affect the quality of your future life.Any health problems that you have before starting treatment, especially trouble urinating, defecating, or sexual dysfunction, will affect your recovery.Perhaps, depending on the situation, active surveillance or radiation therapy may be a reasonable option.
If you and your doctor does decide that you need an operation, try to choose a highly qualified surgeon in a hospital that has good success rates.Research shows that men have fewer side effects from prostate surgery, when an operation performed by a qualified and experienced surgeon.
Preparation for surgery to remove a line-item
before prostatectomy your doctor is likely to prescribe a number of surveys, including:
- Research on PSA (prostate specific antigen);
- Transurethral ultrasound;
- Digital rectal examination;
- biopsies as necessary.
Follow your doctor's instructions about what to do before surgery.Here are some general guidelines that you must follow:
- Your surgeon may ask you to stop taking drugs that increase the risk of bleeding for a few days before the procedure.These include blood thinning drugs such as Warfarin, Clopidogrel (Plavix) and nonprescription pain relievers, such as aspirin, ibuprofen and naproxen.Talk to your doctor, who prescribed your medication before making any changes.
- Do not eat on the day before surgery.Your doctor is likely to ask for what you would not eat or drink after midnight.
- Organize your free time, for example, to plan an operation on the eve of holidays.You may be unable to work for several weeks after surgery.Ask your doctor how long you may need to restore.
- The surgeon may ask you to do an enema before surgery and shave the hair in the abdomen and pubic hair, or will do it in the hospital before the operation.
In an open prostatectomy, the surgeon makes an incision in order to reach the prostate gland.Depending on the situation, an incision is made either in the lower abdomen or in the perineum between the anus and the scrotum.Open prostatectomy is performed under general anesthesia and a hospital stay of 2 to 4 days.
- retropubic prostatectomy. In the most common type of radical prostatectomy incision about 10-12 centimeters long runs in the lower abdomen, and the prostate is removed behind the pubic bone.Then the surgeon will sew the urethra directly to the bladder.This is called the retropubic approach.During this procedure, the surgeon may remove lymph nodes in the area, so that they can be screened for cancer.When possible, the doctor tries to keep the nerve bundle that is responsible for erection and for the retention of urine in the bladder.
recovery after such an operation usually takes a few days.To get used to this new system of urination, the bladder catheter or tube is inserted.Urine will flow automatically from the bladder, urethra down to the special outer bag (the bag) without the need of conscious control of the sphincter.The catheter is usually required within 1 to 3 weeks, as long as the returns to normal urination.Control of the bladder may be poor weak for several months after catheter removal.
- perineal prostatectomy. Another type of operation, known as a radical perineal prostatectomy, nowadays rarely performed.In this procedure, the surgeon makes razrezv perineum (area between the scrotum and anus) length of about 4 cm and the prostate is removed from behind the safety of nerve bundle so much more difficult to implement, and virtually no access to the lymph nodes, which are often removed together with the prostate.If surgery is necessary to remove lymph nodes for testing, it is necessary to make a separate incision.If the lymph nodes not exposed to cancer PSA and the test results are satisfactory, the surgeon may remove lymph nodes.
recovery time after such an operation may be shorter than the retropubic approach.
Today open prostate surgery is largely replaced by new minimally invasive operations.
Laparoscopic and robotic surgery
For laparoscopic surgery, the surgeon makes several small incisions in the abdomen.
Illuminated instrument equipped with a video camera, called a laparoscope, is inserted into one of the incisions for visual monitoring of the operation.Through other incisions, the surgeon uses special instruments to reach and remove the prostate gland.
Laparoscopic surgery can be done manually.But some doctors now do so by sending robotic arms - handles that hold the surgical instruments and remote translation movement of the surgeon's hand into smaller and more precise actions.This is called robotic prostatectomy.
This is the most advanced minimally invasive surgery using the Da Vinci robot (Da Vinci), invented by the American IntuitiveSurgical Corporation.
This operation requires special training of doctors and has become very popular over the last 10 years due to smaller incisions, three-dimensional visualization of the surgical field, a minimum penetration into the tissue, and the short postoperative recovery period.
prostatectomy Radical prostatectomy is usually effective in the treatment of prostate cancer that has not spread beyond its borders, iein the early stages of cancer.
PSA level drops to almost zero if the operation was successful and the cancer has not spread.If the cancer has spread beyond the prostate gland, it may occur again, even if the prostate gland has been removed.
Men under 65 with early stage cancer (I and II), which had surgery lived longer than those who used active surveillance.However, men older than 65 years with early-stage cancer who chose surgery, lived just as long as the men who choose other treatments, including active surveillance.
According to different authors, the 5-year disease-free survival rate is 70-85%.10-year-old - 60-75%.
Studies show that well-executed operation and the degree of side effects to a greater extent depend on the skill of the surgeon than on what type of surgery you have had.
Although prostatectomy is often removes all the cancer cells, the subsequent screening, which can lead to early detection and treatment of new-onset cancer, as needed.
- Prostate cancer (prostate): causes, symptoms, diagnosis, treatment
- Treatment of prostate cancer: a comparison of methods, side effects of treatment
- Benign prostatic hyperplasia (BPH): causes, symptoms, treatment, complications
- Transurethral resection of the prostate (prostate)
- prostate biopsy
complications and risks prostatectomy
Radical prostatectomy is major surgery.Thus, it carries the same general risks as any other surgery, including heart problems, blood clots, allergic reactions to anesthesia, blood loss, infection, and inflammation of the surgical wound.
In addition, radical prostatectomy has specific complications:
- Erection problems
urine - urethral damage
- Damage to the rectum
- Difficulty urinating
- Male infertility
recovery of potency after the removal of the prostate
erection problems are one of the most serious side effects of radical prostatectomy.The nerves that control a man's ability to have an erection lie next to the prostate gland.They are often damaged or removed during surgery.Sometimes these nerves can be isolated during the operation, to maintain an erection.
About half of men able to restore the ability to have an erection, but this takes time.In some, it can take as little as 3 months, but for most men it will take from 6 months to 1 year.
recovery of erection depends on:
- whether the man was able to have erections before surgery.
- How is the surgery affected the nerves responsible for erections.
- Age of the patient at the time of surgery.
Drugs such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), and mechanical aids may help men regain sexual function.Talk with your doctor about your situation.
Urinary incontinence after prostatectomy
Half of all men who underwent radical prostatectomy, urinary incontinence develops.Studies show that in a year, from 15% to 50% of men reported urinary problems.This is due to the fact that for the removal of the prostate, the surgeon must cut the urethra, and then recover by connecting it directly to the bladder.Experience shows that the more experience and skill of the surgeon, and in making this reconnection, the lower the risk of developing urinary incontinence.
Some men may need treatment after prostatectomy if urine leakage continues for more than 1 year.