Pathological changes in the prostate gland are not a death sentence; they are successfully treated with conservative treatment. An important organ for men is restored through special medications.
But when there is an advanced case with complications, surgical intervention is performed. Removal of the prostate is carried out using prostatectomy.
The patient must prepare for it and prepare for a long recovery period.
General concept
A prostatectomy is an operation in which the prostate gland is removed. If the case requires it, part of the urethra, seminal vesicles, adjacent tissues, and lymph nodes are excised.
The procedure is performed under general anesthesia and takes from 2 to 4 hours, it all depends on the complexity of the disease and the method of intervention.
The indicated operation is performed according to certain indications:
- prostatitis in chronic form, in which conservative therapy does not show positive dynamics;
- the presence of a malignant tumor in the prostate, devoid of metastases;
- very rare acute urinary retention;
- hyperplasia in the prostate gland of a benign type in severe form (adenoma);
- prostatitis, accompanied by a purulent process.
The operation is performed after prolonged drug treatment that has not shown positive results, if the patient’s health is in real danger.
In most cases, surgical manipulation is prescribed for oncology with the aim of stopping the cancer process, restoring the functioning of the organ while partially preserving it.
The procedure is considered quite complex and involves the use of general anesthesia. There are also contraindications:
- severe pathologies of the cardiovascular system;
- age after 70 years;
- inflammation observed in the pelvic organs;
- impaired blood clotting;
- diabetes mellitus in decompensated form.
The operation is performed by a qualified surgeon with experience in this field. To count on a positive result and outcome of the surgical intervention, the patient must promptly contact a urologist and undergo a thorough examination.
Modern proctology involves performing the operation in three generally accepted ways. This is a laparoscopic, open or cavity and robot-assisted operation. The choice of manipulation remains with the doctor.
Open prostatectomy is an outdated technique that involves a cavity incision in the body. The nerve trunks that are responsible for erectile function are often disrupted, and complications are highly likely to occur. This manipulation is divided into two types :
- Retropubic (retropubic) surgery involves access to the problematic gland through the peritoneum in close proximity to the navel. In such a situation, the entire organ, as well as the tissue adjacent to it, must be excised. The bladder is connected to the urethra, a catheter and drainage are installed. It is not always possible for a specialist to preserve the urinary drainage and nerve endings responsible for an erection. During the operation, lymph nodes affected by cancer cells are excised, which is almost impossible to do with other manipulations. Duration - about 4 hours.
- Perineal (perineal) procedure, in which a small incision is made between the anus and the scrotum. Due to the inconvenience, this method is used very rarely; moreover, it does not allow excision of problematic lymph nodes, and nerve trunks are not preserved. The advantage is the presence of minimal cosmetic defects, the duration is about 2 hours.
Radical prostatectomy is appropriate only when another method of surgery cannot be used for certain reasons. If possible and medically indicated, minimally invasive procedures are performed.
Laparoscopic surgery
This relatively new surgical technique has found wide application in modern urology. Its main advantages should be highlighted:
- there is no need for a cavity incision;
- high chances of maintaining the integrity of the nerve trunks;
- no seams, low trauma;
- short rehabilitation period;
- minimal complications, no bleeding.
This operation lasts for 3 hours, and the patient is subject to general anesthesia. To insert a laparoscope and other surgical instruments into the body, small incisions are made in the abdominal wall. The progress of the entire operation is clearly monitored through the image displayed on the monitor.
This way, the pathologically changed gland and the lymph nodes adjacent to it are removed, the nerve endings remain intact. Recovery is painless, which significantly improves the patient’s quality of life.
This type of surgery is most preferable in comparison with other methods of treating the prostate gland.
Robot-assisted procedure
This type of operation is a type of laparoscopic procedure. It is planned to use robotic, super-precise and cutting-edge equipment.
Standard laparoscopy involves the performance of all manipulations by a doctor, in which case shortcomings and errors are quite appropriate. Using new technology, the surgeon controls a robot that performs the operation with maximum precision.
The procedure is the only one possible regarding the preservation of nerves in the treatment of oncology in the prostate gland. The patient is guaranteed:
- no infection;
- preservation of erectile function;
- minimal risks regarding dysfunction of the urinary system;
- minimal blood loss;
- rapid achievement of complete recovery;
- positive cosmetic effect, no scars or stitches.
In most cases, such operations in medical centers are carried out using a special da Vinci system. Structurally, it is represented by a surgical console, optics and a convenient control panel.
The doctor’s responsibilities include monitoring the progress of the operation and carefully monitoring the image on the monitor.
Even the most advanced urological cases have a positive and high-quality outcome, and medical errors are negligible.
Features of the preparatory stage
The preoperative period is of great importance; it has a direct impact on the successful outcome of the proposed operation. The man is admitted to the inpatient department to undergo a series of examinations. Diagnostics consists of the following activities:
- taking a urine test;
- blood test - biochemical and general;
- analysis of prostate secretion;
- MRI, ultrasound, CT in the pathological area;
- if there is a suspicion of oncology, tissue is taken from the gland for a biopsy;
- palpation rectal examination;
- anesthesia sensitivity test.
As additional measures, at the discretion of the attending physician, an analysis for hepatitis, syphilis, HIV, coagulogram, electrocardiogram, and fluorography is performed. A set of diagnostic procedures is selected individually, everything depends on the presence of concomitant pathologies and the general condition of the person. Activities to be performed before surgery:
- abstaining from dinner before the day of the procedure;
- conducting a cleansing morning enema;
- hair removal on the abdomen and perineum.
In this state, the patient is fully prepared for surgery, the outcome of which largely depends on the quality of the preparation.
Rehabilitation period
Prostate therapy does not end with surgery. The next stage is the recovery period, on which the positive outcome of the entire event largely depends.
After surgery, the patient is immediately admitted to the intensive care unit. If there are no complications and normal recovery from general anesthesia, he is transferred to the general ward already on the second day.
Postoperative hospital stay starts from 7 days for laparoscopy, up to 3 weeks for abdominal surgery. If positive dynamics are observed, the drainage is removed after 4-5 days, the sutures are removed after 7 days, and the catheter is removed after 15 days.
During radical prostatectomy, the following rehabilitation is carried out:
- for several days after surgery, following a strict diet;
- the use of antiseptics, the use of medications, including analgesics, antibiotics;
- drinking regular water in unlimited quantities;
- restriction from any physical activity;
- performing special exercises aimed at strengthening the muscles in the pelvic floor;
- smooth restoration of motor function, starting with basic movements around the ward.
With successful and properly carried out rehabilitation, a man returns to full sexual relationships and normal life after 3 months. In order to prevent complications and relapses, it is recommended to regularly visit a specialist and undergo prescribed diagnostic measures.
Possible consequences
What the complications of prostatectomy will be will be determined by the recovery period. The frequency of adverse outcomes directly depends on the chosen method of surgery. Consequences may include the following conditions:
- Wound infection.
- Pain upon completion of the manipulation in the groin and abdomen, severe discomfort during urination, hematuria. All this gradually goes away during the recovery process.
- Creation of blood clots.
- Narrowing of the urethral canal.
- Malfunction of the digestive system.
- Lymphocele or collection of lymph.
As a result of radical prostatectomy, erectile dysfunction with urinary incontinence most often occurs.
The latter problem is often eliminated through additional surgical intervention, which is necessary to improve the man’s quality of life.
However, measures related to the removal of the prostate gland are constantly being improved, minimizing the risk of complications.
Lack of potency can be temporary due to severe pain; the psycho-emotional state of the patient also plays an important role.
Such problems can be easily solved; the use of Cialis, Conegra, and Viagra is recommended. When nerve fibers are damaged during surgery, restoring an erection is not possible.
That is why it is recommended to undergo nerve-sparing surgical methods.
Prostatectomy is a complex operation that is performed strictly according to doctor’s indications; in some cases it is replaced by cystprostatectomy.
Refusing it will not bring relief or improve the general condition of a man, especially if we are talking about cancer.
A properly planned preparatory stage and recovery period minimize possible complications and speed up the recovery process.
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Source: https://manbe.ru/muzhskie-bolezni/prostatektomiya-i-vosstanovlenie-posle-operatsii-reabilitatsiya.html
Details about prostatectomy: types, features of the recovery period and possible consequences
Prostatectomy is a type of surgery that involves the complete removal of the prostate gland. Indications for surgery are malignant prostate tumors, as well as large benign neoplasms (adenomas) when other treatment methods are ineffective.
Types of operations and methodology
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Prostatectomies are divided, depending on the method of surgical access, into open and laparoscopic. Open ones include the retropubic (retropubic) and perineal. In practice, retropubic is performed more often.
Radical prostatectomy involves not only the complete removal of prostate tissue, but also the urethra, seminal vesicles, lymph nodes and neurovascular bundles running inside the prostate. The purpose of this operation depends on the individual characteristics of the disease and is performed by any of the following approaches.
Radical prostatectomy
With retropubic prostatectomy, a surgical incision is made along the midline of the abdomen below the navel in the direction of the pubic bones, up to 12 cm in length.
In the pelvic area, access to the prostate is opened, which, together with the seminal vesicles, is separated from the bladder and removed from the body.
The resulting tissues are examined (histologically, in a laboratory), and the results are presented in about a week.
In case of radical surgery, the division of the cavernous nerves is mandatory. In this case, sexual function is impaired.
Neurovascular bundles pass close to the prostate gland and can be affected by the pathological process.
Given the widespread nature of the tumor and its malignant nature, it is not possible to preserve these formations (and erectile function).
It is advisable to discuss this aspect before surgery with a surgeon to clarify the likelihood of weakening or loss of potency after prostatectomy.
Radical removal of the prostate gland.
- The final stage of the operation is to connect the urethra to the bladder, install a drainage tube in the area of the removed organs, and pass a catheter through the urethra into the bladder.
- Retropubic prostatectomy allows removal of pelvic lymph nodes, intraoperative (during surgery) diagnosis for the presence of tumor cells, which makes it possible to clarify the extent of the process and increases the efficiency of the operation.
- Retropubic prostatectomy has the longest duration (up to 4 hours), with perineal and laparoscopic access - about 2-3 hours.
In a perineal prostatectomy, the incision is made between the anus and the scrotum. This type of operation has the disadvantage of lack of access to the pelvic lymph nodes, the removal of which involves radical prostatectomy. Perineal is the method of choice for people with significant excess weight.
Laparoscopic surgery
During laparoscopic surgery, 3-6 incisions (1-1.5 cm) are made, where the optical system is placed. The optical system allows you to illuminate the surgical field, capture it on the camera and transmit the image to the monitor. Also, special instruments are placed at the incision sites, with the help of which the prostate is removed.
Laparoscopic prostate surgery.
Currently, so-called robot-assisted prostatectomy is also performed laparoscopically. Its difference is that during surgery, ultra-precise robotic manipulators are used, which are controlled by a doctor.
Contraindications for surgery
The large volume of the operation and removed tissue, the need for general anesthesia, and the duration of up to 4 hours determine a number of limitations and features in preparation.
Main contraindications:
- age over 70 years;
- decompensation and severe damage to the cardiovascular system;
- planned intake of medications that affect the blood coagulation system (fraxiparin, heparin, aspirin, warfarin, syncumar, clopidogrel).
Surgery is possible no earlier than a week after stopping medications that slow down blood clotting.
Consequences and complications
It is necessary to distinguish between complications associated with the disease for which prostatectomy is performed and the consequences of the operation itself.
Urinary dysfunction is the most common complication after prostatectomy.
Surgery can be complicated:
Features of the recovery period
The average recovery period is 1.5-2 months.
Its duration depends on:
- severity of the disease;
- volume of surgery (removal of only the prostate or lymphatic and blood vessels, nerve bundles);
- age;
- the general health of the patient.
The early postoperative period and hospital stay ranges from one to three weeks. For laparoscopic operations, as a rule, 7-10 days.
The basis of rehabilitation in the early period is adequate pain relief, infusion of a sufficient amount of saline and nutrient solutions to restore water and salt balance, normalization of intestinal activity and urination.
You can drink water 3-4 hours after the patient has woken up and recovered from anesthesia. The doctor allows food intake, in the absence of complications, one day after the operation.
Recommended as a diet in the first days:
- fermented milk products that do not contain sugar;
- boiled or steamed lean meat (veal, rabbit, turkey);
- low-fat boiled fish (pike perch);
- eggs.
From the second or third day, the diet can be expanded with boiled vegetables (beets, carrots) in the form of salads with the addition of vegetable oil, steamed prunes. Such food helps normalize intestinal function.
After the first emptying (in most cases - after 2-3 days), you can gradually and carefully switch to your usual diet, excluding irritating spices (vinegar, pepper), as well as smoked and salty foods.
After prostatectomy, drainages from the postoperative area are removed on days 4-5, and sutures are removed after 1-2 weeks. The urinary catheter installed during the operation stays in the bladder for a longer time; it is treated daily and removed after 2-3 weeks.
After surgery, you should not lift heavy objects.
To prevent vascular thrombotic complications and congestion in the lungs, as prescribed by a doctor, it is recommended to get up starting 2-3 days after surgery. In the future, gradually expand the motor mode. Physical activity is not recommended until complete recovery (up to 2 months).
In the early period, it is very important to hold the postoperative suture site with a pillow during sudden movements (sneezing, coughing, laughing).
In the future, to preserve the sutures and prevent the development of postoperative hernias, special bandages are used, which must be worn (lying down) before walking and other minor physical activity.
Wearing them constantly is not recommended, as this weakens the muscle frame.
To reduce discomfort in the suture area, it is recommended:
- wear loose trousers or a tracksuit;
- use a round-shaped bedding with filler (gel or foam rubber) to reduce pressure in the perineal area when the body is sitting;
- comfortable armchair.
During the first month, you must avoid heavy lifting (you can lift no more than 3-5 kg) and active physical activity.
10 days after the operation, you need to gradually expand your physical activity: take walks in the fresh air, increasing their time from 15 to 45 minutes. You can return to driving 3 weeks after surgery. You can begin your usual morning exercises and resume sexual activity (if erectile function is maintained during the operation) 2 months after the operation.
Possibility of recovery and relapse of the disease
Recovery or complete cure is possible with early diagnosis of malignant tumors, as well as with timely intervention for benign ones.
After prostatectomy, survival rate for five years reaches 100%, ten years - from 60 to 95%, depending on the type and extent of the tumor process, as well as with complete removal of all tumor cells.
It must be borne in mind that for most malignant tumors, treatment is not limited to removal of the prostate gland. Other types of treatment are used: radiation, chemical methods.
To monitor a possible recurrence of a malignant tumor, monitoring PSA levels is used.
Prostate-specific antigen (PSA) is a marker of oncological processes and increases sharply with malignant neoplasms of the prostate. The first time this indicator is examined in a patient who has undergone prostatectomy is carried out 3 months after surgery.
If a PSA level of more than 0.2 ng/ml is detected, there is fear of a relapse of the disease.
Further dynamic monitoring of PSA levels:
- in the first year after surgery - 3-4 times a year;
- in the second year - 2 times a year;
- further - one study per year.
The PSA level after prostatectomy should not exceed 0.2 ng/ml. If its growth is observed, this indicates the presence of relapse or metastatic cells producing PSA.
Since the detection of an increased amount of this antigen in the blood is significantly ahead of the confirmation of the presence of malignant cells by instrumental methods (ultrasound, CT, MRI), this condition is called a biochemical relapse.
When a diagnosis of recurrent prostate cancer is made, conservative methods are used to treat it.
The most effective are:
- remote irradiation of the removed tumor bed;
- high-intensity focused ultrasound (HIFU) treatment, which allows targeted treatment of areas deep in the body;
- hormonal therapy, including in combination with chemotherapy.
In case of late (no earlier than 2 years) biochemical relapse and a slow increase in PSA levels (more than 10 months), they are limited to observation and control of the general condition of the body and possible changes in the pelvic area.
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Source: http://MenQuestions.ru/urologiya/prostatektomiya-podrobno-ob-operatsii.html
Rehabilitation after radical prostatectomy
Complete removal of the prostate gland is carried out in cases of third-degree adenoma with pronounced manifestations of hyperplasia, as well as in case of confirmation of the diagnosis of a malignant tumor.
Depending on the method of surgical intervention, a man requires a different recovery time.
Rehabilitation after radical prostatectomy includes two stages and requires the man to follow the doctor’s recommendations for a speedy return to normal life without complications.
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How long can it last
The duration of the rehabilitation period after prostatectomy depends on individual characteristics, age and type of surgery for adenoma or prostate cancer.
Wearing a catheter usually takes two, rarely three weeks, during which the man is hospitalized, receives the necessary medical procedures and learns the basic rules of everyday life in the late postoperative period.
During the first three months after removal or partial resection of the prostate gland, increased attention to physical activity, hygiene and proper nutrition is required. A man receives restorative physiotherapeutic procedures at home or in an outpatient setting to quickly heal and improve the functionality of the urinary system after a radical prostatectomy. The most favorable option for rehabilitation after radical prostatectomy is treatment in a sanatorium, where all conditions for a quick recovery are created.
The return of erectile function takes a period of one to two years, so you need to be patient, and it is important for your loved ones to be understanding of the man’s condition after the operation and ensure a positive psychological attitude.
The rehabilitation process takes a long time, complications and relapses occur, so a prerequisite is a follow-up examination after surgery and measurement of the level of acid phosphatase, an enzyme that serves as a marker of oncological pathology.
An unfavorable outcome of surgical intervention is disability, which is associated with damage to nerve bundles and internal organs during surgery. This is a rare type of complication and before a radical prostatectomy, a man is warned about the possible risks.
Stages of rehabilitation
For any type of surgery, there are two stages of recovery:
- The first stage is associated with the elimination of possible postoperative complications of prostatectomy and is carried out during inpatient treatment. In the early rehabilitation period after removal of the prostate, the man is under close medical supervision and receives the full range of necessary therapy.
- The second rehabilitation stage begins from the moment of discharge home and after removal of the catheter, which is used to drain the abdominal cavity during surgery to remove urine. Most of the recovery measures are aimed at returning to normal life after radical prostatectomy using therapeutic exercises, nutrition, hygiene requirements and medication.
Early
The consequences of prostatectomy in the early postoperative period are associated with the development of complications, which can only be successfully dealt with in a hospital setting:
-
Attachment of infections. Violations of sterility standards during surgery, during dressings or insufficient hygiene levels lead to the development of aseptic complications, which are treated with antibiotics and the use of local bactericidal agents. Medical care of the urinary catheter and training a man in the rules of independent antiseptic measures are important. - Bleeding. They are caused by the divergence of postoperative sutures due to non-compliance with the motor regime or may be a consequence of incomplete elimination of bleeding vessels during prostatectomy. To eliminate the complication, hemostatic agents are used; in rare cases, repeated surgery is used.
- Scarring of the urethra. Narrowing of the urethra due to the formation of a dense scar at the site of removal of prostate tissue causes urination problems. Prevention consists of maintaining a drinking and physical regime, and to eliminate it, it is often necessary to resort to surgical excision of the scar.
The duration of inpatient treatment depends on how large and complex the volume of surgical intervention was performed, as well as on the course of the recovery processes. Typically, the early rehabilitation period coincides with the time of wearing a catheter to drain the bladder.
Late
The next period of rehabilitation begins after removal of the catheter and, under normal conditions, coincides with the time of discharge from the hospital. For 2-3 months, a man is put on a special postoperative bandage, which reduces the load on the muscles of the perineum and abdominals and promotes rapid healing.
Complications of the second period are associated with the development of impotence, the elimination of which is the main goal of rehabilitation after radical prostatectomy, as well as urinary incontinence due to atrophy of the bladder muscles while wearing the catheter.
A weak reservoir is not capable of holding a large volume of urine, and to eliminate the symptoms of incontinence, a man is recommended to use special urological pads and train intimate muscles using Kegel exercises during the rehabilitation period.
Recommendations
Compliance with a motor regimen, a special diet and the implementation of simple hygienic measures - every man receives a memo with these recommendations when being discharged for outpatient follow-up treatment after radical prostatectomy.
Diet
After surgery, you need to eat little and often, this will help reduce intra-abdominal pressure and avoid pain associated with muscle tension. The diet should be enriched with vitamins and healthy proteins, foods containing fiber, which is necessary for the normal functioning of the intestines and the prevention of constipation.
There are no strong restrictions on the composition of food, it is not recommended to get carried away with salty and smoked dishes, it is necessary to eliminate semi-finished products and excessive consumption of confectionery products. Small doses of good alcohol are allowed, but only in reasonable quantities. The most important condition for proper nutrition is drinking enough fluid.
Nutrition after surgery is a source of energy and restores the functions of all systems, facilitating their work during the rehabilitation period.
Increased attention to hygiene
Care of the catheter after prostatectomy is usually required while you are in the hospital and if questions arise, the medical staff always gives the necessary explanations and tells you what needs to be done. Sometimes the catheter remains with the man for longer than 2-3 weeks, in which case it is necessary to independently care for the urinary device.
A hygienic shower does not harm the drainage system; maintaining a clean and comfortable body condition is the key to quick recovery. It is usually recommended to secure the urine bag to the man's thigh with adhesive tape, and after showering, wipe all external parts of the device dry with antiseptic wipes.
Active lifestyle
Heavy physical work and prolonged stay in one position are equally harmful to health and can cause long-term postoperative complications. A man should not lift heavy objects or drive a car for 2-3 months after radical prostatectomy. Jumping, cycling, heavy loads and walking up stairs without support are prohibited.
Physical rehabilitation includes light physical activity, gymnastic exercises from the complex of physical therapy, on the contrary, contribute to a speedy recovery. The expansion of the physical activity regime occurs as functional abilities are restored after preliminary consultation with a doctor.
Restoring an erection
Erectile dysfunction in men after radical prostatectomy is associated with hormonal imbalance. The condition requires correction with the help of medications, as well as the use of special devices to artificially create an erection.
It is impossible to completely get rid of erectile disorders, but it is possible to return sexual activity using conservative therapy methods or penile prosthetic surgery in most cases.
- Viagra and its analogues are used to stimulate blood flow in the pelvic organs.
- Local injections of Papaverine are used to create an erection and maintain it during sexual intercourse.
- To stimulate the production of hormones, synthetic testosterone analogues are used.
- Vacuum devices to stimulate the filling of the penis with blood are used according to the recommended scheme.
- In the most difficult cases, they resort to prosthetics with the introduction of silicone or biological implants.
Sometimes erectile function can improve without the use of special means, but you should not count on such an outcome. It is better for a man to follow the doctor’s recommendations and carry out the proposed set of rehabilitation measures after radical prostatectomy.
Possible complications
After radical prostatectomy, men are always at risk of developing early and late complications: obstruction of the urinary duct due to fusion of the urethral walls, infectious processes, damage to the lymph nodes and large vessels, impotence, recurrent cancer, vascular blood clots and urinary incontinence due to damage to large vessels. nerve nodes. Modern technologies for performing radical prostatectomy, as well as following recommendations during the rehabilitation period, help in most cases to avoid unpleasant consequences and return to normal life.
Source: https://kisstyle.ru/predstatelnaya-zheleza/adenoma-prostaty/reabilitatsiya-posle-radikalnoj-prostatektomii/
Progress of radical prostatectomy and rehabilitation after surgery
Procedure for preparing for surgery
Before the operation, the patient must undergo the following tests:
- general and biochemical blood test;
- electrocardiogram (this requirement applies only to older men);
- palpation of the prostate (except for those cases when the patient has stones in its tissues);
- fluorography or chest x-ray;
- tests for syphilis, HIV, all types of hepatitis;
- osteoscintigraphy (for metastasis);
- prostate biopsy.
Persons suffering from somatic diseases (atherosclerosis, diabetes, etc.) need to undergo a full examination and adjust their treatment courses.
Types of operations
There are several types of prostatectomy, depending on the access to the prostate gland:
- retropubic;
- perineal;
- radical;
- laparoscopic.
All of them are performed under general anesthesia. The course of the operation depends on which technique was chosen by the attending physician.
Retropubic technique
In a retropubic prostatectomy, the doctor makes a cut in the anterior wall of the abdomen from the symphysis pubis to the umbilicus. Having gained access to the abdominal cavity, the surgeon:
- Cuts and ligates nerves and blood vessels.
- Removes the prostate and surrounding tissue.
- Connects the urethra to the neck of the bladder.
- Inserts a catheter into the bladder to drain urine.
- Places drainage devices in the pelvis to ensure the outflow of wound fluid.
- Sutures fabrics.
On average, the operation lasts about 3 hours. The described technique involves preserving the nerve plexuses responsible for the processes of erection and urination.
Perineal surgery
During a perineal prostatectomy, the doctor makes an incision between the rectal sphincter and the scrotum.
This technique is used in the treatment of stage 1 or 2 prostate cancer (provided there are no metastases). On average, the operation lasts about 3 hours.
Its main disadvantages are the lack of access to regional lymph nodes and the high risk of damage to the nerve bundle responsible for urination and erection.
Radical prostatectomy
When performing a radical prostatectomy, doctors use a robotic Da Vinci mechanism equipped with a highly professional camera. During the operation, the surgeon:
- makes a miniature incision in the lower abdomen;
- inserts special instruments into the abdominal cavity;
- excises affected prostate tissue;
- connects the bladder and urethra;
- installs a drainage system and a foley catheter;
- suturing damaged tissue.
The average duration of surgery is 3 hours.
Laparoscopic technique
Laparoscopic prostatectomy is characterized by low morbidity. However, when using this technique, the surgeon is not able to remove all the affected tissue. During the operation, the doctor:
- makes several incisions in the peritoneum;
- inserts a video camera, a miniature light source and surgical instruments into the abdominal cavity;
- removes the prostate and surrounding tissues;
- installs drainage;
- suturing damaged tissue.
Features of recovery after surgery
Men who have undergone prostatectomy undergo a two-week course of rehabilitation after radical prostatectomy in a hospital setting. Doctors prescribe radiation therapy, medication, and Kegel exercises to patients.
Removing the catheter from the bladder
Doctors remove the catheter from the bladder 2 weeks after surgery, unless severe consequences of the prostatectomy occur. On the day of the procedure, patients are advised to drink at least 2 liters of fluid.
This is necessary so that the doctor can make sure that the man who has undergone surgery can urinate in a strong stream.
If the fluid that the catheter drains contains bloody impurities, the procedure is postponed to a later date.
Restoring the patient's ability to work
A patient who has undergone prostatectomy can return to his professional duties within the following periods:
- for office work – after 2-4 weeks;
- for work activities associated with increased physical activity - after 1.5-2 months;
- for work that involves constant travel – in a month.
The operated man can drive a car immediately after the catheter is removed.
Regaining control of urination
The function of maintaining control over microphones is restored in 3 stages:
- I – the patient controls his urination during night sleep;
- II – a man who has undergone surgery regains the ability to control the urge to micturate while walking;
- III – a person undergoing rehabilitation after surgery controls urination during the moments when he rises from a sitting position.
Initially, the urine stream may be very weak. In order to restore the functions of the urinary system, it is necessary:
- regularly perform a simple exercise: interrupt the stream with each micturition, tensing and relaxing the muscles of the perineum;
- use disposable diapers or pads that protect against urine leakage (such hygiene products can be purchased at any pharmacy);
- stop using condom catheters and clamps that hold urination (this prevents the development of muscles that allow you to control micturition);
- Limit your intake of liquids, alcoholic beverages and products containing caffeine.
If urinary incontinence persists for 9–12 months, you need to undergo additional examination by a doctor to rule out the development of a scar process in the surgical area.
Restoration of sexual function
Sexual function in the postoperative period after radical prostatectomy is restored much more slowly than the ability to control urination. Typically, it takes at least 4 years to treat post-operative impotence . Men who have undergone prostatectomy and are faced with the problem of erectile dysfunction need to:
- be patient;
- give preference to tactile stimulation before sexual intercourse;
- trying to insert the penis into the partner’s vagina even with a partial erection;
- perform sexual intercourse in an upright position;
- use moisturizing vaginal lubricants;
- take medications that stimulate erection - Viagra, Levitra, Cialis and their analogues (only in the absence of contraindications and no more than once a day);
- try to return to full sexual activity immediately after removal of the catheter that provides urine drainage.
In addition, doctors recommend that patients use erection tourniquets. These devices are rubber rings that prevent venous leakage.
By putting a tourniquet on the base of the penis before erotic stimulation, a man is able to retain blood in his cavernous bodies for a long time and maintain an erection.
Such devices do not disrupt blood flow in the groin.
Men who have undergone prostatectomy should undergo regular examinations by a urological oncologist. The first visit to the doctor should take place one month after surgery to remove the prostate gland.
Complications after prostatectomy
It is impossible to completely exclude the development of complications after prostatectomy. The incidence of complications after removal of the prostate gland, which involves complete removal of the prostate, does not exceed 10%. The most common problems faced by men who have had a prostatectomy are:
- heavy bleeding;
- damage to the nerves of the lumbar plexus, urinary tract, rectum;
- failure of the suture connecting the urethra and the bladder;
- fistulas in the bladder;
- acute blockage of blood vessels with blood clots;
- cardiac disorders;
- infectious damage to the urinary system;
- accumulation of lymphatic fluid in the cavities of the pelvic region;
- divergence of superficial postoperative sutures.
Late complications after removal of the prostate gland include potency disorders, the formation of urethral strictures, the appearance of inguinal hernias and enuresis.
Rehabilitation activities
After removal of the urethral catheter, men who have undergone surgery to remove the prostate gland are prescribed antibacterial drugs to avoid tissue infection by bacterial microflora. In addition, patients are recommended:
- wear a support bandage for 30 days after surgery;
- avoid heavy loads, do not lift loads weighing more than 3 kg for 90 days after surgery.
- resort to physical exercise.
Regular walks bring invaluable benefits to patients.
Prognosis for prostate removal
The five-year survival rate after complete removal of the prostate gland is 100%, and the 10-year survival rate is about 90%. The consequences of prostatectomy appear at the very beginning of the rehabilitation period.
The most common of them are lymphocele after prostatectomy (accumulation of lymph in the body cavities), sclerosis of the cervix of the urethra and fusion of the lumen of the urethra.
The listed disorders can only be treated surgically.
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Source: https://posle-operacii.ru/urologia-andrologia/radikalnaya-prostatektomiya
Recovery after prostatectomy
Today, leading clinics in Russia offer many methods of surgical treatment of prostate cancer. Radical prostatectomy is considered the gold standard treatment for localized prostate cancer, but there are many other types of surgical treatments available.
One of the most important factors for a patient when choosing a method of surgical treatment is the recovery time after prostatectomy . Given the current trend towards less invasive treatment, urologists have developed many types of surgical options for prostate cancer.
Let's consider these types of operations from the point of view of the patient's recovery after prostatectomy.
Recovery after various types of prostatectomy
Radical retropubic prostatectomy is performed most often compared to other surgical procedures.
Most often, this prostate cancer operation is performed with bilateral pelvic-obturator lymphadenectomy (removal of lymph nodes), which increases the volume of the operation and thereby increases the recovery period after prostatectomy.
Pelvic-obturator lymphadenectomy is performed to prevent the development of the oncological process; its implementation has predetermined indications. Thus, despite the longer recovery, pelvic-obturator lymphadenectomy is rather an advantage of this treatment rather than its disadvantage.
During the recovery period, the patient experiences urinary incontinence after prostatectomy in 3% to 60% of cases (according to world literature). The degree of urinary incontinence varies from mild to total. Another problem during the recovery period that a patient may encounter is erectile dysfunction after prostatectomy. The degree of manifestation of these complications makes it possible to reduce the implementation of nerve-sparing techniques during surgical treatment.
Perineal radical prostatectomy is considered less invasive, so patients recover faster. There is a limitation in the recovery period that should be mentioned - the patient is not allowed to sit.
Laparoscopic and robot-assisted prostatectomy are performed using optical devices that increase the precision of the bladder neck and proximal end of the urethra, significantly reducing the incidence of urinary incontinence after prostatectomy.
Optical devices also provide an advantage when performing nerve-saving techniques, which reduces the risk of developing erectile dysfunction in the postoperative period. Access with these benefits is the least invasive and therefore the patient recovers faster. Another advantage is the removal of the urethral catheter earlier than with open catheters.
Thus, the recovery period for robot-assisted and laparoscopic prostatectomy is shorter and is easier for patients to tolerate.
Source: http://laparo-urology.ru/vosstanovlenie-posle-prostatektomii
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