What is a Prostatectomy?
A prostatectomy is a surgical procedure that is performed to remove the prostate gland, seminal vesicles (glands) and a section of the vas deferens. This surgery is a treatment option for men diagnosed with prostate cancer, and is performed as either an open surgery, or a robot assisted surgery.
What is a Robot Assisted Laparoscopic Prostatectomy?
A robot assisted laparoscopic prostatectomy is a minimally invasive procedure in which several small incisions are made in the patient’s abdominal region to give access to robotically controlled surgical instruments. This surgery is different from a radical or open prostatectomy in which a large incision is made in the body to remove the prostate.
Robotic surgery gives the surgeon technological advantages including better visualization and magnification of the prostate gland, surrounding nerves, and tissue. The robot also gives the surgeon more flexibility and precise maneuvering during the operation. While minimally invasive, this is a major surgery that is performed under general anesthesia that takes between two to four hours to complete.
Robotic assisted surgery has documented benefits compared to an open prostatectomy including: the potential for less pain and blood loss, minimized complications, shorter hospital recovery, better outcomes for erectile function and urinary continence, and smaller scars at the entry points.
Possible risks and complications
As with any surgical procedure, there are possible risks. Because the robot assisted laparoscopic prostatectomy is less invasive than open surgery, the patient should generally encounter milder aftereffects. Following surgery, the patient may experience urinary leakage, urinary urgency (an urgent need to urinate that may result in wetting accidents), a difference in their erectile function, pain, or small amounts of blood in their urine.
As a general rule, infection may also occur. If you are experiencing infection related symptoms, such as fever, ongoing pain, tenderness, or burning at the incision site(s), contact our office as soon as possible. In addition, notify the surgeon if you experience severe nausea, vomiting, or the inability to urinate (urinary retention). Finally, if the patient has on-going or large amounts of blood in their urine, they should also contact our office. Following surgery, a catheter will be placed to aid in urinary flow.
Prior to the procedure
Several days prior to surgery, the patient will undergo pre-operative testing including imaging, blood work and possibly cardiac clearance. The surgeon will advise individual patients about the discontinuation of blood-thinning medicines and any dietary restrictions.
Basic pre-op preparation
- Discontinue blood-thinning medications as outlined by the surgeon.
- Bring containers for contact lenses or dentures to the hospital to store items during surgery.
- Bring loose-fitting clothing to wear home after release.
Following the procedure
Following the procedure, patients will be instructed on dietary and activity guidelines, basic incision care, allowable medications, washtub restrictions, their expected recovery time, and return-to-work instructions. Because a drainage tube may be placed in one of the incisions, and a Foley catheter is inserted to assist with urinary function, the patient will be given specific care instructions and when to follow-up with their surgeon.
Patients will be instructed by their surgeon when they can resume prescription and over-the-counter medications – particularly blood thinning medications.
After surgery, patients will leave with a Foley catheter that will remain in place usually up to two weeks. Patients will be instructed on how to change and empty bags, proper cleaning protocol, and things to watch for (urinary leakage, blood, bladder spasms). A follow-up appointment will be scheduled with the patient’s surgeon for removal of the catheter.
Urinary control and erectile function
The prostate is surrounded by nerves and vessels that affect erectile function. Likewise, the external sphincter muscle, and the internal urinary sphincter mechanism control urinary continence. During a prostatectomy, there is a risk that these nerves, vessels, and muscles may be affected.
If the sphincter muscles are affected during surgery, men may experience a form of urinary incontinence called stress incontinence. This type of incontinence is caused by a change in bladder pressure, and is triggered by ‘stressors’ such as laughing, coughing, sneezing, lifting, or other physical activities. The surgeon/provider will assist patients in working toward regaining urinary control. For some men, this may take up to 12 weeks following their surgery. For others, a more gradual return to control may take up to a year. Others may experience some level of permanent urinary incontinence.
Because nerves are within such close proximity to the prostate, nerve trauma is to be expected. Consequently, some level of erectile dysfunction is likely after surgery. The surgeon/provider will work with patients to follow protocols established to improve erection (including nerve-sparing techniques where appropriate), however, this can be a long process for some patients. Generally, erectile function will improve in increments, and may need to be assisted by medical protocols specific to impotence (oral medications, injections, devices). The surgeon will advise men when it is safe to return to sexual intercourse following their surgery.
Pelvic floor rehabilitation
Kegel exercises is a form of pelvic floor rehabilitation (physical therapy) that is beneficial for strengthening pelvic floor muscles. It is an effective modality for addressing temporary loss of urinary control in men following prostate surgery. Urology Austin is fortunate to have a team of physical therapists trained in pelvic floor rehabilitation in our offices. Learn more about the benefits of post-surgical physical therapy at Urology Austin.