Surgery is one of the main methods of treatment of this disease . The doctor at the clinic Assuta tells in detail about the operation to remove the prostate cancer, the possible unintended consequences and other alternative therapies.
Surgery for prostate cancer in the early stages
The main type of surgery in these stages is a prostatectomy and its various modifications: retropubic and perineal (abdominal approach), laparoscopic and robotic, nerve-sparing.
This operation for prostate cancer is performed by a urologist surgeon who specializes in the treatment of prostate operational, kidney and bladder. The prostate with the surrounding tissue (seminal vesicles, the neck of the bladder, pelvic lymph nodes, part of the urethra that passes through the prostate) are completely removed through an incision in the abdomen (retropubic prostatectomy) or cut between the scrotum and anus (perineal does not allow removal of lymph nodes ). This surgery is known as open prostatectomy.
The main task - to completely remove the cancer cells. Indications are:
- The localized tumor at early stages (I or II), do not spread beyond the prostate.
- Locally advanced prostate cancer (III stage).
- Life expectancy of at least 10 years.
- Age up to 75 years. Prostatectomy is usually offered to young men in good health. But each patient is evaluated individually, so the elderly can also be offered surgery.
- The normal state of health, that move anesthesia and surgery.
Surgery for prostate cancer can become a cause of impotence and infertility, as well as cause problems with bladder control - incontinence.
The Israeli hospitals are currently conducting a nerve-sparing prostatectomy, keeping the nerve fibers of the prostate gland.
Nevrosberegayuschaya radical prostatectomy in Assuta
Radical prostatectomy is often associated with erectile dysfunction. The nerve fibers that are responsible for erections, located two beams on either side of the prostate. During this operation in prostate cancer , they can be damaged or removed. When this happens, a man can not get or maintain an erection to have sex. Nerve-sparing prostatectomy preserves the nerve bundles with complete removal of the prostate gland. Tissue around the nerves, not cancerous, can be left. But if the tumor has spread to the nerve fibers, they can not be saved.
The surgeon is quite difficult to say prior to surgery for prostate cancer, whether it is possible to keep the nerves. The decision is taken directly during surgery using cavity approaches (retropubic and perineal) and laparoscopic techniques, including by a robot.
Higher results nerve-sparing prostatectomy shows in the early stages of the disease in young and sexually active men.
The risk of erectile dysfunction in Israel amounts to 3% after this surgery.
Advantages of Radical Prostatectomy
Complete removal of the prostate gland can stop cancer at an early stage and lead to a cure. When aggressive neoplasm radical prostatectomy can extend life, but in the case of a small and slow-growing tumor benefits are unclear, largely manifested in the case of treatment of young men.
Disadvantages radical prostatectomy
Any surgery carries risks such as bleeding problems or infection. But now, surgeons have a high level of expertise and professionalism, minimizing the risks. There is some risk of incontinence and impotence.
Laparoscopic radical prostatectomy
With this operation, the surgeon performs four or five small incisions (about 1 cm each), using specially designed tools. The abdomen is filled with carbon dioxide. By means of a tiny video camera prostate image is transferred to the screen. Iron is separated from the surrounding tissue and removed through one of the incisions. Laparoscopic technique provides less blood loss, reduced pain and shorter recovery period.
Robot-assisted laparoscopic radical prostatectomy
Assuta Hospital can offer this operation for cancer of the prostate with a unique robotic surgical system - robot "Da Vinci." Instead, the surgeon and an assistant camera and instruments controlled robot whose hands move very accurately and skillfully.
This type of surgery for prostate cancer is sometimes called the "Da Vinci" prostatectomy.
A large number of studies have shown that laparoscopic and robotic surgery to remove prostate cancer is also effective, as well as abdominal surgery. After application of the robot "Da Vinci", patients recover more quickly and spend less time in the hospital.
Due to the fact that these approaches do not apply as long as abdominal operation, lack of information about long-term side effects such as erectile dysfunction and urinary incontinence.
This operation resection of regional lymph nodes. The lymphatic fluid from the prostate gland drains into the pelvic lymph nodes. Typically, cancer that has spread to these lymph nodes is considered incurable. But in some cases, when the disease struck only partially microscopically, it is possible to cure it with the help of surgery. Lymphadenectomy performed during radical prostatectomy, removes the main groups of lymph nodes.
After surgery for prostate cancer - prostatectomy
After surgery, the patient will be attached drip intravenous infusion catheter to drain urine from the body may drain for removing fluid from the wound. They are usually removed after a few days. After the abdominal surgery suture is in the abdomen or in the area between the scrotum and anus.
There are pains for several weeks, especially when walking. Therefore regularly carried analgesics.
After 3-7 days after surgery for prostate cancer patient leaves the clinic. For a short time may leave the catheter to the urethra has healed and the swelling was asleep.
Following LRP hospitalization and recovery period is shorter.
Most men return to normal activities within two to three months after surgery for prostate cancer in Israel.
Potential adverse effects of radical prostatectomy
This operation for prostate cancer may cause impotence. This is due to reduction of blood flow to the penis due to arterial injury or nerve endings. Nerve-sparing techniques reduced the risk of these problems, but there are situations when it is impossible to avoid damage to the nerve fibers, as they are affected by a malignant process.
Many studies have focused on the identification of the statistics, how many men gain potency problems after nerve-sparing prostatectomy. Figures depend on different factors: the patient's age, pre-existing such problems, the surgeon to retain partially or totally nerves. The risk increases with age, if Nervo-saving techniques do not apply if the infringement had been before.
It is important to know that erection can recover some men, when the only way of treatment was surgery. Sometimes it takes a year or two. The probability is reduced if there is a further treatment - hormonal therapy or radiotherapy .
The prostate produces prostatic secretions, which is connected with the sperm from the testes. Removing the prostate violates ejaculation process, the sperm can not come naturally, it causes infertility. If a patient plans to children after treatment, it is important to preserve sperm before surgery for prostate cancer. It will still be able to feel orgasm, but so-called "dry ejaculation."
Difficulty with bladder control are less common side effect. Some difficulty may arise after removal of the catheter, but usually the situation improves with time as the recovery of the body. Six months after surgery for prostate cancer may be a so-called "stress incontinence" - the selection of a few drops of urine during lifting, sneezing, coughing, or a sharp change of position. Application of modern surgical techniques greatly reduces the risk of complications, carefully avoiding any damage to the bladder.
Scarring of the bladder
A rare side effect of complicating the process of urination. Since it is easy enough to cope with minor surgery, called the expansion of the bladder neck.
Surgery for locally advanced prostate cancer at Assuta
A team of doctors working with the patient to discuss the possibility of surgical treatment at this stage of the disease. The patient talk about possible adverse effects of therapy, and alternative methods.
Used three types of operations for locally advanced prostate cancer.
- Radical prostatectomy aims - to cure the disease by removing the prostate gland. Suitable only a small number of men. Also used abdominal and laparoscopic approaches. However, after surgery the disease may recur in the area of tumor removal. In such cases further treatment with radiation or hormonal therapy.
- Transurethral resection of the prostate (TURP) relieves the symptoms of the disease (eg, difficulty urinating), but does not cure cancer.
- Subcapsular orchiectomy removes a portion of the testes. This procedure is performed in order to reduce levels of the male hormone testosterone in the body.
Transurethral resection of the prostate (TURP) in Assuta
TUR carried out when the tumor blocks the urethra. That is, the operation for prostate cancer aims to eliminate problems with urination, and not for treatment of the disease.
During the procedure resectoscope comprising a video camera, is introduced through the urethra, advancing it to the prostate. The tumor is removed, blocking the urethra.
Transurethral resection is performed with general anesthesia or epidural anesthesia.
After TURP in Assuta
The next morning, the patient has to be able to walk. Fits for drip intravenous fluid and the catheter to drain urine. At this time in the composition of urine may be blood, this is normal. To prevent blockage of the catheter, irrigation of the bladder is carried out. Generally hospitalization of 3-4 days. Perhaps, some time after returning home, will have to use a catheter.
For several days after the operation with prostate cancer have pain and discomfort. The doctor prescribes effective painkillers.
After TOUR 1 in 5 men retrograde ejaculation occurs when semen comes not through the urethra and into the bladder returns. So after sex urine is turbid, but it does not bring harm.
Sometimes there are long-term problems with urination, difficulty in achieving an erection.
Thus, the value TOUR - operation facilitates difficulty urinating. Disadvantage - does not eliminate the malignant cells. There is a small risk of urinary incontinence, as well as some men there are problems with erection.
Surgery for advanced prostate cancer in Assuta
The doctor discusses options transactions, based on the specific situation, talks about the potential side effects and other appropriate methods of treatment. In advanced cancer is no sense to completely remove the prostate gland, so prostatectomy operation is not carried out. The following types of surgery may be recommended:
- Subcapsular orchiectomy - a surgery for partial removal of the testicles. It aims at reducing the level of male hormones - testosterone in the body.
- Transurethral resection of the bladder (TUR) facilitates the problems with urination, performed when tumor blocks the urethra.
- Percutaneous nephrostomy and JJ stent. In some men, one or both ureters (ducts that connect the kidneys and bladder) may be blocked common tumors of the prostate. In this case it is recommended percutaneous nephrostomy - established nephrostomy catheter, by which the flow of urine from the kidney. Another embodiment is a stent JJ - specially designed hollow tube, which is located in the ureter. With the help of the kidneys continue to work, the patient is not subject to severe pain due to water retention in the kidneys. The doctor at the clinic Assuta will provide more information on these procedures.
Other possible undesirable effects after surgery for prostate cancer
Undesirable potential consequences largely depend on the type of surgery and your overall health.
- Nausea and vomiting. May occur due to the effects of general anesthesia. Doctors often prescribe drugs to prevent and eliminate them. This time the symptoms that pass in a few days.
- Paralytic ileus is a common side effect of abdominal surgery. The duration of this state depends on the complexity of surgery for prostate cancer, blood loss and time of general anesthesia - may last 2-4 days. It is recommended after surgery for prostate cancer, a liquid diet, adherence to diet.
- Deep vein thrombosis can develop in the absence of motion after surgery, so to prevent this side effect of the patient encouraged as early as possible to begin to walk, and to perform certain exercises permissible. It contributes to the prevention of DVT receiving blood thinners (anticoagulants) and the use of compression stockings. If you experience any redness, cramps, pain, or swelling of the calf should always tell the team, working with the patient.
- leg lymphedema. When surgically removed a large number of lymph nodes is disrupted normal circulation of lymphatic fluids. This leads to its accumulation in the soft tissues and is called lymphedema. The goal of treatment is to prevent further congestion and minimize swelling.