|
Laparoscopic
Radical Prostatectomy
Laparoscopic
radical prostatectomy is an operation that removes
your whole prostate. It also removes some healthy tissue around
it, including the seminal vesicles, two small glands that
(like the prostate) produce the fluid that comes out with
your sperm when you ejaculate.
What
does the operation involve?
 
Schematic
diagram to explain the steps of radical prostatectomy
The operation
involves the surgeon placing a narrow telescope (called a
laparoscope) and other metal instruments through small tubes
(ports) inserted into the abdomen through four or five1cm
incisions. You will be given a general anaesthetic to put
you to sleep. The operation lasts between 3 and 5 hours. This
operation removes the entire prostate gland following which
the water tube (urethra) is rejoined to the bladder. Please
ask Mr Puri if you want further details.
Advantages
of Laparoscopy
Open
Radical Prostatectomy Laparoscopic Radical Prostatectomy
Incision Incisions
As there
is no large incision this result is shorter hospitalisation
and convalescence, less bleeding and post-operative pain and
fewer wound complications.
Although
laparoscopy is a type of keyhole surgery, the view obtained
is much better than looking through a keyhole. Modern equipment
produces a wide, bright, clear and magnified view of the operation.
The gas used to distend the abdomen during laparoscopy also
greatly reduces bleeding during surgery.
ALL
PATIENTS OFFERED LAPAROSCOPIC SURGERY HAVE TO UNDERSTAND THAT
IN CASE OF ANY DIFFICULTY IN CARRYING OUT THE PROCEDURE LAPAROSCOPICALLY
I WILL CONVERT TO AN OPEN PROCEDURE
What
are the advantages of surgery
- The
true extent (stage) and aggressiveness (grade) of prostate
cancer can be determined.
- If
the cancer is confined to the prostate and completely removed
the operation should be curative
- PSA
value should decrease to <0.1 six weeks after the operation
- This
operation also relieves the obstruction caused by enlargement
of the prostate gland and relieves symptoms as poor flow
and getting up at night to pass water.
- If
cancer recurs PSA rise will detect this 4-5 years before
symptoms so the radiotherapy can be given.
Disadvantages
of surgery
- Wound
discomfort- The wounds heal within 10 days and most
patients are able to resume normal activity like driving
within 2-3 weeks. The discomfort is easily controlled by
painkillers. Wound complications are rare Serious
complications are unusual but are rapidly recognised and
dealt with.
Common
- Erectile
dysfunction (problems getting an erection)
- Incontinence
(problems controlling your flow of urine)
Occasional
- Chest
infection
- Bleeding
- Blood
Clot formation
Rare
- Bowel
problems. It is possible for your rectum to become damaged
during surgery, although this is not common.
- There
is a very small (less than 1 percent) chance that you may
die from your surgery. As operation involves a general anaesthetic
and this can lead to complications such as heart problems
and breathing problems.
Despite
your surgeon's attempt to remove the entire tumour, you may
not be cancer-free. Even if your test results indicate your
cancer is only in your prostate, it's still possible
that it has spread to other parts of your body but can not
be detected. It is essential that you have regular follow
up for 5 years after operation.
What
happens before the operation?
Approximately
weeks before your admission date you will be requested to
attend the pre-admission clinic to have blood tests and examinations
performed to ensure you are fit for the operation. On admission
to the ward, you will be welcomed and shown to your bed. You
should plan to be in hospital for 3-4 days. The nursing staff
will discuss your discharge from hospital with you.
You
will be seen by the Surgeon who will explain the operation
again to you and ask you to sign the consent for surgery.
If you are unsure about any aspect of the operation, please
ask for more details from the medical or nursing staff. You
will be advised of the approximate time of your operation.
You
will be seen by an anaesthetist who will discuss the anaesthetic
you will be given. They will be interested in chest troubles,
dental treatment and any previous anaesthetics you have had.
The anaesthetist will discuss with you the different methods
of controlling pain after the operation. The most common method
a special pump that delivers pain-killing medication when
you press a button, this is known as ‘Patient Controlled Analgesia
(PCA).
The
nurses will advise you as to when you need to stop eating
and drinking before surgery. This allows a period for your
stomach to empty preventing vomiting during the operation.
You
will be asked to wear stockings to prevent blood clots and
aid circulation and a cotton gown. You will also be asked
to remove or secure with tape all jewellery.
You
will be accompanied to theatre by a ward nurse. Your details
will be checked several times before your anaesthetic begins.
What
happens after the operation?
Although
you will be conscious a minute or two after the operation
ends, you are unlikely to remember anything until you are
back in your bed. You will have a tube (called a ‘catheter’)
coming from your penis. This tube drains the urine from your
bladder and is connected to a collecting bag. It is quite
normal for your urine to be bloodstained initially. Some men
experience slight discomfort around the catheter. You will
also have one wound drain.
A
team of anaesthetists and specialist nurses (known as the
‘Pain Team’) will see you to ensure that the pain is controlled
with the epidural or PCA. This team will visit you daily in
the first few days after your operation.
On
the morning after your operation, you will usually be able
to sip fluids and progress to tea or coffee later. By the
end of the day you will probably be drinking quite freely,
and should be able to tolerate a light diet. You will have
an intravenous drip and this will make up for any fluids you
are unable to drink in the early hours after the operation.
There is also a small possibility that you may need to be
in the High Dependency Unit overnight to monitor your progress
after the operation.
Your
bowels may stop working for a few days after surgery. If you
have not opened your bowels after 2 days, or are feeling uncomfortable,
please ask the nursing staff for advice. It is also normal
to have some bruising and swelling of the scrotum after the
operation. You will be given a special support to wear; this
will help with the swelling and make you more comfortable.
This swelling will usually settle within a week or two after
surgery.
You
will be encouraged to get out of bed and start walking from
the first day. You will not do your wound any harm and it
is important to start moving to avoid complications.
You
will need to remain in hospital until you can walk freely
without pain, and can manage by yourself. We will also ensure
that you are eating normally, and that your bowels are working,
before you are discharged home. The majority of patients will
be discharged home between 2 and 3 days after their operation
The
length of time that the catheter needs to remain in place
will depend on a number of factors, including the surgical
technique used and the ease or difficulty the surgeon encountered
with particular aspects of your operation. It may be possible
to remove the catheter quite early (around 7 days) but it
is also possible that it may need to remain in for around
two weeks. Very occasionally it may be necessary to leave
a catheter in place for around two weeks while healing takes
place and confirm that the join has healed by carrying our
a special x-ray (cystogram). The catheter must not be removed
for any reason except on your surgeon’s instructions.
Very
rarely, the catheter may stop draining altogether. If this
happens, drink plenty of fluids and then lie down flat for
an hour. If this does not result in drainage from the catheter,
then ring your ward for advice. It may be suggested that you
return to the ward.
Bleeding
It
is common for there to be a slight discharge of blood around
the catheter when you open your bowels. This will settle down
by itself and is not a cause for concern. You may also see
some blood in the catheter bag, particularly after exercise.
If this happens, you should increase your fluid intake to
help flush out the blood. This kind of bleeding usually settles
by itself and does not require treatment in most cases.
Leaking
around the catheter
Like
bleeding, this is also common and does not require treatment.
If the leakage is very severe, then it can be managed by absorbent
pads. The catheter should not be removed.
Wound
You
can shower or bathe at home as normal, this will not affect
the small wounds. You should observe for signs of infection
such as redness or swelling. If this happens seek advice from
your GP or Community Nurse.
Clots
in the leg (Deep Vein Thrombosis)
There
is a risk that blood clots may form in the veins of the calf
during surgery (known as "Deep Vein Thrombosis").
This may lead to a swollen, tender calf. Although this is
easily treated, it can lead to further problems if the clots
break away and move up to the lungs (Pulmonary Embolus). The
stockings you are given to wear prior to surgery should be
kept on throughout your stay on the ward. You will be required
to wear them at home for 2 weeks. Please ask the nurses on
the ward and ensure that you obtain a spare pair so that they
may be washed. Your surgeon may also prescribe daily injections
during your hospital stay to thin the blood slightly and reduce
the risk of forming these clots.
In
the first six weeks after surgery blood clots are the most
serious potential complications. If you develop any of the
symptoms such as chest pain, shortness of breath, pain or
swelling in your leg, then call your GP or contact your nearest
Accident and Emergency Department if you are away from home.
You should tell the doctor who sees you that you have had
a Radical Prostatectomy, and are concerned about a
possible blood clot.
Infection
in the urine
Urinary
tract infections are quite common in anyone who has a catheter
in place. Unless you have symptoms, the infection will not
require any treatment.
Symptoms
of a urinary tract infection include
- Chills
and fever
- Concentrated
or cloudy urine
- General
feeling unwell
Sometimes
there may be cloudiness in the urine, which does not necessarily
signify an infection, but may represent sediment in the urine
that is a normal occurrence. If you suspect that you have
a urine infection please contact your G.P.
Urinary
control
In
the discussions you had with your Consultant and Specialist
Nurse prior to surgery, the problem of urinary incontinence
following surgery was discussed. The majority of men find
that they experience some urinary leakage. However for a few
men, the problem is more severe and can in rare cases last
over 12 months, especially if they had problems with urinary
urgency or frequency before the operation.
The
return to normal control occurs in three phases, and you should
try to be patient with the speed of your recovery.
- The
first phase is that you will be dry when you are lying down
at night.
- In
phase two you will be dry when walking around.
- Finally
in phase three you will be dry when you get up from a sitting
position, cough or sneeze.
The
return to normal occurs at different speeds in different men
and is impossible to predict accurately. Until you gain full
control, you may find it useful to limit the amount of caffeine
drinks (tea and coffee) and alcohol that you drink as these
drinks act as a stimulant on the bladder.
Pelvic
floor (or Kegel’s) exercises
- To
do these exercises effectively, you need to first relax
your abdominal and buttock muscles.
- To
identify and correctly contract the pelvic floor muscles,
imagine that you are trying to hold back bowel movements
or from passing gas. During this action, you should feel
a ‘lifting sensation’ inside and a tightening around your
anus. You should not be tensing your thighs, buttocks or
anus.
- Tighten
the muscles for 3-5 seconds and then relax for 6-10 seconds.
Repeat this sequence 20-25 times.
- Do
the set of 20-25 contractions 3-4 times daily.
During
the first week of the programme, perform the exercises whilst
lying down, but later while sitting and standing. After the
initial learning period, perform the exercises when you need
them, i.e. just before sneezing, coughing or straining.
Sexual
function
After
surgery, you may find it difficult to get or maintain an erection
that is firm enough for intercourse.
Erectile
dysfunction happens because the nerves and blood vessels that
control erections lie close to the prostate and can become
damaged during surgery. A technique called nerve-sparing
surgery can protect the nerves from injury and where possible
this will be done. However, nerve-sparing surgery is not possible
for all men. Even when nerves are spared, it may not prevent
erectile dysfunction. However, your erections may continue
to improve over time. The nerves that are involved seem
to be able to recover after surgery, but the older you are,
the less likely you are to regain the ability to have an erection.
Although
you may not be able to have penetrative sex, you may still
experience the sensation of an orgasm, which may be achieved
from either foreplay or masturbation. After your prostate
is removed, you will no longer be able to ejaculate (release
fluid from your penis when you orgasm). This is because you
no longer have a prostate to produce this fluid. As you will
be sterile you do not need to use any form of contraception.
There
are treatments available for erectile dysfunction, so
it's worth talking to your Consultant or Specialist Nurse
about which one may be right for you at your regular follow
up appointments. Current research suggests that early treatment
is associated with greater success.
Potency
(erection) rates differ amongst surgeons. Good potency rates
would be 50% of patients, at 12 months after surgery.
Do
not be afraid to attempt intercourse, but it is better to
wait for at least 6 weeks after surgery, to make sure everything
has healed. Do not be tempted to wait for a perfect erection
before attempting intercourse
Discharge
advice
Diet
You
can eat and drink whatever you wish. Try to avoid constipation
by keeping to a diet that contains plenty of fruit and fibre.
If you do become constipated, then ask your doctor or nurse
for advice.
Exercise
After
you go home, you should avoid heavy lifting and vigorous exercise
for 4 weeks, to allow the small wounds to heal.
For
the first two weeks at home, try to avoid sitting upright
in a firm chair for more than an hour at a time. Instead sit
in a semi-reclining chair, on a sofa, or on a comfortable
chair with a foot stool.
This
achieves two aims:
- It
raises your legs and improves the drainage from your leg
veins reducing the risk of clots forming
- It
avoids placing weight on the area of your surgery
Most
men will be able to take light exercise with in two weeks.
You should particularly exercise the calf muscles to reduce
the risk of blood clot formation. You can drive your car when
you can operate the pedals without any discomfort at all.
Removal
of the catheter
You
will be given an appointment to come back into hospital after
your operation for removal of the catheter. Very occasionally
a special x-ray is required to determine whether the internal
stitches around the join between the urethra and the bladder
have healed.
The
catheter will be removed on the ward. This procedure is performed
at the bedside. You will then be able to pass urine normally,
although you may need to remain on the ward overnight so that
we can ensure you are able to control your water sufficiently.
When
the catheter is removed, you may find to begin with that you
get little warning before needing to pass urine, and may leak
urine on movement. This is quite common and usually settles
quickly. If it does not, please let the nursing staff know.
Absorbent pads can used to help manage this problem. Please
ensure that you have a supply of pads when you leave the hospital
after your catheter has been removed. Further supplies will
be obtained via your community nurse.
Follow
up after surgery
6-8
weeks after the operation you will be seen by the Consultant
in the outpatient clinic. This is so the results of the surgery
can be discussed with you, and any other treatments planned.
A PSA test may be done either at the hospital or at your GPs
practice, 7-10 days before the appointment date.
Further
follow up appointments will be given at regular intervals.
The time between visits will lengthen if there are no particular
problems.
A final
word
Please
do not hesitate to contact us with any questions or concerns
that you may have about your condition. We are here to help
you.
Any
questions?
If you
have any questions please contact
Uro-oncology
nurse specialists
BRI Yorkshire
Clinic
Mr
David Tyson 01274 382079 Mrs Lyn Taylor 01274 550600
Miss
Zoe Scaife
Ward
14 Ward 1
Bradford
Royal Infirmary Yorkshire Clinic
Tel
(01274) 364383 Tel (01274) 560311
Secretary
to Mr R. Puri
Bradford
Royal Infirmary Yorkshire Clinic
Duckworth
Lane Bradford Road
Bradford
BD9 6RJ Bingley BD16 1TW
Tel
(01274) 382655 Tel (01274) 564521
|
