Mar 15, 2018
Pseudo-prostatectomy is the more common of the two ways of removing the prostate. In this case, the prostate gland is removed through the incision in the lower abdomen, which usually begins just below the navel and ends a few centimeters from the penis.
This is the most commonly used method of removing the prostate gland for two reasons. Through the same incision, the surgeon can remove the nearby lymph nodes, which are then sent for analysis to determine if the cancer has spread beyond the prostate. In addition, such an operation allows the doctor to get better access to the prostate and not to damage the nerve bundles responsible for erection.
In the evening before surgery, the patient is given an enema or a laxative to clean the rectum from stool. This reduces the risk of infection if a rectal wall is punctured during surgery, which is unlikely, but still possible.
You can choose general anesthesia for the operation or remain conscious, preferring spinal anesthesia, which deprives the sensation of only the lower part of your body. General anesthesia is used more often.
Having made a cut, the surgeon can cut out the lymph nodes surrounding the prostate gland and send them for analysis to the histologist. The enlarged or suspicious lymph nodes are checked by the partial freezing technique, which allows to determine the presence of cancer cells. Result
taty analysis is usually ready in 15-30 minutes. If a cancer is detected, the doctor can sew the incision without removing the prostate gland, or continue the operation. The decision to continue the operation if cancer is detected in the lymph nodes depends on how many lymph nodes already contain cancer cells, on your age and the symptoms of the disease. The fewer lymph nodes are involved in cancer, the younger you are, the more moderate your symptoms, the more likely that the doctor will continue the operation and remove the prostate gland.
To remove the prostate, it must be separated from the bottom of the bladder. The urethra is also separated from the prostate gland( see Figure 11), but above the external( urethral) sphincter, which controls the outflow of urine from the bladder. Seed-bearing ducts, through which the sperm rises from the testicles to the urethra, connecting with the urethra, pass through the back of the prostate. They also have to be cut to remove the prostate. Seminal vesicles adhere to the prostate and are the likely site of the spread of cancer cells. They are removed together with the prostate gland. Then the surgeon reconnects the bladder and urethra under the place where the prostate gland was located. This will allow you to continue to urinate normally, although your body will need from several days of
to several weeks - and sometimes months - to regain control of the bladder.
Depending on where the cancer is located, the surgeon will try to keep the nerve bundles that fit to each side of the prostate gland. These nerves are responsible for the ability to erect. Often, the doctor manages to keep one or both of these bundles.
Radical prostatectomy involves the removal of the prostate( shown in the figure with a cancerous tumor) and seminal vesicles. The urethra, which is cut when the prostate is removed, then re-connects under the bottom of the bladder.
Men under 60 who managed to keep the nerve bundles are more likely to restore an erection than older men. Some older men, especially those who are not sexually active, do not worry because of the loss of these nerves. About half of men who have undergone the operation face the problem of impotence or a decrease in sexual function.
An erection is possible while maintaining at least one neural bundle. If both beams are damaged, a normal erection is unlikely to be restored without proper treatment. But even if there is no erection, you will have a normal sexual desire( libido), your feelings will remain the same and you will also be able to experience orgasm. Now the medicine has special devices and medicines that will help you achieve an erection if it does not occur naturally. Some of these are discussed in Chapter 12.
Regardless of whether you retain the ability to erect after a surgery or restore it by treatment, your orgasm will not be accompanied by ejaculation. This is because during the operation the organs that produce and transport spermatozoa and seminal fluid - the prostate, seminal vesicles, seed-carrying ducts - either are removed or damaged. The fact that you have a dry orgasm does not affect your feelings in any way, but this
means that you can not have children without medical assistance.
After the surgery, you usually spend a few days in the hospital, and then recover at home for three to five weeks. Two or three weeks you will have to use a catheter to give the urinary tract recovery.
Before leaving the hospital, you will receive instructions from your doctor how to take care of yourself at home. You should know those things that will enter your daily life.
The use of a urinary catheter will make it possible to recover your urethra in the place where it was sewn to the bladder. You will be told how to use the catheter. Accurately follow all instructions, this will help you avoid getting infection and stagnation of urine. In addition, we will try to give you some tips that will simply make life easier.
When consuming a catheter, sufficient fluid intake is particularly important. This will allow the urine to flow freely and reduce the risk of blockage.
It is useful to make a table of medicines. Write on the sheet of paper all the medications that you take every day, leave space to indicate the dose and time of admission.
During the recovery period, try to avoid constipation. Eat a lot of vegetables and fruits, for a couple of months, give up pork and red meat. Within a few months after the operation, you can not put enemas and perform a rectal examination.
During the recovery do not lie on the couch. It is very important to stay active, especially useful to walk. Movements help to avoid blood clots in the legs. If you have redness or dullness in the area of the leg veins, talk to your doctor about it. Thrombi can be life threatening.
When you remove the catheter, urine may begin to drip. The muscles responsible for holding the urine, you need time to resorb the tumor and restore their strength. For a few days you may need an oilcloth, and then - absorbent pads. You will be helped by exercises that strengthen muscles. Choose the time and perform these simple exercises every day( see "Kegel exercises" in Chapter 5).These exercises will help you reduce incontinence or completely get rid of it. But be patient. It may take a year, and even more. A sense of humor will help you survive the temporary use of gaskets.
Urine leakage can cause a rash on the glans penis. This is a yeast infection called balanoposthitis. The doctor can prescribe an antifungal ointment that will cure the infection and prevent it from reappearing. Before applying ointment, wash the penis with water and soap and wipe thoroughly.