Comparing Robotics Vs Open Continence Outcomes
There are few head-to-head comparisons of open versus robotic surgery performed by the same surgeon at the similar points in their learning curve or case experience. It would be easy to skew the comparison in favor of the robotic camp by cherry-picking a handful of favorable robotics series and several low quality open radical prostatectomy studies. It is more informative to take an honest look at all of the available literature and analyze the outcomes data from the highest quality available studies from the top robotic and open surgeons. When analyzing these data from high volume surgeons where the technique from case to case is nearly identical, we have technical data so-to-speak, that is, data which is more influenced by surgical modality and operative technique than by patient factors. We must also review, however, bread-and-butter studies, which are more representative of the experience the average patient will have in a general community surgeon practice. The reality is that many patients are not having their operation done at the high volume academic centers from the top tier surgeons who are writing the papers from which we are extracting this data.
How Long Does It Take To Regain Bladder Control After Prostate Surgery
Continence After Your Prostate Robotics Surgery Most people regain control in the weeks after we remove the catheter. The vast majority of men who had normal urinary control before the procedure achieve it again within 3 to 18 months after the surgery.
How long should a catheter be left in after prostate surgery?
Your doctor and health care team will decide how long you need to have a catheter. For example, after prostate cancer surgery, most men will have a catheter for about two weeks.
What Are Pelvic Floor Exercises And Can Improve Erection Quality
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
Those muscles are the core of how your body maintains blood flow to the penis and therefore keeps erections strong.
They put pressure on the veins in your penis, preventing blood from flowing back into the rest of your body. If they arent strong enough then even if you can get an erection, you wont be able to keep it.
The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
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Are There New Techniques That Minimize The Chance Of Becoming Incontinent
When removing the prostate, surgeons attempt to conserve as much of the area around the sphincter and the bladder muscles around the urethra as possible, hence curbing damage to the sphincter.
Surgeons have likewise fine-tuned the procedure of putting radioactive seed implants, utilizing advanced computer system forecasts that permit the seeds to damage the prostate while limiting damage to the bladder.
Still, at this point, any male who is going through radiation or surgical treatment to deal with prostate cancer needs to anticipate establishing some issues with urinary control.
Some men will have just temporary issues managing their urine, and lots will gain back complete control of their bladder in time.
What Causes Frequent Urination After Prostate Surgery
Q: Is frequent urination normal after a radical prostatectomy? A: Yes, but its usually only a matter of time before urination returns to normal. Bladder capacity is usually reduced somewhat by the surgery, but the main cause is that, after surgery the bladder wall is swollen and thickened and irritable.
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Urinary Control After Prostatectomy
Most patients leak urine immediately after surgery, however most patients regain their urinary control in time. The prostate itself serves as a dam to the flow of urine, and the external urinary sphincter muscle is normally required little to help keep the urine in the bladder. Once the prostate is removed, this relatively weak muscle is called upon, all of a sudden, to perform much more work. There is an angular support issue, as well, which is disrupted upon removal of the prostate. This angular support is typically restored during the reconstructive portion of surgery. In time, as you strengthen the muscle with Kegel or pelvic floor muscle exercises, you will regain your urinary control
Kegel Exercises Instructions
The rate of return to urinary control appears to be twice as fast with the robotic method . Again, there is variability in reports in the literature. In Dr. Kaynans experience, patients regain urinary control faster with the robotic method.
Typical progression of urinary control following robotic prostatectomy:1st week postop: catheter is in the penis and urine drains to a bag. Some patients experience bladder spasms and urine may leak around the catheter. Aside from being annoying this is inconsequential.
2nd and 3rd week postop: You will be incontinent of urine with little obvious control.
4th and 5th week postop: Most patients begin to be dry at night, and show purposeful voids during the day, though there is still little control.
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How Common Is Urinary Incontinence After Prostate Surgery
If you have a radical prostatectomy, a tube called a catheter will be placed inside your bladder to allow urine to drain. When the catheter is removed, most men will have some difficulty controlling their urine flow.
For most men, the urinary leakage will improve in the months following surgery. In an NHS trial, 46% of men needed to use absorbent pads six months after having a radical prostatectomy. But, one year on from having the procedure, this figure had improved to 17%.
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Exercise Your Pelvic Floor Muscles
Learning how to control the pelvic floor muscles can speed up the recovery process and reduce leakage. If you don’t strengthen these muscles, the leakage may persist.
Please note: Performing pelvic floor muscle exercises before and after prostate surgery is vital to your recovery. Resume pelvic floor exercises once the catheter has been removed to avoid bladder irritation and discomfort. It is recommended that you seek help from a mens, womens and pelvic health physiotherapist, Nurse Continence Specialist, or urology nurse to learn the correct technique.
More information about the pelvic floor muscles can be found on our pelvic floor and male pelvic floor pages. You can also learn more about pelvic floor friendly exercises at pelvicfloorfirst.org.au.
How Can I Help Myself
Urinary problems can affect your self-esteem and independence, and affect your work, social and sex life.
Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.
- Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
- Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
- Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
- If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
- Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
- Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they cant find a toilet.
- Get our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
- Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
- If you often need to use the toilet at night, leave a light on in case youre in a hurry, or keep a container near your bed.
For more information look at our How to manage urinary problems guide.
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Is My Trip Going To Cost More If Ive Got Prostate Cancer
Unfortunately, it probably will. Travel insurance is likely to be more expensive after a diagnosis of prostate cancer even if youre not having treatment or if the cancer is under control.
Insurance is worked out by averages and risks. Because insurers think youre more likely to need medical assistance on your trip, they charge more. Most men with prostate cancer can find travel insurance, but you might have to shop around to get a good deal. There are specialist insurers and brokers for people with health conditions, but dont ignore mainstream providers they might also have what youre looking for.
Some men decide to take out insurance which doesnt cover everything related to their cancer. All insurance has gaps in what it covers. Its a case of deciding whats most vital for you and what risk youre prepared to take. But always declare everything when you take out the policy if you dont, you might make the whole policy invalid.
Other things might also raise the cost of a holiday. For example, you may be more concerned about having home comforts, or need to be sure youll have a fridge to store medicines.
How To Regain Urinary Continence After Surgery
- Kegel ExercisesDr. Samadi recommends kegel exercises to every man after robotic prostate surgery. This simple exercise involves repetitive sets of clenching and releasing the muscles that stops the flow of urine. Research indicates that men who begin these exercises prior to surgery see improved recovery results afterwards.
- Continence MedicationSome patients may be advised to take prescription medications such as anticholinergics to alleviate the frequent sensation of having to urinate. For some, decongestants can help strengthen sphincter muscles, but should only be used under physician advisement.
- Collagen InjectionsCollagen injections can also provide short-term relief from issues of incontinence after prostate cancer. Urine control is improved by plumping the urinary sphincter through a series of collagen injections.
- Surgery For IncontinenceLong-term incontinence after prostate removal is rare. Dr. Samadi and his team of specialists will assist men with long-lasting incontinence through a range of treatment options. Several surgeries are available for restoring urinary control in patients whose symptoms persist for a year or more.
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Are There New Techniques That Reduce The Chance Of Becoming Incontinent
When removingthe prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.
Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.
Improve Bladder Control Regain Your Continence Sooner After A Robotic Prostatectomy
Kegel exercise strengthens the group of muscles called the pelvic floor muscles These muscles contract and relax around the bladder and the bladder opening at your command. When these muscles are weak, urine leakage may result. You can exercise these muscles just like any other muscle in your body, and building them up may help reduce your symptoms. It is important that you perform these exercises correctly and consistently to gain maximum benefit after prostate cancer surgery.
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Biofeedback For Incontinence After Protatectomy
Biofeedback is a widely used technique that helps people understand how to control their body functions, including the urinary control. It has proved its efficiency in helping many men regain their urinary control.
Biofeedback therapy uses computer graphs and audios to make it easier for you to locate the muscles you a are working on. It is a teaching tool that instructes you how to strengthen your muscles.
How Long Does It Take For Nerves To Heal After Prostate Surgery
How long does nerve regeneration take? Recovery of potency may be very rapid in younger patients and is sometimes immediate. However, for most patients the recovery is gradual and can take up to 3 years to plateau, although typically a patient sees a return to erectile function after about 12 months.
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What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy
Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeons sophisticated maneuvers.
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Patient Instruction Training And Biofeedback
PFMT programmes can be delivered by health-care professionals, for example, physiotherapists with a special interest and training in mens health and a scope of practice that includes continence management. A 2019 meta-analysis comprising 22 studies reported that PFMT delivered by a health professional and/or physiotherapist led to faster recovery and increased odds of becoming continent at 1, 3, 4 and 12 months after radical prostatectomy, compared with controls : OR and 95% CI at 1, 3, 4, 6, 12 months postoperatively: 1 month 2.79 , P=0.0008 , 3 months 2.80 , P< 0.0001 , 4 months 2.93 , P=0.02 , 6 months 4.11 , P< 0.0001 and 12 months 2.41 , P=0.004 .
A progressive patient-centred PFMT programme can incorporate a stepwise approach . Teaching and training pelvic floor muscle function preoperatively can commence with isolated pelvic floor muscle contractions in stationary positions . The patient can progress to training the pelvic floor musculature during more complex dynamic tasks where men are likely to experience postprostatectomy incontinence symptoms including coughing, lifting weighted objects, sitting to standing and when walking,,. Training men to consciously activate, coordinate and correctly time voluntary pelvic floor muscle contractions is essential to increase and maintain urethral closure pressure in order to avoid urinary leakage following radical prostatectomy.
Fig. 4: Components of a progressive pelvic floor exercise training programme.
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How To Do The Male Kegel Exercises
*Male Kegel exercise is best done after emptying your bladder. * Tighten the muscles you located above and hold for 3 to 5 seconds, or as long as you can at first. As these muscles get stronger, you will able to hold them longer. * Relax for 3 to 5 seconds or for as long as you tightened the muscles, then repeat. * Breathe normally. * Do 5 to 7 exercises at a time, 3 times a day minimum. As you get stronger, increase up to 15 exercises at a time, 4 times a day. * In addition for more advanced exercises, you might consider incorporating a series of quick flexes into this routine of long flexes. For example, perform 30 quick rapidly. Then 1 long contraction for as long as you can. Then repeat. Add more repetitions as you get stronger. * The key, as with any physical training, is to set up a consistent routine and to perform the exercise properly.
How Do You Retrain Your Bladder After A Catheter Is Removed
Gradually increase the amount of time between bathroom breaks. Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom.
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What Are The Types Of Radical Prostatectomy
Your surgeon will choose among several types of radical prostatectomy:
- Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
- Robot radical prostatectomy: Your surgeon makes several small incisions or one single incision across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.
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What Are Laparoscopic And Robotic Surgery
Laparoscopic and robotic prostate surgery are minimally invasive techniques for performing surgery. Both these procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive surgery with advanced robotic technology.
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Why Does Incontinence Occur After Prostate Cancer Surgery
There are two sphincter muscles that keep men continent before radical prostatectomy , the internal urethral sphincter and the external urethral sphincter. The internal sphincter is not under your control and is found at the bottom of the bladder, called the “bladder neck,” and in the prostate. This is removed during your surgery because the prostate cannot be taken out without removing this sphincter. You control your external sphincter, which is the muscle you can use to stop your urine stream and the one you can strengthen with pelvic floor muscle exercises. Normally, a healthy external sphincter is sufficient to provide continence. However, after RP, there can be some damage or dysfunction of the external sphincter, which can prevent you from recovering your bladder control. This may be due to damage to the nerves, blood supply, supporting structures, or the muscle itself as the external sphincter is located at the apex of the prostate gland.