Managing Incontinence after Robotic Prostatectomy
- On April 19, 2018
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The popularity of the Robotic Prostatectomy has increased rapidly since its introduction in 2000.
As stated on the UCLA Health website, robotic prostatectomy offers “a minimally invasive treatment with less blood and a rapid overall recovery”. It is generally thought to be an accurate and precise method for removing Prostate Cancer.
What are the Advantages of Choosing Robotic Prostatectomy?
Patients who undergo Robotic Prostatectomy have significant advantages over those who have Open Prostatectomy. A huge advantage of Robotic Prostatectomy is that it is minimally invasive. Instead of having a 5 or 6” incision to the skin and abdominal fascia, patients have a series of small incisions. As Alliance Urology Specialist surgeon Lester Borden explains, “robotic prostatectomy patients receive the benefit of smaller incisions, which results in less postoperative pain, shorter hospitalization and quicker recovery”. In Robotic Prostatectomy, incisions are located across the abdomen, rather than vertically on the lower abdomen as with open surgery.
Experts agree that a Urologist is able to visualize the pelvic organs better than in other methods of surgery. The magnification of a 3D high-definition camera provides enhanced visualisation of small blood vessels, nerves and other structures. A mobile camera view also allows the surgeon to easily look behind the prostate. The dexterity of the robot allows a tension-free closure of the bladder and urethra. The surgeon is able to control the camera personally, allowing the instrument movement to be synchronized with the camera.
Studies over the years have suggested that Robotic Prostatectomy achieves clinically superior results and has a reduced risk of complications. The procedure has been known to cause less post-operative pain. Surveys have shown that patients undergoing the treatment utilize less pain medication during recovery than open surgery.
Another advantage of Robotic Prostatectomy is that it results in less blood loss. The national blood transfusion rate after surgery for robotic prostatectomy is around 2-3%, whereas open prostatectomy has a rate of 20-30%. There is no need for pre-operative blood donation by the patient or administration of drugs to increase the blood count prior to surgery.
Are you a male suffering from incontinence? Read our section on male incontinence for tips and advice.
What Does Robotic Prostatectomy Consist Of?
During Robotic Prostatectomy, a robotic machine is used to help the surgeon conduct the surgery. During this surgery, the surgeon makes 5 small incisions in your abdomen. With robotic assistance, cutting and putting in the stitches is much easier than Open Radical Prostatectomy. Instruments and cameras are inserted through the cuts to do the surgery. The surgeon can reach the prostate by cutting through the abdominal cavity’s lining from the inside. The surgeon then creates a separation between the rectum and the prostate, cutting the blood supply to the prostate. The dorsal vein complex and the urethra are cut to free the prostate, which can be placed in a plastic bag for removal.
Life After Surgery
Robotic Prostatectomy is often chosen to avoid causing long-term damage to urinary function. In Robotic Prostatectomy, the urologist can visualize the pelvic organs better and there is less trauma to the pelvic muscles, which are designed to prevent unwanted leakage. However, it is completely normal and common for men to leak urine for the first few weeks after having the procedure. This temporary incontinence occurs due to the sphincter muscle becoming damaged during the surgery. However, this incontinence is often light and does not result in complete loss of bladder control. It is common to develop temporary stress incontinence or urge incontinence. Erectile dysfunction is another /stress-incontinence possible side effect of the surgery, which can be managed with medication until it resolves over time. A urinary catheter is put in place and is typically removed after seven days.
Although incontinence can be hard and embarrassing to manage, the control of urine returns in the majority of cases. It is thought that a man’s age also plays an important role in how much they will “leak.” As health professional Marc Greenstein asserts, “a 50-year-old man usually has better sphincter control than a 70-year-old man”. Other determining factors include your overall health and whether any damage was done to the sphincter muscle before. The fear of leaking however often outweighs the reality. The ratio of patients cured of urinary incontinence at one year after open surgery is well over 90%. Dr Catalona asserts, “permanent incontinence occurs rarely with an experienced surgeon”. She explains that surgeons are being trained to know the anatomy in the area of the operation and to be gentle to prevent as much trauma and bleeding as possible. It is estimated that 8% of patients are mildly incontinent 18 months or longer after surgery. It is estimated that only 1 and a half percent of patients have severe incontinence after 18 months.
Managing your Incontinence
After surgery and removal of the catheter, it is recommended that you practice pelvic floor exercises, also known as kegel exercises. These are a safe option to strengthening the pelvic floor muscles after the procedure. You should practice these in sets of ten, four times a day. Kegel exercises are considered to the first option of treatment for incontinence after the surgery by professionals.
There are also a number of lifestyle changes you can make to improve symptoms. These include limiting fluid intake at night time and avoiding bladder irritants such as caffeine and alcohol. If you smoke, it may be beneficial to consider quitting to reduce coughing and bladder irritation. Avoiding food and liquids that irritate the bladder can also help in improving symptoms. Spicy foods, carbonated drinks and citrus fruits are known to worsen your symptoms.
Experts also recommend doing gentle exercise to ensure your weight does not put additional pressure on the bladder. However, you should avoid over-exercising after your surgery. This has been proven to slow down the healing and stretching. Straining and heavy lifting are also discouraged for the first four weeks after surgery.
Symptoms of incontinence after Robotic Prostatectomy should not be heavy after 18 months of surgery. If your incontinence lasts for 18 months after surgery, ensure you contact a professional and seek immediate medical attention. If the conservative methods mentioned in this blog are ineffective, you should consider surgery. Your options include an artificial sphincter, bulking agents or sling surgery. A Doctor can talk to you about your individual situation and choose a method that is ideal for you.
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