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Plans for Prostate removal

CAC5615's picture
CAC5615
Posts: 2
Joined: Nov 2020

I was diagnosed in September with PC. 10 out of 12 core samples are positive for cancer. Gleason 3+4=7. I have opted for the Robotic Surgery. I was wondering if anybody here has had the same procedure and can offer some insight on what I can expect.

What are do's & don'ts on preparing for the surgery?

Appreciate any and all information you can share.

lighterwood67's picture
lighterwood67
Posts: 284
Joined: Feb 2018

When I was first diagnosed, I started educating myself on treatment options and as you are doing looking for folks that have first hand knowledge of curative treatments (Radical Prostatectomy (RP) and radiation).  Once I decided on the treatment option (RP), I started looking for a surgeon.  In my case, I was sent to a physical therapist to see how strong my pelvic floor muscles were.  They had a machine, I scored 4 of 5 on.  They still wanted me to start kegel exercises and I did.  They started me on sildenafil (viagra) prior to surgery.  The surgeon said think of that as fertilizer.  You need to understand what they are removing (in my case, prostate, seminal vesicles, urethra shoretning, bladder neck reconstruction, pelvic lymph nodes).  Some of the side effects are erectile dysfunction; incontinence; urethra shortening).  You will be catherized and carry a bag with you for a few days after the surgery.  Once that is removed, you will probably be incontinent.  You will need to wear Depends or Tena's; pads; thins; until you get control of your urine flow.  You will probably experience erectile dysfunction.  For a lot of folks that is a work in progress and may very well take a long time to recover from.  My advice there is to engage it as much as you can.  Your PSA will be tested probably for the rest of your life.  Ok.  Enough for now, I will tell you I am 70 years old;  My gleason was 4+3=7.  I had a RP 3/18.  At this time my PSA is undetectable; I am continent;  As with most men, I try to have sex as much as I can, if I can catch my wife.  She is awfully fast.  Remember the decision you make is yours.  Take your time; do your homework and move on.  Please keep quality of life in front of you.  Best of luck on your jouney.

CAC5615's picture
CAC5615
Posts: 2
Joined: Nov 2020

Thanks for sharing the information and your experience. I've started doing kegels already. Haven't thought about the physical therapist before surgery, that's a good ideal, I'll have to look into that. My urologist is here in town an has pretty much turned me over to the surgeon for now. My surgeon is out of state so communication with the surgeon is mostly done by email. 

Sounds like you had a good outcome from your surgery once you got over the hurtles. For now I'm trying to build my knowledge and trying to stay positive. Thanks again!

lighterwood67's picture
lighterwood67
Posts: 284
Joined: Feb 2018

This the surgical procedure performed on me during my RP.  Please be sure and weigh out all avenues for treatment.  Not just surgery.  You need to be evaluated by a radiation oncologist.  Anyway your decision.  You said you wanted to know what to expect.  So here you go.  If you go with the surgery, be sure and get the pathology report post surgery.

Description of the Procedure:

FINDINGS AND TECHNIQUE:The patient was taken to the operating room where he was placed under general anesthesia in the supine position. He was then placed in low lithotomy position,prepped and draped in the usual manner for a robotically-assisted radicalprostatectomy. The abdomen was entered through a periumbilical incision and adouble balloon 12 mm port was placed here. The abdomen was insufflated. The other five port sites were marked off and placed under direct laparoscopic vision. The robot was docked and the procedure was begun from the console.We began the procedure by releasing large bowel adhesions on the left side of the abdomen. This was done with cold sharp dissection. The space of Retzius was then developed by dividing the median umbilical ligaments bilaterally as well as the urachus. Both vas were divided as they entered through the internal ring. Once the space of Retzius was fully developed, the endopelvic fascia was opened close to the prostate. The dorsal vein complex was suture ligated with 0 Vicryl over the baseof the gland and then divided with the bipolar cautery over the bladder neck.A bilateral pelvic lymph node dissection was then done (obturator and hypogastric)including deep pelvic nodes on the left side. All longitudinal lymphatics were clipped or sealed.Bladder neck was dissected out anatomically and divided. We went wide anteriorly and obtained a negative frozen section here.Seminal vesicles and vas deferens were then identified, mobilized, dissected up and elevated. Denonvilliers fascia was then opened posteriorly and I dissected between the layers of Denonvilliers fascia all the way to the apex. The vascular pedicles to the prostate were taken with the ENSEAL device and large clips as we got close tthe neurovascular bundles. The bundles were well preserved bilaterally. Small metal clips were used as we worked under the posterior aspect of the prostate. An element of high lateral release was done, but I was not aggressive about getting too close to this capsule. I specifically went wide at the left apex to avoid capsularincision. As I dissected along to the apex I noted excellent neurovascular bundle sparing bilaterally.The dorsal vein complex was then isolated and taken with the ENSEAL device. The DVC was oversewn with a V-lock suture. The urethra was divided with cold sharp dissection. The prostate was put into a specimen bag.The anastomosis was then done in a two layer fashion using a Rocco suture toapproximate the urethra posteriorly. This was a single horizontal mattress.Continuous 3-0 Monocryl was then used employing a Quill suture to achieve awatertight anastomosis. The bladder neck was tapered with 2-0 Vicryl. Theanastomosis was sealed with Eviseal and stented with an 18-French Foley catheter. A Blake drain was placed in the abdomen through the fourth arm port. This was secured with silk.Marcaine was used to block all port sites.The right-sided 15 mm port was closed at the fascial level with 2-0 Vicryl. The prostate was removed in its bag through the umbilical port. The umbilical port sitwas closed with continuous #1 PDS in the fascia. All skin incisions were closed with Monocryl and Dermabond. The patient was awakened and taken to the recovery room in good condition. Estimated blood loss for the case was 100 mL. Sponge and needle counts were correct x 2. 

lighterwood67's picture
lighterwood67
Posts: 284
Joined: Feb 2018

I would say yes.  I have overcome the hurdles of side effects for having a RP.  My Pathology report (pretty much as clean as a whistle).  You need to get this post surgery for RP.  If that is the route you take.   If possible let us know what treatment you take.  Good luck on your journey.

 

 

lighterwood67's picture
lighterwood67
Posts: 284
Joined: Feb 2018

Hope I did not scare you off wth the surgical procedure.  Anyway, good luck on your journey.

scoop317
Posts: 7
Joined: Oct 2020

 

Hi, I'm 3 weeks post robotic surgery. I also was 3+4=7, surgery took 7hrs , had my catheter in for 2weeks.Now dealing with incontinence but each day I see improvement doing kegel, 4 day hospital stay, only had pain for couple days, sent home with pain meds but was not needed. It's been 3 weeks and I feel great just gotta work on incotinence and ED, also pathology report came back clean,Good Luck

Clevelandguy
Posts: 651
Joined: Jun 2015

Hi,

Do find the best surgeon around your area and also find the best facilities for Robotic Surgery in your area.  The better the doctor and facilities the better the outcome.  My robotic surgery was pretty uneventful with a 10 day internal catheter which was the worst part of the whole ordeal.  I had no infections and very little pain which meant no heavy drugs, I managed my pain with over the counter pain reliever.  I did laps around the inside of my house right after surgery to get the blood flowing.  Erections and urine leakage improvement took me about 1.5-2 years to reach a plateau and I just drip a couple of drops during heavy lifting and erections are back at about 90% level.  Some people heal faster than this some longer.

Do keep doing your Kegels after your surgery for months or years to come, I still do about 100-200 squeezes per day five years later. As stated by Lighterwood do your Kegels as a prep for surgery.  I had help from drugs like Viagra after surgery to help getting blood flow back into your genital area.  Also start being sexually active as soon as your doctor OKs it.  You might be dissapointed at first but it should continue to improved the more you use it. I feel the use it or loose it really applies in this case.  Good luck and let us know if we can help with our experiences.

Dave 3+4

hopeful and opt...
Posts: 2295
Joined: Apr 2009

I wonder about what diagnostic tests that you have done.

With a large volume of cancer found, it is possible that the cancer has escaped the capsule. If so robotic surgery which is a localized treatment may not achieve your desired results..There is a T3 MRI that may indicate extracapsular extension if it exists. 

I wonder also to your age. An expert surgeon can do the exact same surgery to a man of 50 and to a man of 70. Since success to surgery is age related, the 50 year old will have no side effects while the 70 year old may..

Best of luck

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3580
Joined: May 2012

CAC,

Robotic prostetectomy is probably the most common choice for first-line curative treatment of PC, although radiation options are likely about as common.      When the doctor removes the gland, he will test it for positive margins (signs of disease escape from the gland), and also remove numerous adjacent nodes ('sentintinal nodes') to test for escape.   IF there is escape, curative radiation would be ordered later, after recovery from the surgery itself.

As Hopeful noted, ASK your surgeon how confident he is that there has not yet been escape from the gland, and why.   The T3 MRI is never a bad idea before treatments begin.

Also, do receive formal training in Kegels prior to surgery, as they will assist in more rapid recovery of continence.    And also expect at least six months or so of impotence, possibly longer.   

I had robotic in 2015, and have been well pleased.

max

MK1965
Posts: 214
Joined: Jun 2016

Not the through. I was 51 y/ o at dx and robotic RP.

My RP turn to be disastrous. Never recovered any sexual function despite trying everything possible.

Rob.Ski
Posts: 12
Joined: Feb 2021

Where did you have surgery?

Decaff
Posts: 1
Joined: Nov 2020

Hey,

I had my Robotic done in 2014 at the age of 47, and yes Kegels are a good thing to start now. as for the ED, I am still fighting it, but it shows signs of great improvement. 

 

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