Urology
| General information on the discipline |
| Professionals |
Anatomy
| Kidney |
| Ureters |
| Bladder |
| Prostate |
| Uterus |
| Ovaries |
| Urethra |
| Penis |
| Testicles |
Examinations
| Biopsy |
| Scanner |
| Bone scintigraphy |
| I.R.M |
| Lymph node excision |
| Digital rectal examination |
Pathologies
| Cancer of kidney |
| Bladder cancer |
| Urinary incontinence |
| Génito-urinary prolapse génito-urinaire |
| Cystitis |
| Prostatic cancer |
| Prostatic adenoma |
| Erectile dysfunction |
Clinic Tivoli
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Prostatectomy
What is a total prostatectomy?
It is a surgical procedure that has for goal the removal of the whole prostate as well as the seminal vesicles. It is a direct treatment against the cancer since it acts directly on the prostate to remove the tumor.
Total prostatectomy is the standard treatment for non metastatic prostate cancer. It is done by a urologist.
Total prostatectomy is the standard treatment for non metastatic prostate cancer. It is done by a urologist.
How does a total prostatectomy occur?
During the operation, the surgeon can start by doing lymph node sampling, meaning removing some lymph nodes in order to exam them under the microscope and check if they do not contain cancerous cells. Then the surgeon removes the whole prostate and the seminal vesicles. Then he reattaches with stiches, the urethra to the bladder to restore a normal flow of urine.
For a good healing of the stiches, a foley catheter is introduced from the urethra to the bladder that will allow flow of urine until the tissues heal. Healing usually needs around 5 to 10 days, then the foley is removed. When waking up, like after any surgeries, the treated area can be painful. The medical team takes dispositions to minimize the patient discomfort, by using painkillers. The average length of the hospital stay is around 5 to 7 days.
After a prostatectomy, the only activities tolerated are the ones of daily life. To prevent problem with healing it is important to follow the advice of the physician during the recommended period. After going out of the hospital, few weeks are still necessary for the patient to be feeling perfectly healthy. After the surgery a PSA level is necessary to make sure everything is normal. Complementary treatments are also available after a prostatectomy (radiotherapy, hormonotherapy..)
For a good healing of the stiches, a foley catheter is introduced from the urethra to the bladder that will allow flow of urine until the tissues heal. Healing usually needs around 5 to 10 days, then the foley is removed. When waking up, like after any surgeries, the treated area can be painful. The medical team takes dispositions to minimize the patient discomfort, by using painkillers. The average length of the hospital stay is around 5 to 7 days.
After a prostatectomy, the only activities tolerated are the ones of daily life. To prevent problem with healing it is important to follow the advice of the physician during the recommended period. After going out of the hospital, few weeks are still necessary for the patient to be feeling perfectly healthy. After the surgery a PSA level is necessary to make sure everything is normal. Complementary treatments are also available after a prostatectomy (radiotherapy, hormonotherapy..)
What are the different types of surgeries?
We distinguish different types of total prostatectomy according to the technique used by the surgeon :
- Abdominal Prostatectomy by opening the abdominal wall or by coelioscopy.
- Perineal prostatectomy.
The choice of technique depends on the type of tumor and the habits of the urologist. In both cases the prostate and seminal vesicles are removed by the surgeon, analized under microscopy by a pathologist that gives a report on the characteristics and extension of the cancer. This analysis allows for the decision of a possible complementary treatment.
Abdominal Prostatectomy
The goal of this procedure is to remove the whole prostate through the abdomen. This is the most common technique used because it allows seeing the prostate and seminal vesicles very clearly. Abdominal prostatectomy is a standard treatment. To perform an abdominal prostatectomy, the surgeon makes an incision in the lower abdomen; he can sample lymph nodes in this area and send them for analysis.
The analysis is done during the surgery; this is called a frozen section. Frozen sections are not systematically done. If the exam reveals cancerous cells in the lymph nodes, it means that the cancer has spread beyond the prostate. Removing of the prostate in that case is not enough. The surgeon can therefore decide to stop the procedure and leave the prostate in place. But in case the extension in lymph nodes is moderate, the surgeon can decide to remove the prostate anyway.
There is a risk of losing blood during the procedure. IN that case a blood transfusion can be necessary. Programs of auto-transfusion exists, ask you physician. After the procedure, the patient may feel some discomfort at the level of the scar. In that case painkillers are given to the patient. A complete rest without physical activities is advised for at least 3 to 4 weeks after the procedure. After that, it is possible to progressively regain some normal activity. In general it needs 2 months to really get back in the same healthy sate as before the intervention
The analysis is done during the surgery; this is called a frozen section. Frozen sections are not systematically done. If the exam reveals cancerous cells in the lymph nodes, it means that the cancer has spread beyond the prostate. Removing of the prostate in that case is not enough. The surgeon can therefore decide to stop the procedure and leave the prostate in place. But in case the extension in lymph nodes is moderate, the surgeon can decide to remove the prostate anyway.
There is a risk of losing blood during the procedure. IN that case a blood transfusion can be necessary. Programs of auto-transfusion exists, ask you physician. After the procedure, the patient may feel some discomfort at the level of the scar. In that case painkillers are given to the patient. A complete rest without physical activities is advised for at least 3 to 4 weeks after the procedure. After that, it is possible to progressively regain some normal activity. In general it needs 2 months to really get back in the same healthy sate as before the intervention
Prostatectomy by coelioscopy
This is the technique proposed by our team by laparoscopy or robotized laparoscopy .
Prostatectomy by coelioscopy is a technique that consists in removing the entire prostate with the use of small tools introduced through tubes in the patient’s body. The surgery occurs along the same principles as the abdominal procedure.
This procedure can be more comfortable to the patients (less pain, return to normal life activities more quickly) therefore it seems more advantageous in the beginning. However, this technique is not always available because it depends on the surgeon’s aptitudes.
The complications are the same as with other techniques. It has not yet been showed that this technique is more efficient than other techniques such as the abdominal or perineal approach.
Perineal prostatectomy
Prostatectomy by the perineal approach is a technique that consists in removing the entire prostate through an incision between the anus and the testicles in the perineal area. This technique can be used in obese patients or patients that have had multiple abdominal surgeries before.
This technique is more comfortable for the patient. He can feel some pain upon sitting but becomes autonomous more rapidly. However, this technique is more difficult to perform by the surgeon. It is not commonly used because lymph node sampling is not possible with this technique.
This technique is more comfortable for the patient. He can feel some pain upon sitting but becomes autonomous more rapidly. However, this technique is more difficult to perform by the surgeon. It is not commonly used because lymph node sampling is not possible with this technique.
What are the immediate side effects of a total prostatectomy?
Even if performed in the best possible conditions, all surgeries have risks. For this reason, the physician should always inform the patient on the different possible complications and risks even if rare.
This information is important for the patient to consent to the procedure. The most common side effects after a total prostatectomy are:
Drains are placed at the site to prevent hematoma formation of an infection. They are left there for 2 days in order to evacuate all biological fluids (blood ...)
Tends to heal rapidly. Care can be performed by a nurse, in the hospital or at home. If a lymphocele persists, drainage can be done.
Can be damaged. During the procedure the function of these muscles is momentarily altered. Since the surgeon attached the bladder to the urethra with sutures, this area needs some time to heal properly. For this reason, a foley catheter is inserted and kept in place for 5 to 10 days.
These urinary leaks are due to the fact that the sphincter has been affected during the surgery. The leaks are provoked by a insufficient contraction of the sphincter fibers.
This sphincter dysfunction lasts a variable amount of time from one patient to another. Usually the sphincter function gets better rapidly in the 2 weeks following the intervention, or more progressively over the next 3 months.
The final result can also occur only a year after the procedure.
possible after the intervention, disappears more rapidly than the daily incontinence. In general, the amount of urinary leaks is mild.
Various medical apparatus allows for limiting the discomfort. The patient should not hesitate talking to his physician.
can also occur, like after every surgeries. Post op anticoagulant needles can prevent this from happening.
This information is important for the patient to consent to the procedure. The most common side effects after a total prostatectomy are:
A hematoma, an infection or a lymphocele at the incision site.
Drains are placed at the site to prevent hematoma formation of an infection. They are left there for 2 days in order to evacuate all biological fluids (blood ...)
A hematoma or an abdominal wall infection.
Tends to heal rapidly. Care can be performed by a nurse, in the hospital or at home. If a lymphocele persists, drainage can be done.
Sphincter and bladder muscles
Can be damaged. During the procedure the function of these muscles is momentarily altered. Since the surgeon attached the bladder to the urethra with sutures, this area needs some time to heal properly. For this reason, a foley catheter is inserted and kept in place for 5 to 10 days.
After the surgery, the patient can not hold his urine.
These urinary leaks are due to the fact that the sphincter has been affected during the surgery. The leaks are provoked by a insufficient contraction of the sphincter fibers.
This sphincter dysfunction lasts a variable amount of time from one patient to another. Usually the sphincter function gets better rapidly in the 2 weeks following the intervention, or more progressively over the next 3 months.
The final result can also occur only a year after the procedure.
The nocturnal incontinence
possible after the intervention, disappears more rapidly than the daily incontinence. In general, the amount of urinary leaks is mild.
Various medical apparatus allows for limiting the discomfort. The patient should not hesitate talking to his physician.
Phlebitis
can also occur, like after every surgeries. Post op anticoagulant needles can prevent this from happening.
What are the long term side effects of a total prostatectomy?
Different long term side effects also called sequelae, can occur.
Incontinence is the most feared complication by the patient, since it involves their quality of life. The patient’s age is a determining factor in the risk of incontinence after the surgery. The surgeon experience can also be an important factor. Now days permanent urinary incontinence after total prostatectomy is very rare (less than 3% of the patients)
It is usually limited to leaks occurring during specific efforts such as carrying heavy weights. Continence improves gradually over time. It is recommended to wait at least 3 to 6 months before thinking of a complementary treatment to reduce incontinence.
Urinary physiotherapy can be useful before and after the intervention. It is suggested to certain patients by the urologist. It can accelerate the return to normal continence and improve patient’s quality of life. This hysiotherapy also helps in reducing urinary consequences due to the intervention, and favours the return to normal continence. An active participation of the patient is necessary.
The surgeon or the physiotherapist can explain the specific movements to re educate the sphincter. Those movements are simple: simple repetitive contraction of the perineal area, outside of the micturition, similar to the will to interrupt the urinary flow. These movements should be done daily. They lead to a progressive improvement of the sphincter control in order to limit incontinence. Exceptionally, urinary leaks can continue after 3 to 6 months post op.
Additional interventions can then be done. A prosthesis (artificial sphincter) can be placed through the natural conduit or through surgery. Then in the majority of cases, urinary leaks resolved.
Erection problems are frequent after the procedure. Nerves and blood vessels that allow for erection to occur surround the prostate. They form two groups of vasculo-nervous connections. When cancerous cells are so close that they light spreads to these connections, they have to be removed. It is not always mandatory; it depends on the tumor size.
If those connections are removed, the risk of impotence is almost 100%. However, if only one or both groups are spared, the risk of impotence decreases to 20-50%. Even if the connections are spared, a delay of 6 months is necessary before normal sexual function resumes. If the patient is impotent after the procedure, many treatments are available.
In addition, prostate and seminal vesicles have been removed with the prostatectomy. And they are the 2 main secretory organs for the seminal fluid. The efferent channels have also been ligated. Therefore, prostatectomy stops definitely ejaculation, but does not remove the pleasure sensation.
When the prostatic tumor is diagnosed early and therefore is still of a small size, a specific surgical technique can maintain erection (in more than 50% of cases) by keeping the vasculo-nervous connections. This intervention is done by working very close to the prostate, in order not to damage the nearby nerves. This technique is suggested to the patient when possible: the results are better in young patients, with regular sexual activity and with no specific sexual dysfunction before the operation.
The patient should not hesitate discussing this technique with his surgeon. In case there is difficulty in obtaining a sufficient erection to have sexual intercourse, different treatments are available. Some are to be taken orally; others can be injected in the carvernous corpa at the base of the penis. A pump can also be a modality to have erections. There exist today effective means to mitigate these sexual disorders and to find the sexual activity most normal possible.
A certain number of these treatments are used early after the intervention in order to easily resume spontaneous erections. As a last resort, a penile prosthesis can be placed, it provides very satisfactory results. Accepting this change in sexual life is not easy. Talking about sexuality with the physician can be difficult to the patient. However, it is essential before and after the intervention, to ask explanations on the topic. The patient can meet with a urologist, a psychologist, or a sexologist, in order to better accept this change. Now days, efficacious ways of reducing the discomfort and bringing back a normal sexual activity are available.
Incontinence
Incontinence is the most feared complication by the patient, since it involves their quality of life. The patient’s age is a determining factor in the risk of incontinence after the surgery. The surgeon experience can also be an important factor. Now days permanent urinary incontinence after total prostatectomy is very rare (less than 3% of the patients)
It is usually limited to leaks occurring during specific efforts such as carrying heavy weights. Continence improves gradually over time. It is recommended to wait at least 3 to 6 months before thinking of a complementary treatment to reduce incontinence.
How to reduce urinary problems ?
Urinary physiotherapy can be useful before and after the intervention. It is suggested to certain patients by the urologist. It can accelerate the return to normal continence and improve patient’s quality of life. This hysiotherapy also helps in reducing urinary consequences due to the intervention, and favours the return to normal continence. An active participation of the patient is necessary.
The surgeon or the physiotherapist can explain the specific movements to re educate the sphincter. Those movements are simple: simple repetitive contraction of the perineal area, outside of the micturition, similar to the will to interrupt the urinary flow. These movements should be done daily. They lead to a progressive improvement of the sphincter control in order to limit incontinence. Exceptionally, urinary leaks can continue after 3 to 6 months post op.
Additional interventions can then be done. A prosthesis (artificial sphincter) can be placed through the natural conduit or through surgery. Then in the majority of cases, urinary leaks resolved.
Sexual dysfunction
Erection problems are frequent after the procedure. Nerves and blood vessels that allow for erection to occur surround the prostate. They form two groups of vasculo-nervous connections. When cancerous cells are so close that they light spreads to these connections, they have to be removed. It is not always mandatory; it depends on the tumor size.
If those connections are removed, the risk of impotence is almost 100%. However, if only one or both groups are spared, the risk of impotence decreases to 20-50%. Even if the connections are spared, a delay of 6 months is necessary before normal sexual function resumes. If the patient is impotent after the procedure, many treatments are available.
In addition, prostate and seminal vesicles have been removed with the prostatectomy. And they are the 2 main secretory organs for the seminal fluid. The efferent channels have also been ligated. Therefore, prostatectomy stops definitely ejaculation, but does not remove the pleasure sensation.
How to decrease sexual dysfunction?
When the prostatic tumor is diagnosed early and therefore is still of a small size, a specific surgical technique can maintain erection (in more than 50% of cases) by keeping the vasculo-nervous connections. This intervention is done by working very close to the prostate, in order not to damage the nearby nerves. This technique is suggested to the patient when possible: the results are better in young patients, with regular sexual activity and with no specific sexual dysfunction before the operation.
The patient should not hesitate discussing this technique with his surgeon. In case there is difficulty in obtaining a sufficient erection to have sexual intercourse, different treatments are available. Some are to be taken orally; others can be injected in the carvernous corpa at the base of the penis. A pump can also be a modality to have erections. There exist today effective means to mitigate these sexual disorders and to find the sexual activity most normal possible.
A certain number of these treatments are used early after the intervention in order to easily resume spontaneous erections. As a last resort, a penile prosthesis can be placed, it provides very satisfactory results. Accepting this change in sexual life is not easy. Talking about sexuality with the physician can be difficult to the patient. However, it is essential before and after the intervention, to ask explanations on the topic. The patient can meet with a urologist, a psychologist, or a sexologist, in order to better accept this change. Now days, efficacious ways of reducing the discomfort and bringing back a normal sexual activity are available.
How do we follow up a total prostatectomy?
An undetectable PSA level lower than 0.1 ng/ML is a good prognostic sign. We talk about remission when PSA levels are undetectable for more than 5 to 7 years post op. If PSA increases during the follow up period, a complementary treatment is possible (by external radiotherapy or hormonotherapy)
Language
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Treatments
| Urinary catheter |
| Curietherapy |
| Hormonal therapy |
| External Radiotherapy |
| Focused ultrasounds |
| Lapararoscopy |
| Laparoscopy robotized |
Surgery
| Prostatectomy |
| Neuromodulation |
| Penile Implants |
Laparoscopy robotized
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F.I.L.U.M
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Urology group
Saint-Augustin
Saint-Augustin
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