LAPAROSCOPY IN UROLOGY
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LAPAROSCOPIC RADICAL PROSTATECTOMY
Prostate cancer is now curable by complete removal of the prostate gland surgically, either by open surgery or laparaocopy. If however, the person is not medically fit to undergo a major surgery, radiation to the gland to burn it off is an alternative treatment.
Laparoscopic removal of the prostate gland has several advantages over open surgery. As the visibility of the prostate gland in the depth of the normal male pelvis is much better during laparoscopy, there is less blood loss and greater accuracy in repair of the bladder and urethra. Hence removal of the catheter in the water passage can be done much earlier and the incidence of incontinence of urine is lesser after laparoscopy. The post operative pain from laparoscopic keyholes will of course be far less than the open surgical wound.
Abdomen after Lap Radical Prostatectomy - pic 1
Prostate specimen after Lap. Radical Prostatectomy.- pic 2
PRE OPERATIVE CHECK UP & PREPERATION.
After the doctor does the necessary investigations regarding the stage of the prostate cancer he will tell you the treatment most suitable for you.
1. You will be send to the physician for a complete medical check up. This will include blood tests, grouping, ECG and chest X ray.
2. Stop smoking, walk for 1 hour every day and have a healthy diet while you are awaiting surgery.
3. Surgery is done 6 weeks after biopsy or 12 weeks after any previous prostate surgery.
4. You will have to arrange 3 units of blood.
5. You will be admitted the day before surgery. A strong purgative will be used in the afternoon to clear your bowels. After this only light easily digestible food should be taken.
ON THE DAY OF SURGERY & IMMEDIATELY AFTER
1. Surgery may last from 4 to 8 hours.
2. After surgery bystanders will be informed by phone and one person can visit you in the surgical ICU.
3. Normally you will be shifted back to your room the next day afternoon.
4. You will be able to sit up with very little pain on the first post operative day itself.
5. There will be a urethral catheter in your water passage and a drain which is brought out through one of the keyhole used during surgery..
6. You will have to abstain from taking any food or drink for 1 or 2 days - this instruction will be given to you by the surgeon.
7. The drain is removed when all drainage stops - usually in the 5th day.
8. Usually you will be allowed to go home on the 6th or 7th post operative day. The urethral catheter is not removed. It will be connected to a bag.
RE ADMISSION FOR CATHETER REMOVAL
1. You will be re admitted after 1 to 3 weeks for catheter removal.
URINARY CONTINENCE AFTER CATHETER REMOVAL
When the prostate is removed or ablated by radiotherapy, part of the urethral sphincter ( the muscle that controls urinary continence) will be destroyed as this part is in the gland itself. The remaining sphincter therefore has to do the work of the part that was removed (or destroyed by radiotherapy). This may take time. Hence statistically about 50% of patients after surgery will be continent on removal of the catheter and 90% after 3 months. Continence improves upto 2 years.
If there is still incontinence - surgical correction is possible to a certain extent. In the meantime the alternatives are - adult diapers and penile clamps..
POTENCY AFTER TREATMENT.
The nerves that control penile erection are microscopic and intimately attached to the prostate gland. Great care is taken during surgery to prevent damage to them. However, impotence is a complication for this surgery (or radiotherapy)