Frequently asked questions: prostate cancer, prostatectomy, types of surgery, endourology

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Laparoscopic surgery uses small incisions, a tiny camera and specialised surgical instruments. And so too does robotic surgery. One major difference is that in robotic surgery, the surgeon controls a pair of robotic hands from a console in the operating theatre. Compared to traditional surgery and conventional laparoscopic surgery, robotic surgery provides the surgeon with greater manoeuvrability and precision. Robotic surgery is also known as robotic assisted surgery. It’s not the robot that performs the operation; the robot merely assists the surgeon who takes all the decisions and guides the robotic arms and hands.

Prostate cancer surgery may be an option for men in cases where the cancer has not spread beyond the prostate, or has spread only to the area just outside the prostate.

A radical prostatectomy is the removal of the whole prostate gland in order to get rid of the prostate cancer cells inside it.

A radical prostatectomy is a major operation. It may not be suitable if you have other health problems, such as heart disease, which would increase the risks involved.

Most robotic prostatectomy patients are able to go home 24 to 48 hours after surgery. The catheter is generally removed after a week and normal activities can be resumed within a month.

Radical prostatectomy is surgery to remove the entire prostate gland. The surrounding nerves, blood vessels and muscles may be weakened during surgery. For a while after the operation, many men are not able to get an erection. Most men do regain the ability to have erections, but medication may be required.

Yes. Behavioural techniques such as pelvic floor exercises can train men to control their ability to hold in their urine. Watch this video explaining urinary continence exercises and the correct way to perform pelvic floor exercises.

Robotic systems provide the surgeon with clear 3D magnified vision. The instruments have an increased range of movement compared to conventional laparoscopic equipment. This allows the surgeon to operate with more precision, especially in areas with limited space such as the pelvis. With the precision of the robot, the laparoscopic arms pivot over the incision site, causing less traction and trauma. The entire procedure is still performed by the surgeon; the robot simply carries out the surgeon’s instructions with utmost precision.

Even with the robot, radical prostatectomy is still a major surgery, with a large number of possible complications that can arise during the operation. There is no guarantee that your cancer will be cured. The most common long-term complications are incontinence (inability to hold in your urine) and erectile dysfunction (inability to get an erection).

Following surgery, many men experience erectile dysfunction (ED), but the disruption may be temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage.  Medication may be required to help with erections.

After radical prostatectomy or cystectomy (removal of the bladder), a man will no longer produce any semen because the prostate and seminal vesicles will have been removed. The testicles still produce sperm cells, but then the body simply reabsorbs them. This is not harmful. The sensation of the orgasm will be similar but no fluid will be expelled.

Generally, you will be discharged 24 to 48 hours after the surgery, and with a robot assisted prostatectomy the catheter is removed after 7 days unless there were difficulties with the surgery.

After robotic surgery you are encouraged to sit out of bed on the day of the procedure and walk the next day. Driving is discouraged for 2 weeks. Return to work and strenuous exercise can be resumed at 6 weeks.

Endourology is surgery performed via scopes that are inserted via the urethra (pipe emptying the bladder). This is commonly used for kidney stones. Specialised equipment such as lasers can be passed through the scope to assist in the removal of the stones.