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The term "prostatectomy" refers to the partial or complete removal of the prostate gland, often as a treatment for cancer. Primary prostatectomy side effects include impotence, incontinence, and urethral stricture. Secondary prostatectomy side effects include blood loss, heart attack, infection, and pain, and are typically associated with any surgery. The severity of all of these side effects depends on the way the prostatectomy is performed. The three methods of prostatectomy are radical open prostatectomy, laparoscopic prostatectomy and robotic prostatectomy.
Impotence is one of the main prostatectomy side effects. Most men experience some degree of impotence following radical prostatectomy. The nerves that control erection closely innervate the prostate, making some damage to the nerves during surgery virtually inevitable. In some men, impotence resolves over time, but this often depends on the age of the man and whether impotence was a problem pre-surgery.
Another common prostatectomy side effect is urinary incontinence, which may be a temporary side effect of the catheter inserted during surgery, or a long-term, potentially permanent condition. In cases where the incontinence persists, damage to the urethra is often to blame. The urethra is a tube that passes directly through the prostate gland as it shunts urine from the bladder to the penis. The amount of damage to the urethra determines the duration and degree of incontinence. The level of incontinence can vary from small leaks to complete lack of control.
Urethral stricture is a less common prostatectomy side effect in which scar tissue or inflammation from the surgery blocks the flow of urine through the urethra. This results in difficulty urinating or the inability to urinate. A temporary catheter will usually alleviate the problem. If it persists, surgery may be necessary to remove the scar tissue.
All prostatectomy side effects are most severe when open prostatectomy is performed. In this procedure, an incision is made in the abdomen through which the prostate gland can be removed. This procedure produces the most blood loss, and the most post-operative pain, and it often results in long-term impotence and incontinence.
Laparoscopic prostatectomy side effects are less serious, because the surgery is less intrusive. In this procedure, the surgery is performed using tiny instruments introduced into the abdomen though small incisions. The use of these small incisions decreases the amount of blood loss and the post-operative pain, though there is still a risk of some impotence and incontinence.
Robotic prostatectomy side effects are the least severe of all types of prostate surgery. In this method, tiny, robotically controlled instruments are introduced through a few holes in the abdomen. This method also minimizes blood loss and post-operative pain. In addition, the more precise and accurate control offered by the robotic instruments results in less nerve and urethra damage, minimizing the chance for long- and short-term impotence and incontinence.
There is simply no data that I have seen to support the contention that robotic and/or lap delivers better cure rates or lesser side effect than open. Dr. Walsh himself at Johns Hopkins disputes this. Early data on robotic seems to say the opposite occur on cure incontinence and sexual side effects. Just to support things like this without data to support it is harmful to men with prostate cancer trying to make a wise decision.
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