Simple retropubic prostatectomy sex after surgery. Retropubic Prostatectomy.



Simple retropubic prostatectomy sex after surgery

Simple retropubic prostatectomy sex after surgery

The most common procedures used currently are the open retropubic and robotic-assisted laparoscopic prostatectomies. Continence in the male requires 1. Accommodation of increasing volumes of urine at a low intravesical pressure normal compliance and with appropriate sensation. A bladder outlet that is closed at rest and remains so during increases in intra-abdominal pressure.

Absence of involuntary bladder contractions detrusor overactivity. We prefer to use the terms smooth and striated sphincter area. This is a physiologic but not anatomic sphincter and is not under voluntary control. Others refer to this area as the internal sphincter, the proximal sphincter, and the bladder neck sphincter. There is virtually no physiologic or pharmacologic response that affects the smooth muscle of the most proximal urethra without affecting the smooth muscle of the bladder neck.

Normally, the smooth sphincter is competent and resistance increases in this area during bladder filling and urine storage and decreases during an emptying contraction. In the proximal urethra there is an inner longitudinal smooth muscle layer and a thinner outer circular layer. Many believe the longitudinal layer is continuous with the musculature of the bladder base.

Teleologically this is consistent with a tonic role of the circular muscle in helping to maintain closure during filling and storage and a phasic role for the longitudinal layer in contributing to opening of this area during voiding.

The function of this entire proximal sphincter mechanism is essentially negated by radical prostatectomy. The intramural portion denotes skeletal muscle that is intimately associated with the urethra from the maximal condensation of the extramural striated muscle to at least the apex of the prostate. This intramural portion is called the rhabdosphincter and includes the intrinsic smooth muscle in that area as well.

The fibers of the periurethral extrinsic to the urethra striated muscle are fast twitch Type 2 and capable of rapid on-demand contraction. Damage to this area or its innervations, rendering it poorly or nonfunctional, is a major cause of PRPI.

Urinary incontinence after prostatectomy is predominantly sphincter related and the amount can range from a few drops with exercise or changing positions to total or near total leakage.

Detrusor dysfunction is often found in such patients but is seldom the sole cause. There are many series that have characterized urodynamic findings in these patients. It is an uncommon cause of PRPI, usually due to postoperative bladder neck contracture, but one that must be ruled out.

There is a long list of factors that have been associated by some clinicians with the occurrence of PRPI, but unanimous agreement on all is lacking. These are summarized compositely by Koelbl et al. In the final analysis, meticulous surgical technique of the apex is probably the most important single factor that we as surgeons can influence.

There is no role in this respect for sphincter electromyography. Postoperative abdominal leak point pressures correlated with the presence of ISD but not severity of continence.

The maximal urethral closure pressure seems to be the most important parameter. Preoperative urethral length apex of prostate to bulb of penis, as defined by Myers et al. Van Cangh et al.

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Robotic Simple Prostatectomy



Simple retropubic prostatectomy sex after surgery

The most common procedures used currently are the open retropubic and robotic-assisted laparoscopic prostatectomies. Continence in the male requires 1. Accommodation of increasing volumes of urine at a low intravesical pressure normal compliance and with appropriate sensation. A bladder outlet that is closed at rest and remains so during increases in intra-abdominal pressure. Absence of involuntary bladder contractions detrusor overactivity.

We prefer to use the terms smooth and striated sphincter area. This is a physiologic but not anatomic sphincter and is not under voluntary control. Others refer to this area as the internal sphincter, the proximal sphincter, and the bladder neck sphincter.

There is virtually no physiologic or pharmacologic response that affects the smooth muscle of the most proximal urethra without affecting the smooth muscle of the bladder neck.

Normally, the smooth sphincter is competent and resistance increases in this area during bladder filling and urine storage and decreases during an emptying contraction. In the proximal urethra there is an inner longitudinal smooth muscle layer and a thinner outer circular layer. Many believe the longitudinal layer is continuous with the musculature of the bladder base. Teleologically this is consistent with a tonic role of the circular muscle in helping to maintain closure during filling and storage and a phasic role for the longitudinal layer in contributing to opening of this area during voiding.

The function of this entire proximal sphincter mechanism is essentially negated by radical prostatectomy. The intramural portion denotes skeletal muscle that is intimately associated with the urethra from the maximal condensation of the extramural striated muscle to at least the apex of the prostate.

This intramural portion is called the rhabdosphincter and includes the intrinsic smooth muscle in that area as well. The fibers of the periurethral extrinsic to the urethra striated muscle are fast twitch Type 2 and capable of rapid on-demand contraction. Damage to this area or its innervations, rendering it poorly or nonfunctional, is a major cause of PRPI.

Urinary incontinence after prostatectomy is predominantly sphincter related and the amount can range from a few drops with exercise or changing positions to total or near total leakage. Detrusor dysfunction is often found in such patients but is seldom the sole cause. There are many series that have characterized urodynamic findings in these patients. It is an uncommon cause of PRPI, usually due to postoperative bladder neck contracture, but one that must be ruled out.

There is a long list of factors that have been associated by some clinicians with the occurrence of PRPI, but unanimous agreement on all is lacking. These are summarized compositely by Koelbl et al. In the final analysis, meticulous surgical technique of the apex is probably the most important single factor that we as surgeons can influence. There is no role in this respect for sphincter electromyography. Postoperative abdominal leak point pressures correlated with the presence of ISD but not severity of continence.

The maximal urethral closure pressure seems to be the most important parameter. Preoperative urethral length apex of prostate to bulb of penis, as defined by Myers et al. Van Cangh et al.

Simple retropubic prostatectomy sex after surgery

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4 Comments

  1. Following a retropubic prostatectomy, a catheter is placed in the bladder through the urethra and remains in place for a week.

  2. Discuss potential risks of open simple prostatectomy with the patient preoperatively, including urinary incontinence, erectile dysfunction , retrograde ejaculation, urinary tract infection, and the need for a blood transfusion. If only one side of the bundle of nerves is cut or removed, the man may have less erectile function, but will possibly have some function left. The length of time this occurs can vary.

  3. In TURP, prostate tissue is removed with a long, thin instrument called a resectoscope, which is inserted into the penis and passed through the urethra to the prostate. It may be necessary for you to stop these medications prior to the procedure.

  4. Longer-term complications can include ED, retrograde ejaculation, and incontinence, all of which can be treated.

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