Goldfields Urology Managing the side effects of a radical prostatectomy Stages of diagnosis Receiving a result of an elevated PSA Referral to urologist Prostatic biopsy TRUS or transperineal ID: 247794
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Mr Rohan HallGoldfields Urology
Managing the side effects of a radical prostatectomySlide2
Stages of diagnosis
Receiving a result of an elevated PSA
Referral to urologist
Prostatic biopsy (TRUS or transperineal)Receiving the diagnosisStagingReceiving results Discussing management of localised prostate cancerDiscussing the side effects of each treatment optionAnxietyDepressionLoss of autonomyFutilityAngerSlide3
Managing the “trifecta”Oncology
Pre-op
Post-op
Review appointmentsContinencePre-op lower urinary tract symptomsPre-op preparationPost-op expectationsErectile FunctionPre-op erectile functionSocial circumstancesMedical comorbiditiesIntra-operative variationPost-op expectationsSlide4
Post-opWound
IDC
Pain
Scrotal oedemaDrivingCyclingSlide5
Urinary ContinenceMale continence mechanismSlide6
Urinary ContinencePre-op pelvic floor education benefits post-op return to continence
Post-op pelvic floor exercises – when to start
What level of continence is normal in the post-operative period
3/12 – 1 pad/day12/12 – 1 pad/day2% of patients will be wet, wet, wetOther factors affecting ability to be continent:Chronic coughObesityDiureticsWhat if continent, then new incontinence?Slide7
Behavioural modificationsDecrease fluid intake
Void frequently
Avoid caffeine, alcohol
Avoid activity that increases intraabdominal pressureSlide8
Urinary ContinenceWhat next – formal
urodynamics
to rule out over active bladder, also can assess ALPP.
Bulking agentsConsidered successful 17% of the time for post radical prostatectomy SUIPro’s - minor procedureCon’s – may need to be repeatedCan set up local chronic inflammatory response making further treatment difficultSlide9
Urinary incontinenceSlide10
AdVance™ Male Sling
Sling
restores
urethra to its proper anatomical position for optimal sphincter function, restoring urinary control
Procedure:
Spinal or general anesthesia
can be used
Three small incisions: 1 under the
scrotum, 2 over groin creases
Specially designed surgical tools
are used to position the sling
Sling is gently tensioned
Incision closedSlide11
Artificial Urinary Sphincter (AUS)
The Gold Standard for treatment
of moderate to severe
incontinence 60± minute outpatient procedure92% of patients would have the device placed again96% of patients would recommend it to a friendDevice is placed completely in the body, providing simple,
discreet control
- Requires dexterity for use of pum
pSlide12
Erectile Dysfunction“The inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance”
Prevalence of ED: 52% men older than 40 have some degree of erectile dysfunction
“
Mandropause” Age 60 – 20% EDAge 70 – 70% EDSet expectations“The best erection they will achieve post-op is 70% of there pre-op erection, and this may be with the aid of a PDE5-I”Slide13
Erectile dysfunctionAetiology
Vasculogenic
:
arteriogenic vs veno-occlusive dysfunctionNeurogenicPsychogenic – depression, stress, anxiety, psychiatric disorderEndocrinologic – hyperprolactinemia, thyroid disorder, hypogonadismMedications (b-blockers,antidepressants,spironolactone,sedatives, phenytoinSlide14
Erectile Dysfunction
PDE5-I
Penile Pump
Intra-urethral suppositoryIntracavernosal injectionSlide15
Erectile dysfunction
PDE5-inhibitors
How to use these tablets?
ContraindicationsSlide16
Erectile dysfunctionPenile Rehabilitation
- Daily
cialis
Aim to achieve 3 erections per weekHigh dose PDE5-IIntracavernosal injections Alprostadil (caverject)Trimix Theoretically makes senseLack of evidence
ExpensiveSlide17
Erectile dysfunction – penile implants
Ideal for men who have tried other treatments without success
On the market for over 30 years
25,000 penile implants per year Over 300,000 implants to date High patient and partner satisfactionSlide18
Types of Penile Implants
One-piece non-inflatable
Two-piece inflatable
Three-piece inflatable
Slide19
One - Piece Non-Inflatable Penile Implant
Advantages
Easy for you or your partner to activate
Good option for men with limited dexterity
Totally concealed in body
The simplest surgical
procedure
Least expensive prosthesis
Disadvantages
Stays firm when not in erect position
May
“
show
”
through clothingSlide20
Three – Piece Inflatable Penile Implant
Simple to use
Fast and simple one-step deflation
Totally concealed in bodyActs and feels more like a natural erection
Expands the girth of the penis
More firm and full than other implants
Feels softer and more flaccid when deflated
Advantages
Disadvantages
Requires some manual dexterity
Possibility of leakage or malfunction
Possibility of unintentional erectionsSlide21
Questions?