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Prostate Diseases Recovery and Follow-up

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.

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Post-Surgical Recovery and Rehabilitation

Prostate Diseases
  • Catheter Management: A Foley catheter is required after prostate surgery to bridge the gap in the urethra (anastomosis) or allow the prostatic fossa to heal.
    • BPH (TURP/HoLEP): Catheter removed in 1-2 days.
    • Robotic Prostatectomy: Catheter removed in 5-7 days after a cystogram confirms the connection is watertight.
  • Activity Restrictions: Patients must avoid heavy lifting (>5kg), straining at stool, bicycle riding, and vigorous exercise for 4-6 weeks. Straining increases pelvic venous pressure, which can blow off the healing scab inside the prostate and cause “Secondary Hemorrhage.”
  • Diet: A high fiber diet and stool softeners are mandatory to prevent constipation, as straining at stool is a significant risk for post-op bleeding.
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Functional Recovery: Continence and Potency

  • Urinary Continence:
    • Post-BPH Surgery: Urgency is common for 4-6 weeks as the bladder heals. Permanent incontinence is rare (<1%).
    • Post-Cancer Surgery: Stress incontinence (leaking when coughing or lifting) is common immediately after catheter removal.
    • Pelvic Floor Muscle Training (Kegels): Patients are taught to identify and strengthen the external sphincter. Biofeedback therapy may be used. 95% of patients regain continence within 3-12 months.
    • Surgical Correction: For the rare cases of permanent incontinence, an Artificial Urinary Sphincter (AUS) or Male Sling can be implanted.
  • Penile Rehabilitation:
    • The nerves responsible for erection (cavernous nerves) are often “stunned” (neurapraxia) during surgery due to traction or thermal energy, even if spared.
    • Protocol: We initiate “Penile Rehab” immediately after catheter removal using daily low-dose PDE5 inhibitors (Tadalafil) or vacuum erection devices. This promotes oxygenated blood flow to the corpora bodies, preventing fibrosis (scarring) and penile shortening while the nerves recover (which can take up to 18-24 months).
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Long-Term Surveillance Strategies

  • PSA Monitoring:
    • After Radical Prostatectomy: PSA should drop to undetectable levels (<0.02 or <0.1 ng/mL). Any consecutive rise >0.2 ng/mL indicates Biochemical Recurrence.
    • After Radiation: PSA drops to a low nadir but never to zero. A rise of 2.0 ng/mL above the nadir indicates failure (Phoenix Criteria).
    • After BPH Surgery: PSA falls by about 50-80% (depending on how much tissue was removed). A significant rise requires investigation for cancer developing in the remaining capsule.
    • Bone Health: Patients on Androgen Deprivation Therapy (ADT) for advanced cancer are at risk of osteoporosis due to testosterone suppression. We monitor Bone Mineral Density (DEXA scans) and supplement with Calcium, Vitamin D, and bone-protective agents (Denosumab or Bisphosphonates).

Prevention and Metabolic Health

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  • Lifestyle Modification: Central obesity increases the risk of recurrence. Patients are counseled on weight loss and exercise.
  • Cardiovascular Health: Men with ED often have underlying heart disease. A urological diagnosis is usually a “sentinel event” prompting a cardiovascular workup.
  • Chemoprevention: While 5-ARIs (Finasteride) reduce the risk of getting prostate cancer by 25%, they are not FDA-approved for prevention because they may mask high-grade disease.

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Prof. MD. Tahir Karadeniz Prof. MD. Tahir Karadeniz Urology
Group 346 LIV Hospital

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FREQUENTLY ASKED QUESTIONS

Will I have pain after prostate surgery?

Post-operative pain is typically mild to moderate. BPH surgeries (endoscopic) involve no skin incisions, so pain is mostly bladder spasms, treated with antimuscarinics. Robotic prostatectomy involves small keyhole incisions; pain is managed with NSAIDs and usually resolves within a week.

Patients can usually drive once the catheter is removed and they are no longer taking narcotic pain medication, typically 1-2 weeks after surgery. However, long car rides should include frequent stops to walk to prevent blood clots.

This is a scarring complication (occurring in 2-5% of cases) where the opening of the bladder scars down to a pinhole size after surgery, obstructing the return. It presents as a weakening stream months after surgery. It is treated with a simple endoscopic dilation or incision.

Prostate surgery for cancer (Radical Prostatectomy) severs the vas deferens and removes the seminal vesicles, rendering the patient sterile (no ejaculation). Men desiring future fertility must bank sperm before surgery. BPH surgery typically causes retrograde ejaculation, making natural conception difficult but not impossible (sperm can be harvested from urine or testicles).

If you are receiving hormone therapy (ADT), the lack of testosterone causes rapid bone thinning (osteoporosis), significantly increasing fracture risk. A DEXA scan measures bone density, so we can start protective medications if bone density becomes low.

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