Post-Da Vinci Surgery: Managing Frequent Urination After Prostate Cancer - Urology

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Post-Da Vinci surgery management, particularly concerning frequent urination after prostate cancer treatment, can be quite complex. Your father's situation, having undergone a Da Vinci robotic-assisted radical prostatectomy for T3A prostate cancer, is not uncommon. Many patients experience changes in urinary function following such surgeries, and the symptoms can vary widely from person to person.

Firstly, it’s important to understand that the urinary tract is significantly affected during prostate surgery. The prostate gland is located just below the bladder and surrounds the urethra, which is the tube that carries urine out of the body. During a radical prostatectomy, the prostate and some surrounding tissues are removed, which can lead to changes in urinary control and function.
In your father's case, the frequent urination and dribbling that he is experiencing could be attributed to several factors. One possibility is that the surgical site, particularly the area where the urethra was reattached, may still be healing. The fact that he has been diligent with Kegel exercises is beneficial, as these exercises can help strengthen the pelvic floor muscles and improve urinary control over time. However, recovery can be a gradual process, and it’s not unusual for patients to experience fluctuations in urinary symptoms during the healing phase.

The suggestion from the urologist that a second surgery might be necessary due to a potential narrowing of the urethra (stricture) is a valid concern. Urethral strictures can occur after surgery, leading to obstructive urinary symptoms. However, before considering another surgical intervention, it is crucial to evaluate the severity of the symptoms and their impact on your father's quality of life. If the symptoms are manageable and not significantly affecting his daily activities, it may be reasonable to continue monitoring the situation.

Furthermore, it’s essential to have a thorough discussion with the surgeon who performed the initial procedure. They can provide insights based on the specifics of the surgery and the healing process. They may also suggest non-invasive options to manage the symptoms, such as medications or bladder training techniques, before resorting to another surgical procedure.

In terms of the PSA levels being below 1, this is a positive indicator that there is no evidence of residual cancer, which is encouraging. It suggests that the cancer treatment was effective, and the focus now should be on managing the postoperative symptoms.

In conclusion, while the prospect of another surgery can be daunting, it is essential to weigh the benefits against the risks and potential complications. Continuous communication with healthcare providers, adherence to prescribed exercises, and monitoring of symptoms will be key in managing your father's recovery. If the symptoms persist or worsen, further evaluation may be warranted, but for now, it may be best to adopt a watchful waiting approach while maintaining open lines of communication with his medical team.