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prostate cancer
bundle of nerves
urinary incontinence
radiotherapy
After A Prostate Cancer A Man Has To Face The Side Effects
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When you receive a diagnosis of this type, when you think the about only cure. The intervention and drug therapies sometimes cause damage to sexual and urinary continence. Learning to talk is the first step towards a solution

The prostate cancer every year affects about 25,000 men. In most cases it is not an aggressive form, and rarely, if taken in time, gives rise to metastases. Nevertheless, it may leave anything but pleasant aftermath, in particular as a result of surgery.

"After three months, with traditional surgery, even in the hands of the best doctors, about four out of ten patients suffering from urinary incontinence and the symptom persists after a year in more than two cases out of ten," said Ottavio de Cobelli, director of the Division of Urology of the European Institute of Oncology in Milan. "More problematic still is the loss of sexual potency: after three months of its removal of the tumor, are eight in ten men suffering from impotence, and six out of ten are still having problems after a year."

The reason this happens is anatomical: the bundle of nerves that controls the urinary continence, bladder function and the stimulation erection goes exactly in the center of the gland and remove the prostate without damaging and very difficult and, often, frankly, impossible to . The surgery is not solely responsible for the damage to the nerves: even local radiotherapy, which is necessary in some cases more advanced or aggressive cancer, can have the same effect, as well as hormonal therapies recommended to prevent recurrence. The latter, while not interfering with nerve transmission by inhibiting the production of testosterone (male hormone) and then make it difficult to erect.

TALK IS THE FIRST CARE FOR PROSTATE CANCER

The legacy of a tumor, even if taken in time, can be particularly heavy in terms of both physical and psychological. "If you are using a surgical technique that spares the nerves, you can have a recovery of sexual potency within one year after surgery. After this time you have to use type andrological therapies to solve the problem, "explains de Cobelli.

Men are not accustomed to talking about their sexual problems and this makes it particularly difficult to treat postsurgical impotence, as told by Dana Jennings, The New York Times since 2008 speaks of his illness on the website of the U.S. daily. "I have not saved anything to my readers for the diagnosis or panic - received only fifty years - or the shame and humiliation I felt when I realized I need to wear a diaper for incontinence, and not longer able to have sex. But it is through public confession that I found the strength to turn to the right specialists to find a solution, albeit partial. "

The post-surgical therapies for impotence are not very different from those for the psychogenic form: the use of drugs for the erection (but in some cases may interfere with substances used to treat the disease) the insertion of implants in hydraulic more severe forms. According to estimates by the Prostate Cancer Foundation, a nonprofit that promotes U.S. research on this type of cancer but also the remedies to alleviate the effects of treatment, with all the weapons available to a good urologist can solve the problem in almost all cases.

REHABILITATION, DRUGS AND SURGERY

Also with regard to urinary incontinence is possible to intervene, and with rehabilitation exercises and bladder with drugs such as alpha blockers. Very often the disorder is worsened by irritative phenomena due to local radiation therapy: in these cases, just wait until the irritation steps to regain continence. However, if the damage was caused by nerves, you can resort to plastic surgery techniques.

The simplest is an injection of collagen into the urethra, the tube that conducts urine from the bladder to the outside. In this way, the caliber of the tube narrows, retaining urine. It is a very simple action, but can unfortunately only in half of cases. Also, because the collagen is reabsorbed by the body, must be repeated over time.

Other techniques are being studied and should be evaluated individually with a urologist expert. Finally, many patients are faced with the side effects of hormonal therapies whose goal is to block production of testosterone, the male hormone that also acts as a "fertilizer" for cancer. The patient manifested andropause symptoms: loss of bone mass, sexual difficulties, loss of desire, hot flashes. Even in these cases it is necessary to talk to a specialist urologist: there are several possible strategies, such as intermittent hormonal therapy, which involves periods of pharmacological suppression of testosterone alternating with periods of interruption of the drugs - in which the hormone back to normal levels - which however have studied case by case basis.

Help for prostate cancer from the robot

The group of Ottavio de Cobelli, thanks to an agreement with the Florida Hospital in Orlando (USA) has acquired particular expertise in a surgical technique that involves the removal of the prostate with the aid of the Da Vinci robot, a machine that allows work of great precision. In 2009 the group IEO has published in the British Journal of Urology, the results obtained with a first group of patients: three months after the operation, if the cancer is in its infancy, urinary incontinence affects 30 percent of men operated with the Da Vinci compared to 37 percent of those who were operated on with classic surgery. At one year follow-urinary disorders have practically disappeared in all cases, while they are still present in 12 percent of the patients with the classic technique. With regard to sexual difficulties, with the robot, after one year, four out of ten patients have problems against six out of ten operated without robots. Throughout Italy there are already more than 25 da Vinci Robot, many of which are used just for prostate surgery.


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