A Radical Prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery or by laparoscopic surgery through small incisions.
Laparoscopic surgery is most often done by hand. A few doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy
Who Is a Good Candidate for a Radical Prostatectomy ?
Men who have early-stage prostate cancer (cancer that hasn’t spread distantly) and who don’t have other serious health concerns that would make surgery especially dangerous are good candidates for radical prostatectomy.
Men with advanced prostate cancer (that has spread well beyond the prostate), have serious other health concerns, or are quite elderly and more likely to die from something other than prostate cancer are less likely to benefit from radical prostatectomy.
Only after discussing your treatment options with your doctors, can the right decision be made for you.
Why the Procedure is Performed ?
Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. Healthy men who will probably live 10 or more years often have this procedure.
Other treatment options for Prostate Cancer are:
- External beam radiation therapy
- Implant radiation therapy (brachytherapy)
- Hormone therapy (androgen deprivation therapy)
- Cryotherapy of the prostate
- Visits with your doctor and tests to check for changes in your prostate cancer (called active surveillance)
Sometimes, your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for your cancer.
Risks for any surgery are:
- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney
- Blood loss
- Heart attack or stroke during surgery
- Reactions to medications
Risks of this procedure are:
- Difficulty controlling urine (urinary incontinence)
- Erection problems (impotence)
- Injury to the rectum
- Difficulty controlling bowel movements (bowel incontinence)
- Urethral stricture (tightening of the urinary outlet from scar tissue)
The surgeon makes an incision in the lower abdomen, from the pubic bone to the navel. Before reaching the prostate gland, the surgeon may remove a small amount of tissue on either side of the bladder. This tissue contains lymph nodes, bean-shaped collections of infection-fighting cells located throughout the body. If prostate cancer has spread outside the prostate gland, one of the first places it may travel is to lymph nodes in the pelvis.
In selected cases, a pathologist (a doctor specializing in identifying disease through noting changes in organs, tissues and fluids) examines the lymph nodes under a microscope to see if they are cancer-free. If the lymph nodes are cancerous, the operation is usually stopped. If no cancer is found in the lymph nodes, the operation continues.
The veins traveling over the prostate and urethra are carefully cut so the operating area is free of blood. These veins will be removed with the prostate gland.
The urethra is the tube that carries urine from the bladder through the penis and out of the body. It also carries semen out through the penis during ejaculation. The urethra runs right through the middle of the prostate gland. Before the prostate can be removed, the urethra must be cut both above and below the prostate. The urethra will be reattached to the bladder later in the operation.
The nerve bundles on either side of the prostate are responsible for erections. If they appear to be cancer-free, the surgeon may not remove them. This modified operation is called a nerve-sparing radical prostatectomy. If the nerves must be removed, the bundles are cut near the urethra and next to the rectum.
The prostate gland is detached from the bladder; the overlying veins, seminal vesicles and vas deferens are also removed. The urethra is reconnected to the bladder. While the patient is still under anesthesia, a Foley catheter, a hollow, flexible tube to drain urine, is inserted into the penis through the urethra and into the bladder. It is left in place until the reconnection heals.
After the Procedure
You may stay in the hospital for about 1 to 4 days. After laparoscopic or robotic surgery, you may go home the day after surgery.
You may need to stay in bed until the morning after surgery. Afterwards, you will be encouraged to move around as much as possible.
Your nurse will help you change positions in bed, show you exercises to keep blood flowing, and recommend coughing or deep breathing to prevent pneumonia. You should do these every 3 to 4 hours. You may need to use a breathing device to keep your lungs clear.
You may also:
- Wear special stockings on your legs to prevent blood clots
- Receive pain medicine in your veins or take pain pills
- Feel spasms in your bladder
- Return from surgery with a Foley catheter in your bladder. Some men will have a suprapubic catheter in their belly wall to help drain the bladder.
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