Radical prostatectomy is surgery to remove the prostate gland. During the procedure, the seminal vesicles, nearby tissues, and often some pelvic lymph nodes are also removed.
The prostate gland is found only in males. It sits below the bladder and wraps around the urethra (the tube that carries urine out of the body). The prostate helps make semen. The seminal vesicles are the 2 sacs that connect to the vas deferens (tubes that carry sperm from the testicles). The pelvic lymph nodes are small oval collections of immune system tissue that filter lymph fluid. When prostate cancer spreads, these lymph nodes are often one of the first places it goes.
A common way to remove the prostate is through an incision (cut) done in one of two ways:
Radical prostatectomy is used to treat prostate cancer that is confined to the prostate gland and the seminal vesicles. There are several ways to do a radical prostatectomy:
This is the most common method. The incision is made in the lower abdomen. If there’s a chance the cancer has spread, the healthcare provider may remove lymph nodes around the prostate gland first so they can be checked in the lab before the prostate is removed. Cancer has spread beyond the prostate gland if it's found in the lymph nodes. If that's the case, then surgery may be stopped, since removing the prostate won't remove all of the cancer. In this situation, other treatments will be used.
Radical perineal prostatectomy is used less often than the retropubic approach. This is because the nerves can't be spared as easily, nor can lymph nodes be removed with this method. But, it takes less time and may be an option if the nerve-sparing and lymph node removal isn't needed.With the retropubic approach, there is a smaller, hidden scar behind the scrotum for a better cosmetic effect. Also, major abdominal muscle groups are avoided. So, there's generally less pain and recovery time.
In this approach, the surgeon makes several small cuts and puts a thin tube with a video camera (laparoscope) inside one of the cuts and long, thin tools through others. The camera helps the surgeon see inside as the tools are used to do the surgery.
Radical prostatectomy is used to treat prostate cancer. It’s used when the cancer is thought to be confined to the prostate gland.
Other less common reasons for radical prostatectomy include:
There may be other reasons for your doctor to recommend a prostatectomy.
Some possible complications of retropubic and perineal methods may include:
Some risks associated with surgery and anesthesia in general include:
One risk of the retropubic approach is rectal injury. This can cause stool incontinence or urgency.
You may have other risks,depending on your condition. Be sure to discuss any concerns with your doctor before the procedure.
Some things you can expect before the surgery include:
Radical prostatectomy requires a stay in the hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a radical prostatectomy (either retropubic or perineal approach) follows this process:
After the surgery, you will be taken to a recovery room to be closely watched. You'll be connected to machines that will constantly display your heart beat, blood pressure, breathing rate, and your oxygen level.
Once you're awake and stable, you may start to drink liquids and will be taken to your hospital room.
You may get pain medication as needed, either by a nurse, or by giving it yourself through a device connected to your IV line.
You will be able to eat solid foods as you're able to handle them.
Your healthcare team will show you how to do breathing exercises and movements while in bed to help your body recover. You may wear compression stockings on your legs. These reduce your risk for blood clots. Your activity will be gradually increased, and you will be urged to get out of bed and walk around for longer periods.
The drain will generally be taken out the day after surgery.
The Foley catheter that was put in to drain your urine will stay in place for about 1 to 3 weeks as you heal. You'll be given instructions on how to care for your catheter at home.
Arrangements will be made for a follow-up visit with your doctor.
Once you're home, it'll be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, if they weren't removed before leaving the hospital.
The surgical incision may be tender or sore for several days. Take a pain reliever for soreness as recommended by your doctor.
You shouldn't drive until your doctor tells you it’s OK. Other activity restrictions may apply, such as no heavy lifting for 3 to 4 weeks.
Once the Foley catheter is removed, you'll probably have some leaking of urine. The length of time this occurs can vary. Your doctor will give you suggestions for improving your bladder control. Over the next few months, you and your doctor will be checking for any side effects and working to improve any problems with incontinence or erectile dysfunction.
Tell your doctor if you have any of the following:
Your doctor may give you other instructions after the procedure, depending on your situation.