Radical Prostatectomy

Radical prostatectomy is a procedure to treat cancer by removing your entire prostate gland. It is done if it has been determined that the cancer is confined to your prostate. Some of the surrounding tissue is removed too. This procedure is done to remove the cancer entirely. It is also done to prevent it from spreading to other parts of your body (metastasize).

ExitCare Image Small oval-shaped organs, connected by vessels, which help filter toxins and dead cells from your body (lymph nodes) also may be removed from your pelvis. If the cancer has metastasized, the first place to which it will metastasize are your pelvic lymph nodes, those closest to your prostate. Tissue from the lymph nodes that is removed will be tested to see if the cancer has metastasized.

LET YOUR CAREGIVER KNOW ABOUT:

  • Any allergies you have.

  • Any medicines you are taking, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Previous problems you or members of your family have had with the use of anesthetics.

  • Any blood disorders you have.

  • Previous surgeries you have had.

  • Any prostate infections you have had.

  • Other health problems you have, including diabetes and kidney problems.

RISKS AND COMPLICATIONS

Generally, radical prostatectomy is a safe procedure. However, as with any surgical procedure, complications can occur. Possible complications associated with radical prostatectomy include:

  • Injury to your bowel or rectum (rare).

  • Intestinal or bowel obstruction.

  • Scarring that can lead to problems with the flow of urine.

  • Inability to control your urine (incontinence).

  • Injury to one of your ureters or your urethra.

  • Impotence. This is the inability to get an erection.

  • Infection.

  • Blood clots in your legs.

  • The formation of a cyst made up of fluid from your lymph vessels (lymphocele).

BEFORE THE PROCEDURE

You should have nothing to eat or drink for 8 hours before your surgery or as directed by your caregiver. You may have a sip of water before the procedure to take with any medicine that your caregiver instructs you to take. You may be asked to drink a liquid that will clean your bowels the night before the surgery.

PROCEDURE

This procedure is performed with medicine that makes you sleep (general anesthetic) or a spinal block. If a spinal block is used, you will be awake but numb from your waist down. A thin, flexible tube for draining fluids (catheter) will be passed through your urethra and into your bladder. The catheter will drain urine from your bladder during the procedure and while you heal.

There are four main types of radical prostatectomy surgery:

  • Radical retropubic prostatectomy—During this procedure, your surgeon will make a cut (incision) that starts just below your belly button and continues to your pubic bone.

  • Laparoscopic radical prostatectomy—During this procedure, the surgeon will make several small incisions in your belly instead of one big one. Long, thin tools will be placed inside the incisions. The surgeon will put a thin, flexible tube with a video camera (laparoscope) inside one of the incisions. This helps the surgeon see inside your belly during the procedure.

  • Robot-assisted laparoscopic prostatectomy—During this procedure, laparoscopic prostatectomy will be performed with the assistance of a robotic arm. The surgeon will control the robotic arm from a computer near the operating table.

  • Radical perineal prostatectomy—During this procedure, an incision is made in the skin between your anus and the base of your scrotum (perineum).

After removal of the prostate, your urethra will be sewn to the neck of your bladder, over the catheter. A small tube called a drain may be placed through one of the incisions to allow extra fluid to flow from your belly. The surgeon will close the incision with stitches. Medicine and a bandage (dressing) will be placed over the incision.

AFTER THE PROCEDURE

After surgery, you will be taken to a recovery room. You will stay in the recovery room until you are stable enough to be moved to a hospital room. When you are able to get out of bed, you will be encouraged to move around as much as possible. Your caregiver may have you wear support stockings on your legs. These stockings help to prevent blood clots. You may stay in the hospital for up to 4 days. However, after laparoscopic or robot-assisted surgery, you may be able to go home the day after surgery. Typically, your catheter will be removed in 2–3 weeks after the procedure.