Radical Prostatectomy

The removal of the entire prostate gland is often chosen in the treatment for prostate cancer. This major surgery removes the entire prostate gland and some surrounding tissue. For treatment of cancer, the goal is to remove the cancer entirely and prevent its spread to other parts of the body.

A tissue sample (biopsy) of the pelvic lymph nodes may also be done during the surgery. The sample will be viewed under a microscope to determine if the cancer has spread.

This procedure is performed with medicine that makes you sleep (general anesthetic) or a spinal block. A spinal block keeps you awake but numb from the waist down.

  • The most common procedure uses a cut (incision) through the abdomen.

  • In another procedure, a curved incision is made between the anus and the base of the scrotum. The prostate is then removed from underneath the pubic bone. The major drawback of this approach is that your urologist cannot remove the lymph nodes through this incision.

  • Minimally invasive surgery involves the use of laparoscopy or robotics to remove the prostate through many small incisions rather than one larger one.

Sometimes a nerve-sparing radical prostatectomy may be done. This is an attempt to save erectile function.

After removal of the prostate, the urethra is sewn to the neck of the bladder over a urinary catheter. The catheter is a narrow tube that is passed through the urethra into the bladder. Drains are placed around the site and then the incision is closed. After surgery, you are taken to a recovery room to be watched closely. The catheter is usually removed in 2 to 3 weeks. Bandages (dressings) remain until there is no more fluid drainage from the wounds.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to food or medicine.

  • Medicines taken, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicines.

  • History of bleeding problems or blood clots.

  • Previous surgery.

  • Previous prostate infections.

  • Other health problems, including diabetes and kidney problems.

RISKS AND COMPLICATIONS

  • Rare injury to the bowel or rectum.

  • Intestinal or bowel obstruction.

  • Scarring called "stricture" that causes later problems with the flow of urine.

  • Bleeding and the need for a blood transfusion.

  • Inability to control your urine (incontinence).

  • Injury to one of the ureters or the urethra.

  • Impotence following the procedure. This is the inability to get an erection. This occurs in 25% to 50% of men after surgery. Treatments are available for these types of problems. All men having this surgery will have absent ejaculation but will still have an orgasm if they are able to have an erection.

  • Infection.

  • Blood clots in the legs.

As with any major surgery, there is always the rare chance of a complicating stroke, heart attack, or other complications, including death. These will be discussed with you by the surgeon and anesthesiologist.

BEFORE THE PROCEDURE

  • In the days before the procedure, you may be asked to temporarily adjust your diet. If so, your caregiver will tell you what you can eat and drink.

  • You may be asked to drink medicine that will clean your bowels the night before the surgery.

  • If you are on blood thinners, stop taking them before the procedure, or as your caregiver advises.

  • You should have nothing to eat or drink for 8 hours before your surgery or as suggested by your caregiver. You may have a sip of water to take medicine not stopped for the procedure.

  • On the day of the procedure, a thin, flexible rubber tube (Foley catheter) will be passed through the urethra and into the bladder. The tube will drain urine and fluid.

HOME CARE INSTRUCTIONS

For your own protection, observe the following precautions for 10 days after your procedure.

  • If you go home with a catheter, take care of it as directed. You will receive instructions on catheter care.

  • After catheter removal, empty the bladder whenever you feel a desire. Do not try to hold the urine for long periods of time. Even after complete healing, you may continue to urinate once or twice during the night.

  • Avoid all lifting, straining, running, strenuous work, walks longer than a couple blocks, riding in a car for extended periods, and sexual relations.

  • You may continue nonstrenuous activities. It is always important to keep active after surgery. This lessens the chance of developing blood clots. Walking on level ground is an excellent activity to avoid blood clots and to keep active.

  • Take 2 tablespoons of heavy mineral oil or other stool softener every morning and night for 3 or 4 days. After that, gradually reduce the dose. You may benefit from continuing on the stool softeners if you require narcotics to control your pain. Stop stool softeners after the stools have been normal for 1 week. If you become constipated, do not strain to move your bowels. You may use an enema, but make sure that you have discussed this first with your caregiver. Notify your caregiver about any problems.

  • In addition to your usual medicine, you may be given an antibiotic to take for 10 to 14 days. Notify your caregiver if you have any side effects or problems with this medicine.

  • Avoid alcohol and caffeinated drinks for 2 weeks as they are irritating to the bladder.

  • Eat a regular diet. Avoid spicy foods for 2 weeks.

  • Keep all follow-up appointments as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • You have blood in your urine.

  • You have redness, swelling, or increasing pain in the wound areas.

  • You notice pus coming from a wound.

  • You have chills or night sweats.

  • You notice a bad smell coming from a wound or dressing.

  • You notice the edges of your wound break open after stitches (sutures) or staples have been removed.

  • You are leaking around your catheter or have problems with your catheter. It is not unusual to experience occasional leakage of urine around your catheter due to spasms of your bladder.

  • You develop side effects from your medicine.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You are suddenly unable to urinate. This is an emergency.

  • You develop shortness of breath or chest pains.

  • You have persistent bleeding or blood clots develop.

  • You have a fever.

  • You develop pain in your back or over your lower abdomen.

  • You develop pain or swelling in your legs.

  • You develop swelling in your abdomen or have a sudden weight gain.

  • Your problems are getting worse.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.