Radical Prostatectomy: An Overview of Prostate Cancer Surgery

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Radical prostatectomy refers to a surgery that completely removes the prostate gland and the tissues surrounding it. This procedure is done as a primary treatment for early stage prostate cancer.

Types of radical prostatectomy

  1. Retropubic
    This procedure allows the removal of the prostate and lymph nodes by way of an incision in the lower abdomen. Retropubic radical prostatectomy allows for a nerve-sparing approach where the surgeon can preserve one or both of the nerve bundles needed for unassisted erection.
  2. Laparoscopic
    This recently developed procedure is done using the assistance of a viewing instrument called laparoscope. The surgeon makes several small (less than 1.0 cm) incisions in the belly, one of which will be the entry point of the laparoscope. In addition to a laparoscope, this procedure can also be done with robotic assistance. The robotic arm, which is inserted in one of the belly incisions, translates the surgeon’s hand motions into finer movements with better precision.
  3. Perineal
    The incision for this type of radical prostatectomy is done in the perineum, the skin between the anus and the scrotum. This procedure does not allow the removal of lymph nodes. If the nodes have to be removed, another incision must be made in the abdomen. Like retropubic and laparoscopic surgeries, perineal surgery also allows nerve sparing.

Before the surgery

Before the surgery, tests are performed to determine the extent of the prostate cancer and decide which surgery type is best used for each case. These tests include blood tests, transrectal ultrasound, and a prostate biopsy. About a week before the patient undergoes surgery, he will be briefed on the various types of anesthesia. The patient can also choose to donate 1 to 2 units of blood that can be used during the surgery.

A day before the operation, the patient must begin preparing his bowels, a common procedure for any type of major abdominal surgery. This can be done by going on a clear liquid diet and taking medication to promote bowel movement.

During the surgery

There may be 2 major activities during a radical prostatectomy. The first, lymph node dissection, refers to the removal of the lymph nodes close to the prostate. This is done only if the cancer has spread to the nodes. Not all radical prostatectomy surgeries require the dissection of the lymph nodes.

The other is radical prostatectomy itself. This involves the removal of the prostate and seminal vesicles. Once these parts are removed, the bladder is reattached to the urethra. To let the bladder heal, a catheter will serve as the exit point of urine for the next few days following the surgery. Radical prostatectomy is said to be nerve sparing if the procedure leaves 1 or both neurovascular bundles on either side of the prostate intact. These bundles allow the penis to become erect. Sparing them preserves complete sexual function in some men.

After the surgery

The patient has to stay in the hospital for 2 to 3 days after the surgery. The patient will be sent home with a catheter to drain urine while the bladder heals. The catheter will be removed approximately 2 weeks after the patient is allowed to go home.

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