Radical Prostatectomy

Radical prostatectomies are performed by the Urology Division of Premier Medical Group.

What is a radical prostatectomy?

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A radical prostatectomy is a surgical procedure to remove the prostate gland and surrounding seminal vesicles and ampullary vas deferens (which form into the ejaculatory ducts). Lymph nodes may be removed, depending on the stage and grade of the cancer. The operation is usually performed with general anesthesia, although spinal or regional anesthesia can be used if needed. The surgery generally takes from 1.5 hours to 4 hours to complete.

Why is radical prostatectomy performed?

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This type of surgery is most often performed in cases where the cancer has not spread beyond the prostate gland. For other treatment options, see prostate cancer.

Types of Radical Prostactomy

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There are four types of radical prostatectomy:

Robotic-assisted laparoscopic prostatectomy

This involves using the da Vinci® Robotic Surgical System in a minimally invasive approach. The surgeon controls the robotic arm while sitting at a computer monitor close to the operating table. The surgery is performed through the small, laparoscopic incisions. The benefits of the robotic system include better visual optics and more precise instruments compared to traditional laparoscopic surgery. The patient experiences less bleeding and pain, a shorter hospital stay and faster return to normal activities compared to open surgery. In experienced surgical hands, excellent outcomes in preserving continence and erections should be expected. Robotic surgery is rapidly becoming the preferred approach for radical prostatectomy. www.davinciprostatectomy.com

Radical retropubic prostatectomy

In the retropubic approach, an incision is made just below the belly button to the pubic bone in order to reach the prostate gland. This has been considered the gold standard, and although performed less commonly now, still provides good clinical results with surgeons who are skilled at performing the operation.

Radical perineal prostatectomy

The prostate gland is removed through the perineum (the area between the scrotum and the anus. Your surgeon makes a cut in the groin, between the anus and base of the scrotum (the perineum). The incision is smaller than in retropubic surgery, making it harder for the surgeon to spare the nerves around the prostate, or to remove nearby lymph nodes. There is usually less blood loss, minimal pain and excellent recovery with this operation. Although very few surgeons perform this operation, it may be useful in patients who are morbidly obese, and for whom robotic surgery cannot be performed.

Laparoscopic radical prostatectomy

This involves several tiny incisions instead of one large one. The surgeon places a thin tube with a video camera (laparoscope) inside one of the cuts. He can see inside your belly during the procedure. With the advent of laparoscopic surgery, this operation is performed less and less.

After the prostate has been removed, your surgeon will insert a catheter to allow the urethra to heal with the bladder. Drains are placed around the site and then the incision is closed. The catheter can usually be removed in 6-7 days after robotic surgery, 10-14 days for open surgery. Dressings should be kept on the wounds until they have completely dried up.

Recovery from Radical Prostatectomy

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You may be required to stay in the hospital anywhere from 1-3 days for open surgery or 1-2 days for robotic or laparoscopic surgery. Rest is encouraged and you may need to stay in bed until the morning after surgery. Afterwards, you will be encouraged to move around as much as possible.

You will receive pain medication as needed and you may be given special stockings to wear on your legs to prevent blood clots.

You should be able to perform normal activities within 1 week after surgery, but heavy lifting or strenuous activity is discouraged for 4 weeks post-surgery.

Initially, post-surgical incontinence can be quite significant and frustrating. However, there will be gradual improvement in the condition and by 12 months after surgery; most patients (90%) have little or no incontinence.

Recovery of potency is also a gradual process. Your surgeon is likely to initiate some form of penile rehabilitation in the form of oral medications (i.e., Viagra), pellets (MUSE), injections, or devices (Penile Vacuum pump). Usually some level of erectile activity returns within 9 months, but it may take up to 2 years for full recovery.

Outlook (Prognosis)

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The chance for long term cure is excellent if the cancer is confined to the prostate with a low to moderate grade disease. PSA testing continues post-surgery to insure that there is no return of the cancer. The frequency and duration of testing is determined by the pathological findings once the prostate is removed.

It’s also a smart idea to begin self-exams to look for the symptoms of testicular cancer.

Radical Prostatectomy Complications

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Urinary incontinence and the inability to achieve an erection are the most common complications of a prostatectomy. There is also a risk for blood clots, blood loss requiring transfusion, delay in bowel function and, rarely, injury to surrounding structures such as the rectum.