Radical Prostatectomy

Overview & Description

A radical prostatectomy is the removal of the entire prostate and the seminal vesicles. The prostate is a gland that goes around the neck of the bladder and the urethra in a male. The seminal vesicles lie behind the bladder and near the prostate. They secrete a thick fluid that forms part of the semen.

Who is a candidate for the procedure?

A radical prostatectomy is one of the treatments for prostate cancer. It may be done on men with localized cancer who have an estimated life expectancy of 10 years or more.

How is the procedure performed?

A radical prostatectomy is done under general or regional anesthesia. General anesthesia means the person is put to sleep with medicines. Regional anesthesia means the person will be awake, but numb below the waist. A medicine may be given to make the person drowsy.

There are two distinct approaches to radical prostatectomy:

The most common approach is radical retropubic prostatectomy. For this procedure, the incision made to remove the prostate starts below the navel and extends to just above the pubic bone.

In the radical perineal prostatectomy, a smaller, curved incision is made between the anus and the base of the scrotum. The prostate is brought out from underneath the pubic bone.

There are advantages and disadvantages to each approach. The retropubic approach allows the surgeon to take a lymph node sample at the same time as prostate removal. The perineal approach has a slightly shorter recovery time.

After removal of the prostate, the urethra is sewn to the bladder neck. This repair is done with sutures, or stitches, 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. Then the skin is closed.

Preparation & Expectations

What happens right after the procedure?

After the surgery, the man will be taken to the surgery recovery room to be watched closely for a short time. His blood pressure, pulse, and breathing will be checked often. Urinary output will be watched closely. At first, the urine will be bloody after this procedure.

Home Care and Complications

What happens later at home?

The man is usually sent home 2 to 4 days after surgery with the urinary catheter in place. Instructions are given to the man and his family about care of the catheter. This catheter is removed 1 to 3 weeks after the procedure. Dressings are kept on the wounds until they have dried up completely.

Regular PSA blood tests will be done to monitor the cancer. The PSA level should fall to near zero levels after the prostatectomy.

What are the potential complications after the procedure?

Acute complications include bleeding, infection, damage to the rectum, and allergic reaction to anesthesia.

The primary long-term complications are erectile dysfunction and urinary incontinence. The incidence of erectile dysfunction varies widely. Surgeons are now using techniques to spare the nerves that control erectile functioning. Any new or worsening symptoms should be reported to the healthcare provider.