Radical Prostatectomy

Overview

Radical Prostatectomy is a surgical procedure to remove all or part of the prostate gland for the treatment of benign prostatic hyperplasia or prostate cancer. The prostate gland is a significant organ of the reproductive system in men and is responsible for producing seminal fluid (semen) that carries sperms in it. Therefore, the prostate plays a very important role in both urinary and sexual functions.

A prostatectomy biopsy helps evaluate the diseased tissues and portions in the prostate gland in order to allow doctors determine the right treatment option. Cancer of the prostate is a serious condition and should be treated without delays. Treatment options for prostate cancer involve surgical intervention, transurethral resection of the prostate and laparoscopic surgery.

It should be noted that a radical prostatectomy surgery is meant to treat cancer inside the prostate that has not yet spread to the surrounding tissues and organs. The type of surgery for prostate cancer treatment depends upon the person's age and other medical health problems.

There are certain risks and complications associated with radical prostatectomy that should be reported to the doctor right away. Medical conditions like injury in the rectum, problems in controlling bowel movements, problems controlling urine, urethral structure and erection problems can be a cause of major concern and should be consulted with your doctor.

Before the treatment of radical prostatectomy, there are many preparations to be taken.

Before the treatment

• You will have to go through a thorough physical examination and other essential tests in order to help the doctor evaluate your health condition, blood pressure, diabetes, lung or heart problems.
• Give details about the vitamins, drugs and supplements you are taking. Your doctor may ask you to stop specific medications that may interfere with your surgery. You may be instructed to have new medicines required before the surgery.
• Stop smoking several weeks before the surgery as suggested by your doctor.
• During the week prior to the surgery, you are asked to stop taking medications like aspirin and blood thinners.
• On the day of the surgery, you are allowed to have only clear liquids (mostly water) and that too in small sips,
• In most cases, doctors prescribe laxatives to help empty your bowel before the surgery.
• Make sure you do not eat or drink anything after midnight the night prior to the surgery.

How it is performed

The surgery typically takes 2-4 hours to perform. There are two types of surgical approaches, radical prostatectomy (auprapubic approach) and radical prostatectomy (perineal approach). There are some common steps followed in both the techniques:

• Once you are sedated, surgeons insert a breathing tube through your mouth down your throat into your lungs.
• The skin on the surgical site is cleansed with an antiseptic. Meantime, your anaesthesiologist monitors your heartbeat, blood pressure, pulse rate and oxygen level while the surgery begins.
• The type of anaesthesia used depends upon your health and requirement of the surgery. Regional anaesthesia is administered through an epidural in the back, while general anaesthesia is administered through a needle in the arm.
• A catheter is inserted into the body to the bladder to help in draining of urine.

Radical Prostatectomy (suprapubic approach)

• An incision is done from bellow the belly button to the pelvic area.
• The surgeons dissect the lymph nodes and release diseased nerve bundles from the surrounding areas. Any nerve bundle spotted near the urethra is also removed carefully. Surgeons may remove the seminal vesicles, if required.
• The prostate gland is then removed after which a drain is inserted in the lower right area of the cut done in your abdomen.

Radical Prostatectomy (perineal approach)

• A U-shaped incision is done in between the anus and the scrotum (in the perineal region.
• The doctor then separates the diseased nerve bundle gently from the prostate area. The prostate gland along with any abnormal-looking tissues is removed carefully.
• The seminal vesicles, a small-like pouch located on either side of the urinary bladder, are removed if the surgeons notice any abnormal tissues in them.

After the surgery, the sutures are closed and a sterile dressing is done on the wounded areas.

Recovery

You are transferred to the recovery room where you are kept under observation to monitor your heartbeat, ECG (electrocardiogram), blood pressure, breathing rates, and your oxygen level. You are given pain medication in case of excessive pain at the surgical sites.

Gradually as your condition improves, you are given liquids to drink. Initially, liquid and soft foods are given, but this changed to solid foods eventually. The catheter, however, stays in place for 1-3 weeks after the surgery, after which it is removed.

Try to avoid heavy-duty tasks and strenuous activities as much as possible weeks and months after the surgery. The more you give time to heal, the faster is the recovery of radical prostatectomy. Do not drive or go to office until your doctor says so. If you notice any swelling, redness or pain at the wounded site or fever or chills, inform it to the doctor right away.