Alternative Names radical retropubic prostatectomy, radical perineal prostatectomy
Definition A radical prostatectomy is the removal of the entire prostate, including its capsule, as well as the seminal vesicles. The prostate is a gland that surrounds 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? This procedure is one of the treatments for prostate cancer. Men with prostate cancer who have an estimated life expectancy of 10 years or more and who have localised disease may be cured by this surgery.
How is the procedure performed? The procedure is done under general or regional anaesthesia. General anaesthesia means the person is put to sleep with medications. Regional anaesthesia means the person will be awake, but numb below the waist. A medication 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, an incision is made below the navel extending to just above the pubic bone to remove the prostate.
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 first approach has the advantage of allowing 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, which is a narrow tube that is passed through the urethra into the bladder. Drains are placed around the site, and the skin is closed.
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. Vital signs, blood pressure, pulse, and breathing will be checked frequently. Urinary output will be monitored closely. The urine will be bloody initially following this procedure.
The man is usually sent home with the urinary catheter in place 2 to 4 days after surgery. This catheter is removed 1 to 3 weeks after the procedure.
What happens later at home? Instructions are given to the man and his family regarding care of the urinary catheter. Visiting nurses are often available to help. Dressings are kept on the wounds until they have dried up completely.
The primary means of assessing for recurrent disease following radical prostatectomy is with the prostate specific antigen blood test, or PSA. The PSA level should fall to near zero levels following this procedure.
What are the potential complications after the procedure? Acute complications include bleeding, infection, damage to the rectum, and allergic reaction to anaesthesia.
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. This decreases the incidence of impotency.
Author: Stuart Wolf, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
