Radical Prostatectomy

This is the standard procedure to remove the prostate gland completely Also some of the tissue near it is removed so as to cure the cancer completely. It may be done either as an open surgery or using laparoscopic surgery.

In open surgery, an incision is made in the lower belly or in the region between the anus and scrotum depending upon the case. The former method is called retropubic approach and the later one is called perennial approach.

In either case the prostate gland is removed through the incision made; after controlling the blood flow and the detachment of the tissues. Often the lymph nodes in the vicinity are also removed so as to eliminate the cancer completely. In perennial approach, for the removal of lymph nodes, separate incisions will have to be made. If the lymph nodes are diagnosed not to be cancerous then they are left as such. The recovery time in perennial approach is much less than retropubic one.

The laparoscopic surgery is performed by making small incisions in the lower abdomen and the surgery is performed with laparoscope and associated instruments. These days, robotic arms which translate the surgeon’s hand motions are used in the laparoscopic surgery which leads to more precise action. This is called robot assisted prostatectomy. It is best suited for a younger man who is in good health, having a small prostate and when the cancer detected is early stage and of lower grade.

Prostatectomy requires general anesthesia and hospital stay of 3-4 days. A catheter is left in the bladder to drain the urine for 3 weeks. Prostatectomy is used mostly when the cancer has spread to the outside tissues around the prostate as well and mostly in its earlier stages. Although the cancer cells may have been completely removed there is a chance that it may recur hence regular follow up checkups are required to ensure total cure.

During the surgery, the nerves that lie close to the prostate often get damaged. This may cause erection problems and impotency. Using medicines soon after the completion of surgery will help in regaining sexual functions. Another problem is urinary incontinence that is occasional dribbling of urine involuntarily. This is because the urethra runs through the middle of the prostate, so in order to remove the prostate it has to be removed first and reconnected later. The recovery time depends on the age of the patient as well as the extent to which the surgery has affected the nerves.