Robert Wood Johnson University Hospital
 

Radical Prostatectomy

Radical Prostatectomy

(Prostatectomy, Radical Prostatectomy, Radical Retropubic Prostatectomy, Radical Suprapubic Prostatectomy, Radical Perineal Prostatectomy, Nerve-Sparing Prostatectomy, RP, RPP, RSP)

Procedure overview

What is a prostatectomy?

A prostatectomy is a surgical procedure for the partial or complete removal of the prostate. It may be performed to treat prostatic cancer or benign prostatic hyperplasia (BPH).

A common surgical approach to prostatectomy includes making a surgical incision and removing the prostate gland (or part of it). This may be accomplished with either of two methods, the retropubic or suprapubic incision (lower abdomen), or a perineum incision (through the skin between the scrotum and the rectum).

Prior to having a prostatectomy, it's often necessary to have a prostate biopsy. Please see this procedure for additional information.

What is the prostate gland?

Illustration of  the anatomy of the male reproductive tract
Click Image to Enlarge

The prostate gland is about the size of a walnut and surrounds the neck of a man's bladder and urethra—the tube that carries urine from the bladder. It's partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It's made up of three lobes, a center lobe with one lobe on each side.

As part of the male reproductive system, the prostate gland's primary function is to secrete a slightly alkaline fluid that forms part of the seminal fluid (semen), a fluid that carries sperm. During male climax (orgasm), the muscular glands of the prostate help to propel the prostate fluid, in addition to sperm that was produced in the testicles, into the urethra. The semen then travels through the tip of the penis during ejaculation.

Researchers don't know all the functions of the prostate gland. However, the prostate gland plays an important role in both sexual and urinary function. It's common for the prostate gland to become enlarged as a man ages, and it's also likely for a man to encounter some type of prostate problem in his lifetime.

Many common problems that don't require a radical prostatectomy are associated with the prostate gland. These problems may occur in men of all ages and include:

Cancer of the prostate is a common and serious health concern. According to the American Cancer Society, prostate cancer is the most common form of cancer in men older than age 50, and the third leading cause of death from cancer.

There are different ways to achieve the goal of removing the prostate gland when there's cancer. Methods of performing prostatectomy include:

Are there different types of radical prostatectomies?

There are two primary methods of radical prostatectomy:

Illustration of Retropubic approach to prostatectomy
Click Image to Enlarge

Reasons for the procedure

The goal of radical prostatectomy is to remove all prostate cancer. RP is used when the cancer is believed to be confined to the prostate gland. During the procedure, the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. The seminal vesicles are the two sacs that connect to the vas deferens (a tube running through the testicles), and secrete semen.

Other less common reasons for radical prostatectomy include, but are not limited to, the following:

There may be other reasons for your doctor to recommend a prostatectomy.

Risks of the procedure

As with any surgical procedure, certain complications can occur. Some possible complications of both the retropubic and perineal approaches to RP may include, but are not limited to, the following:

Some risks associated with surgery and anesthesia in general include, but are not limited to:

One risk associated with the retropubic approach is the potential for rectal injury, causing fecal incontinence or urgency.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

Some things you can expect before the procedure include:

During the procedure

Radical prostatectomy requires a stay in the hospital. Procedures may vary depending on your condition and your doctor's practices.

Generally, a radical prostatectomy (retropubic or perineal approach) follows this process:

  1. You'll be asked to remove any jewelry or other objects that may interfere with the procedure.
  2. You'll be asked to remove your clothing and will be given a gown to wear.
  3. You'll be asked to empty your bladder prior to the procedure.
  4. An intravenous (IV) line will be started in your arm or hand.
  5. If there is excessive hair at the surgical site, it may be clipped off.
  6. The skin over the surgical site will be cleansed with an antiseptic solution.
  7. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  8. Once you're sedated, a breathing tube may be inserted through your throat into your lungs and you'll be connected to a ventilator, which will breathe for you during the surgery.
  9. The doctor may choose regional anesthesia instead of general anesthesia. Regional anesthesia is medication delivered through an epidural (in the back) to numb the area to be operated on. You'll receive medication to help you relax and analgesic medication for pain relief. The doctor will determine which type of anesthesia is appropriate for your situation.
  10. A catheter will be inserted into your bladder to drain urine.

Radical prostatectomy, retropubic or suprapubic approach

  1. You'll be positioned on the operating table, lying on your back.
  2. An incision will be made from below the navel (belly button) to the pubic region.
  3. The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra (narrow channel through which urine passes from the bladder out of the body) will be identified. The seminal vesicles may also be removed if necessary.
  4. The prostate gland will be removed.
  5. A drain will be inserted, usually in the right lower area of the incision.

Radical prostatectomy, perineal approach

  1. You'll be placed in a supine (lying on your back) position in which the hips and knees will be fully bent with the legs spread apart and elevated with the feet resting on straps. Stirrups will be placed under your legs for support.
  2. An upside-down, U-shaped incision will be made in the perineal area (between the scrotum and the anus.)
  3. The doctor will try to minimize any trauma to the nerve bundles in the prostate area.
  4. The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.
  5. The seminal vesicles (a pair of pouch-like glands located on each side of the male urinary bladder that secrete seminal fluid and promote the movement of sperm through the urethra) may be removed if there concern about abnormal tissue in the vesicles.

Procedure completion, both methods

  1. The incisions will be sutured back together.
  2. A sterile bandage/dressing will be applied.
  3. You'll be transferred from the operating table to a bed, then taken to the post-anesthesia care unit.

After the procedure

After the procedure, you may be taken to the recovery room to be closely monitored. You will be connected to monitors that will constantly display your heart beat (electrocardiogram—ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.

You may receive pain medication as needed, either by a nurse, or by administering it yourself through a device connected to your intravenous line.

Once you're awake and your condition has stabilized, you may start liquids to drink. Your diet may be gradually advanced to more solid foods as you are able to tolerate them.

The drain will generally be removed the day after surgery.

Your activity will be gradually increased as you get out of bed and walk around for longer periods of time.

The urinary catheter will stay in place upon discharge and for about one to three weeks after surgery. You'll be given instructions on how to care for your catheter at home.

Arrangements will be made for a follow-up visit with your doctor.

At home

Once you're home, it'll be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, in the event they weren't removed before leaving the hospital.

The surgical incision may be tender or sore for several days after a prostatectomy. Take a pain reliever for soreness as recommended by your doctor.

You shouldn't drive until your physician tells you to. Other activity restrictions may apply.

Once your catheter is removed, you'll probably have some leaking of urine. The length of time this occurs can vary.

Your doctor will give you suggestions for improving your bladder control. Over the next few months, you and your doctor will be assessing any side effects and working to improve problems with erectile dysfunction.

Notify your doctor to report any of the following:

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and wasn't designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we don't control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Cancer Society

American Urological Association

American Urological Association Foundation

National Association for Continence

National Cancer Institute (NCI)

National Coalition for Cancer Survivorship

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Prostate Cancer Foundation

 

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