A radical prostatectomy is the surgical removal of the entire prostate. The seminal vesicles and some of the pelvic lymph nodes may also be removed.
The procedure is carried out in a hospital under general or spinal anaesthetic.
The surgeon makes an incision in the lower part of the abdomen, between the navel and the base of the penis.The surgery will be completed through this incision.
The surgery will include the removal of the entire prostate, the associated seminal vesicles, and (often but not always) some of the pelvic lymph nodes to see whether cancer has spread into these nodes. After removal of the relevant organs, the surgeon will reconnect the urethra to the bladder so that urinary function is restored.
Most patients stay in hospital for two to three days after an open radical prostatectomy.
All patients will initially require a urinary catheter (a tube that runs up through the penis into the bladder). The primary reason for the catheter is to ensure healing of the connection between the bladder and the urethra in the proper anatomical position (the tube will be removed after around ten days).
Most patients do not pass intestinal gas for one to two days and do not have a bowel movement prior to the third day after surgery, depending on how much narcotic pain medication they have had. There may be further short term issues with passing bowel motions.
Immediately following surgery almost every patient will experience temporary incontinence (loss of bladder control) and impotence (loss of erections). A high level of urinary control will start to return within weeks or a couple of months. However, recovery of erectile function normally takes significantly longer. It can take weeks or months for urinary and sexual function to return to normal.
Seeing blood in the urine is quite common for the first six weeks, however, excessive bleeding or burning when passing urine, or a frequent need to pass urine should be reported.
Pain after an open radical prostatectomy can generally be controlled with prescription pain medications.
The Risks of Open Radical Prostatectomy
All surgical procedures are associated with some risk. The specific risks relating to open radical prostatectomy are outlined below:
- Infection – any incision poses a risk of infection however this is minimised by administering antibiotics post operatively.
- Bleeding – this is minimal during Open Prostatectomy and very rarely would a blood transfusion be needed.
- Incontinence (loss of urine without control) – once the catheter is removed you may experience some incontinence particularly when coughing. You may need to wear pads in your underwear initially. The length of time this is required varies but, in most cases, is resolved within 4-6 months.
- Impotence (loss of erections) – even if the nerves that control erections are preserved it is likely that there will be a degree of impotence. However in virtually all cases potency can be regained with the use of tablets, injection therapy, vacuum devices or implants.
If you’re interested in having an open radical prostatectomy at Grace Hospital to treat your prostate cancer, contact your GP for a referral to Andre Westenberg.