It refers to the surgical removal of part or all of the prostate gland.
It is the therapeutic approach commonly chosen to treat patients with prostate cancer that has not yet spread beyond the prostate gland, and surgery is therefore an appropriate option for patients with prostate cancer in T1 or T2.
The most common form is radical prostatectomy which involves the removal of the entire prostate together with part of the surrounding tissue and the seminal vesicles.
Types of prostatectomy
It is when the enlarged prostate is removed when it is enucleated by its capsule. The sphincter muscle and nerves remain intact. It is used to treat benign conditions such as enlarged prostate (benign prostatic hyperplasia or BPH).
Open focus or traditional prostatectomy
Here the surgeon operates through a single long incision in the patient’s flesh and removes the prostate and the surrounding tissues. There are two forms of open prostatectomy:
Radical retropubic prostatectomy : For this procedure, the incision is made between the navel and the pubic bone. The prostate gland and the surrounding tissues, as well as sometimes the lymph nodes, are carefully removed and special attention is paid not to damage the nerves of either side of the gland because these control the erection.
This is known as the nerve-sparing approach. If the cancer is growing too close to the nerves or already affects the nerves, it will be necessary to remove them and the patient will no longer be able to achieve spontaneous erections.
Radical perineal prostatectomy: For this procedure, the incision is made in the meat between the anus and scrotum and the prostate gland is removed. This approach is less popular, since it does not allow the removal of lymph nodes and nerves can not be easily saved.
On the other hand, the procedure is faster than radical retropubic prostatectomy and recovery may be less painful. Therefore, this procedure may be preferred by people who do not want the nerve-sparing procedure and do not need to remove their lymph nodes.
Laparoscopic radical prostatectomy
This modern form of radical prostatectomy involves only small incisions made for the insertion of a fiber optic instrument and four trocars or cutting instruments.
These are used to separate and remove the prostate, nearby tissue and lymph nodes.
Compared to open prostatectomy procedures, this more modern approach causes significantly less bleeding, allowing for a more stable surgical procedure and minimizing the need for longer transfusions or hospital stays and recovery time.
Robotic assisted laparoscopic prostatectomy (RALRP)
Another recent approach is the RALRP where, once again, only small incisions are made in the patient’s abdomen but, during this procedure, the insertion and manipulation of the surgical instruments is controlled remotely using a robotic interface.
The surgeon sits on a control panel a short distance from the operating table and controls the instruments with robotic arms.
The advantages of RALRP are similar to those of the direct LRP, since the patient loses less blood and is less likely to suffer pain or need a long hospital stay or recovery time.
However, until now, there does not seem to be a significant benefit of RALRP over direct LRP.
Risks and side effects
There are some risks associated with the procedure, as with any major surgery. These include:
- Deep venous thrombosis.
- Urinary tract infection (UTI).
Prostatectomy is a life saving procedure, however, there are some possible side effects.
These include erectile dysfunction due to injury to the nerves surrounding the penis, urinary incontinence due to injury to the nerves or the urinary sphincter, or urinary obstruction (which is rare) where scar tissue forms at the point where the urethra turns to connect to the bladder. The transfusion rate is also very low.
After the procedure, patients are taken to recovery and monitored closely. The stay in the hospital depends on multiple factors.
Patients will have a urinary catheter in the bladder after surgery to drain the urine. This will remain for approximately 1 week after the surgery.
There will also be a drainage tube that will be removed within a day or two of the surgery, depending on the level of drainage. Patients will be taught how to care for their catheter when they are at home.
Once discharged from the hospital, patients should take special care not to risk further injuries or complications. The surgical area should remain dry and clean; Specific bathing methods will be provided by your doctor.
Full recovery can take up to six weeks. During this time, driving, lifting heavy objects and exercising is discouraged. Your doctor will notify you when you can return to work.