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What is Prostatectomy?
Prostatectomy is an operation to remove the prostate gland and tissues surrounding it. This usually includes the seminal vesicles and some nearby lymph nodes. Radical prostatectomy can cure prostate cancer in men whose cancer is limited to the prostate.
Types of Prostatectomy
Radical prostatectomy with retropubic (suprapubic) approach. If there's reason to believe the cancer has spread to the lymph nodes, the doctor will remove lymph nodes from around the prostate gland, in addition to the prostate gland. Cancer has spread beyond the prostate gland if it's found in the lymph nodes.
Nerve-sparing prostatectomy approach. If the cancer is tangled with the nerves, it may not be possible to maintain the nerve function or structure. Sometimes nerves must be cut in order to remove the cancerous tissue. If both sides of the nerves are cut or removed, the man will be unable to have an erection. If only one side of the bundle of nerves is cut or removed, the man may have less erectile function, but will possibly have some function left. If neither nerve bundle is disturbed during surgery, function may remain normal. However, it sometimes takes months after surgery to know whether a full recovery will occur. This is because the nerves are handled during surgery and may not function properly for a while after the procedure.
Laparoscopic radical prostatectomy. The surgeon makes several small cuts and long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts and instruments through others. This helps the surgeon see inside during the procedure.
Robotic-assisted laparoscopic Prostectomy. Sometimes laparoscopic surgery is done using a robotic system. The surgeon moves the robotic arm while sitting at a computer monitor near the operating table. This procedure requires special equipment and training. Not every hospital can do robotic surgery.
Radical prostatectomy with perineal approach. Radical perineal prostatectomy is used as this procedure takes less time and may be an option if the nerve-sparing approach isn't needed. This approach is also appropriate if lymph node removal isn't required. Perineal prostatectomy may be used if other medical conditions rule out using a retropubic approach. With the retropubic approach, there is a smaller, hidden incision for an improved cosmetic effect. Also, major muscle groups are avoided. Therefore, there's generally less pain and recovery time.
Why this surgery needs to be done?
Inability to completely empty the bladder
Recurrent bleeding from the prostate
Bladder stones with prostate enlargement
Very slow urination
Increased pressure on the ureters and kidneys from urinary retention (called hydronephrosis)
Urinary incontinence . Incontinence involves uncontrollable, involuntary leaking of urine, which may improve over time, even up to a year after surgery. This symptom may be worse if you're older than age 70 when the surgery is performed.
Urinary leakage or dribbling. This symptom is at its worst immediately after the surgery, and will usually improve over time.
Erectile dysfunction, also known as impotence.
Sterility. RP cuts the connection between the testicles and the urethra and causes retrograde ejaculation. This results in a man being unable to provide sperm for a biological child. A man may be able to have an orgasm, but there will be no ejaculate. In other words, the orgasm is "dry."
Lymphedema. Lymphedema is a condition in which fluid accumulates in the soft tissues, resulting in swelling. Lymphedema may be caused by inflammation, obstruction, or removal of the lymph nodes during surgery. Although this complication is rare, if lymph nodes are removed during prostatectomy, fluid may accumulate in the legs or genital region over time. Pain and swelling result. Physical therapy is usually helpful in treating the effects of lymphedema.
Change in penis length. A small percentage of surgeries will result in a decrease in penis length.
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential for rectal injury, causing fecal incontinence or urgency.
Before the procedure
Doctor will explain the procedure and may ask if you have any query.
You need to sign the consent form. Read carefully before signing the document.
Doctor may go for some tests to ensure you are in good health before the procedure.
You will be asked to fast for 8 hours.
Notify your doctor if you're sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).
Notify your doctor of all medications (prescribed and over the counter) and herbal supplements that you're taking.
Notify your doctor if you have a history of bleeding disorders or if you're taking anyblood tinner medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you smoke, you should stop smoking as soon as possible prior to the procedure in order to improve your chances for a successful recovery from surgery and to improve your overall health status.
You may receive a sedative prior to the procedure to help you relax.
Based on your medical condition, your doctor may request other specific preparation.
During the procedure
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.
An upside-down, U-shaped incision will be made in the perineal area (between the scrotum and the anus).
The doctor will try to minimize any trauma to the nerve bundles in the prostate area.
The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.
Generally, a radical prostatectomy (retropubic or perineal approach) follows this process:
You'll be asked to remove any jewelry or other objects that may interfere with the procedure.
You'll be asked to remove your clothing and will be given a gown to wear.
You'll be asked to empty your bladder prior to the procedure.
An intravenous (IV) line will be started in your arm or hand.
If there is excessive hair at the surgical site, it may be clipped off.
The skin over the surgical site will be cleansed with an antiseptic solution.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
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.
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.
A catheter will be inserted into your bladder to drain urine.
seminal fluid and promote the movement of sperm through the urethra) may be removed if there's concern about abnormal tissue in the vesicles.
Procedure completion, both methods
The incisions will be sutured back together.
A sterile bandage or dressing will be applied.
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'll 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're 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.
If you have any related query, you can send us your report on below mention email address or you can call us or whatsApp for any second opinion.
The major possible side effects of radical prostatectomy are urinary incontinence (being unable to control urine) and erectile dysfunction (impotence; problems getting or keeping erections). These side effects can also occur with other forms of prostate cancer treatment.
Most often, prostatectomy is done to treat localized prostate cancer. It may be used alone, or in conjunction with radiation, chemotherapy and hormone therapy. Radical prostatectomy is surgery to remove the entire prostate gland and surrounding lymph nodes to treat men with localized prostate cancer.
In addition, radiation can be given after surgery if necessary, with a limited risk of any additional side effects. Patients who choose radical prostatectomy should: Be in very good health. Have a life expectancy exceeding 10 years.
You no longer ejaculate semen if you have had a radical prostatectomy. This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
Your doctor may prescribe medications like sildenafil, vardenafil, or tadalafil after your surgery. These medications work by increasing blood flow to the penis, which may restore the ability to have an erection
Chemotherapy After Prostatectomy Delays Cancer Progression in Prostate Cancers. The use of chemotherapy following a radical prostatectomy delays the time to cancer progression among men with prostate cancer who are at a high risk of developing a recurrence.
One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.
Avoid carbonated beverages. Once you have had a bowel movement, you should move to a soft food diet of things like soups, scrambled eggs, toast, oatmeal etc. and then work your way back to your normal diet as you feel comfortable. Avoid gas-producing foods such as flour, beans, and broccoli.
Once you are ready, you should sit up and walk a few steps. Early walking is the key for fast recovery and return to bowel activity. It also improves blood circulation in the legs and prevents clot formation. The best way to a speedy recovery is to start walking the hallways on the day after surgery
You usually can return to normal activity, with minor restrictions, around four weeks after surgery. Simple prostatectomy provides long-term relief of urinary symptoms due to an enlarged prostate. Although it's the most invasive procedure to treat an enlarged prostate, serious complications are rare.
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