What is radical prostatectomy?
Radical prostatectomy is an operation or surgery to remove the prostate gland and surrounding tissues. It is the most common operation for prostate cancer. This usually includes the seminal vesicles and some nearby associated lymph nodes. Radical prostatectomy can cure prostate cancer in men whose cancer is limited to the prostate if in early stages.
Who should undergo radical prostatectomy?
Men younger than the age group of 65 to 70 years with early stages of prostate cancer who are expected to live at least 10 more years tend to get the best benefit from radical prostatectomy.
Types of radical prostatectomy:
The prostate gland is just under the bladder right in front of the rectum. Surgeons may choose from two different approaches to reach and remove the prostate during a radical prostatectomy.
The traditional approach is known as open prostatectomy. The other more recent approach is minimally invasive. Two minimally invasive procedures used in radical prostatectomy laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy or robotic surgery.
A radical prostatectomy means an operation to remove the whole of the prostate gland. A specialist surgeon removes the prostate through a cut or incision made in your abdomen or between the testicles and the back passage.
The aim of this surgery is to remove the cancer or the malignant portion. The surgeon may suggest radical prostatectomy if the cancer has not spread outside the prostate.
Keyhole surgery (laparoscopic prostatectomy):
Quite often a radical prostatectomy is done using keyhole (laparoscopic) surgery. The key-hole surgery is assisted by a small camera inserted through a tube. The surgeon makes the incision and extracts the targeted area which is malignant.
Robot assisted surgery:
Robot assisted surgery is similar to a laparoscopic surgery. One has several small cuts in the abdomen. The surgeon controls the instruments and camera using a machine (robot). It is sometimes called d Vinci surgery.
Side effects of the surgery:
Radical prostatectomy is major surgery with certain possible side effects. In aging persons cancer also ages slowly, the main aim of prostrate surgery is to increase the life span, which may not be viable in such cases.
Risks of surgery include:
- Bleeding and the possible need for a blood transfusion to replace the lost blood.
- Injury to nearby organs such as the bowel and nerves
- Blood clots in the lower leg that may travel to the lung
- Wound infection
- Effects such as leaking urine and erection problems.
- Surgeons who do at least 20 radical prostatectomies each year and ideally more than 35 surgeries a year have better results including lower rates of side effects as they become well versed with it.
What are the advantages and disadvantages of the surgery?
The advantages and disadvantages of all types of surgery depend on factors such as age, health and the stage of the cancer.
- If the malignancy is in the prostate then the best results are achieved.
- The prostate removed is sent for testing which will give a clear picture about the extent of malignancy.
- There are risks in having a surgery as with any major operation.
- One will need to stay in hospital this may be for one to seven days.
- One won’t be able to have children naturally after surgery.
Extent of Hospital stay:
You can usually go home about 3 to 7 days after open prostatectomy and 1 or 2 days after keyhole surgery.
How the surgery will be performed?
Removing the prostate gland is done by specialist oncologists. They take out the whole prostate gland with the aim of getting rid of cancer and arresting its malignancy. The surgeon makes an incision in the abdomen or between the testicles and the back passage. This operation called open prostatectomy. As well as the prostate gland the surgeon also removes the surrounding tissues the lymph nodes and the tubes that carry semen (seminal vesicles). The surgeon closes the wound.
Often the prostate can be removed using keyhole surgery. The surgeon uses a tube with alight and eyepiece to look inside the body. They fill the abdomen with carbon dioxide gas so they can see the prostate clearly. A tiny video camera gives a magnified view of the prostate gland on a video screen. The surgeon cuts away or removes the prostate gland from the surrounding tissue and puts it in a small bag before removing it through one of the cuts in the abdomen.
The main difference with this surgery is that you won’t have big wound in your abdomen; instead you have several small cuts in the targeted area.
Most studies have shown that laparoscopic surgery is as good as open surgery. Most men recover and go back to normal activities more quickly than with open radical prostatectomy surgery. Two of the most common side effects of prostatectomy are problems with control over when to pass urine and inability to have an erection. There doesn’t seem to be any difference in the number of men who have these side effects after open prostatectomy or after laparoscopic prostatectomy.
Robotic assisted prostatectomy is a new type of keyhole surgery for prostate cancer. It also called da Vinci surgery. A surgeon uses a special machine (robot) during the operation. Doctors need to have special training before they can carry out this type of surgery. At KIMS, we have gained this expertise in robotic surgeries and the success rate is quite amazing.
Before the operation:
A few weeks before the operation you will have tests at the hospital to make sure you are fit enough for the surgery. Doing pelvic floor muscle exercises for a few weeks before your operation may help you recover more quickly from urinary problems caused by surgery.
Blood thinning medications must be stopped one week prior to the surgery.
The operation will take two to four hours. You will be administered a general anaesthetic so you will be asleep during operation.
There are two bundles of nerves attached to the prostate which control erection activity. Theses nerves can be damaged during the operation and cause problems with getting an erection. Your surgeon will definitely try to save them. This is called nerve sparing surgery. If the cancer has spread too close to the nerves, your surgeon may need to remove one or both bundle of nerves. These nerves only control erections and do not damage general health.
After the operation:
One will have a thin tube called catheter passed through the penis into the bladder to drain urine out of your body. Mostly, men go home with the catheter. You will have a thin tube in your stomach area to drain fluids from the wound. This is usually removed 24 to 48 hours after the operation.
You will be given pain relieving drugs after the operation. These should control any pain you have and swelling around your testicles and penis.
Eating and drinking:
More fluids must be taken to remove unwanted toxins from the body. Diet as suggested by the dietician or the doctors must be followed.
Taking care after going home:
- Before you go home your nurse will show you how to look after your catheter.
- Urine infections can be common if one has a catheter in place.
- Always wash your hands before and after handling the catheter.
- Drink plenty of fluids. Your doctor and nurse should tell you how much.
- Eat plenty of fibre to avoid constipation as this can stop the catheter draining properly.
The catheter is removed at the hospital one to three weeks after the operation. This can be uncomfortable but it shouldn’t be painful. Your doctor or nurse will make sure you are able to urinate before you go home and have to manage on your own.
Going back to work:
Recovery usually is faster in robotic surgery or key hole procedure. Recovery is faster in younger patients. One can go back to work if one gains the energies to do so.
When to call your doctor?
- Your bladder feels full or you tend to notice your catheter isn’t draining urine.
- Your catheter leaks or falls out.
- Your urine contains blood clots turns cloudy dark red or has a strong smell associated.
- The area around your wound becomes red swollen or painful.
- You get cramps in your stomach that will not go away.
- You get pain or swelling in the legs.
Follow-up visits are a must as suggested.
The medications as suggested must be taken.
KIMS, is the first hospital in Hyderabad is pioneering in cancer research and using innovative cancer care methodologies in treating various cancers. Many robotic prostate surgeries are being performed with utmost precision and accuracy with excellent positive outcomes.