What is a prostatectomy?
A prostatectomy could be a surgical procedure for the partial or complete removal of the prostate. it’s going to be performed to treat prostate cancer or benign prostatic hyperplasia.
A common surgical approach to prostatectomy includes creating a surgical incision and removing the prostate gland (or a part of it). this might be accomplished with either of two strategies, the retropubic or suprapubic incision (lower abdomen), or a perineum incision (through the skin between the scrotum and therefore the rectum).
Prior to having a prostatectomy, it’s typically necessary to own a prostate biopsy.
Types of surgery
There are several ways of removing the prostate.
Keyhole surgery (also called laparoscopy or minimally invasive surgery).
- Keyhole surgery by hand – your surgeon makes five or six small cuts in your abdomen (stomach area) and removes the prostate using a thin, lighted tube with a small camera on the tip and special surgical tools.
- Robot-assisted surgery – your surgeon uses three robotic arms (one for the camera and two for the surgical tools) to do the operation. Your surgeon controls the robotic arms from a computer. You may hear this called the ‘Da Vinci® Robot’.
Your surgeon makes a single cut in your stomach area to reach the prostate. This is called retropubic prostatectomy.
- Radical prostatectomy with retropubic (suprapubic) approach. This is the most common surgical approach used by urologists (doctors who specialize in diseases and surgery of the urinary tract). 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. If that’s the case, then surgery may be discontinued, since it won’t treat the cancer adequately. In this situation, additional treatments may be used.
- 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. This won’t improve over time (although there are interventions that may restore erectile function).
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 prostatectomy. 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 less frequently than the retropubic approach. This is because the nerves can’t be spared as easily, nor can lymph nodes be removed by using this surgical technique. However, 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.
What are the advantages and disadvantages?
- If the cancer is completely contained inside the prostate, surgery will aim to remove all of it.
- The prostate is removed and sent for testing which will give a clearer picture about how aggressive the cancer is and how far it may have spread.
- It is easy to measure the success of your surgery, as your PSA should drop to less than 0.1 ng/ml at six to eight weeks after the operation.
- If your PSA starts to rise, you may be able to have radiotherapy or hormone therapy.
- There are risks in having a surgery, as with any major operation.
- You will need to stay in hospital – this may be for one to seven days.
- If the cancer has broken out of the prostate, the surgeon may not be able to remove all of it.
- You won’t be able to have children naturally after surgery.
Before the procedure
Some things you can expect before the procedure include:
- Your doctor will explain the procedure to you and offer you the opportunity to ask any questions you might have about the procedure.
- You’ll be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something isn’t clear.
- In addition to a complete medical history, your doctor may perform a physical examination to ensure you’re in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.
- You’ll be asked to fast for eight hours before the procedure, generally after midnight.
- 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 any anticoagulant (blood-thinning) 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
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:
- 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.
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.
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