Prostatectomy types: Radical Prostatectomy | Johns Hopkins Medicine

25.07.202321.06.2023 by alexxlab

Radical Prostatectomy | Johns Hopkins Medicine

Procedure overview

What is a prostatectomy?

A prostatectomy is a surgical procedure for the partial or complete removal
of the prostate. It may be performed to treat

prostate cancer

benign prostatic hyperplasia.

A common surgical approach to prostatectomy includes making a surgical
incision and removing the prostate gland (or part of it). This may be
accomplished with either of two methods, the retropubic or suprapubic
incision (lower abdomen), or a perineum incision (through the skin between
the scrotum and the rectum).

Prior to having a prostatectomy, it’s often necessary to have a

prostate biopsy

. Please see this procedure for additional information.

What is the prostate gland?

The prostate gland is about the size of a walnut and surrounds the neck of
a man’s bladder and urethra—the tube that carries urine from the bladder.
It’s partly muscular and partly glandular, with ducts opening into the
prostatic portion of the urethra. It’s made up of three lobes, a center
lobe with one lobe on each side.

As part of the male reproductive system, the prostate gland’s primary
function is to secrete a slightly alkaline fluid that forms part of the
seminal fluid (semen), a fluid that carries sperm. During male climax
(orgasm), the muscular glands of the prostate help to propel the prostate
fluid, in addition to sperm that was produced in the testicles, into the
urethra. The semen then travels through the tip of the penis during
ejaculation.

Researchers don’t know all the functions of the prostate gland. However,
the prostate gland plays an important role in both sexual and urinary
function. It’s common for the prostate gland to become enlarged as a man
ages, and it’s also likely for a man to encounter some type of prostate
problem in his lifetime.

Many common problems that don’t require a radical prostatectomy are
associated with the prostate gland. These problems may occur in men of all
ages and include:

Benign prostatic hyperplasia (BPH)
.

This is an age-related enlargement of the prostate that isn’t
malignant. BPH is the most common noncancerous prostate problem,
occurring in most men by the time they reach their 60s. Symptoms
are slow, interrupted, or weak urinary stream; urgency with leaking
or dribbling; and frequent urination, especially at night. Although
it isn’t cancer, BPH symptoms are often similar to those of
prostate cancer.
Prostatism.
This involves decreased urinary force due to obstruction of flow
through the prostate gland. The most common cause of prostatism is
BPH.
Prostatitis.
Prostatitis is inflammation or infection of the prostate gland
characterized by discomfort, pain, frequent or infrequent
urination, and, sometimes, fever.
Prostatalgia.
This involves pain in the prostate gland, also called
prostatodynia. It’s frequently a symptom of prostatitis.

Cancer of the prostate is a common and serious health concern. According to
the American Cancer Society, prostate cancer is the most common form of
cancer in men older than age 50, and the third leading cause of death from
cancer.

There are different ways to achieve the goal of removing the prostate gland
when there’s cancer. Methods of performing prostatectomy include:

Surgical removal includes a radical prostatectomy (RP), with either
a retropubic or perineal approach. Radical prostatectomy is the
removal of the entire prostate gland. Nerve-sparing surgical
removal is important to preserve as much function as possible.
Transurethral resection of the prostate, or TURP, which also
involves removal of part of the prostate gland, is an approach
performed through the penis with an endoscope (small, flexible tube
with a light and a lens on the end). This procedure doesn’t cure
prostate cancer but can remove the obstruction while the doctors
plan for definitive treatment.
Laparoscopic surgery, done manually or by robot, is another method
of removal of the prostate gland.

Are there different types of radical prostatectomy?

There are several methods of radical 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.

Reasons for the procedure

The goal of radical prostatectomy is to remove all prostate cancer. RP is
used when the cancer is believed to be confined to the prostate gland.
During the procedure, the prostate gland and some tissue around the gland,
including the seminal vesicles, are removed. The seminal vesicles are the
two sacs that connect to the vas deferens (a tube running through the
testicles), and secrete semen.

Other less common reasons for radical prostatectomy include:

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)

There may be other reasons for your doctor to recommend a prostatectomy.

Risks of the procedure

As with any surgical procedure, certain complications can occur. Some
possible complications of both the retropubic and perineal approaches to RP
may include:

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.

Recovery of sexual function may take up to two years after surgery
and may not be complete. Nerve-sparing prostatectomy lessens the
chance of impotence, but doesn’t guarantee that it won’t happen.
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.

Some risks associated with surgery and anesthesia in general include:

One risk associated with the retropubic approach is the potential for
rectal injury, causing fecal incontinence or urgency.

There may be other risks depending on your specific medical condition. Be
sure to discuss any concerns with your doctor prior to the procedure.

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.
A catheter will be inserted into your bladder to drain urine.

Radical prostatectomy, retropubic or suprapubic approach

You’ll be positioned on the operating table, lying on your back.
An incision will be made from below the navel (belly button) to the
pubic region.
The doctor will usually perform a lymph node dissection first. The
nerve bundles will be released carefully from the prostate gland
and the urethra (narrow channel through which urine passes from the
bladder out of the body) will be identified. The seminal vesicles
may also be removed if necessary.
The prostate gland will be removed.
A drain will be inserted, usually in the right lower area of the
incision.

Radical prostatectomy, perineal approach

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.
The seminal vesicles (a pair of pouch-like glands located on each
side of the male urinary bladder that secrete 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.

At home

Once you’re home, it’ll be important to keep the surgical area clean and
dry. Your physician will give you specific bathing instructions. The
sutures or surgical staples will be removed during a follow-up office
visit, in the event they weren’t removed before leaving the hospital.

The surgical incision may be tender or sore for several days after a
prostatectomy. Take a pain reliever for soreness as recommended by your
doctor.

You shouldn’t drive until your doctor tells you to. Other activity
restrictions may apply.

Once your catheter is removed, you’ll probably have some leaking of urine.
The length of time this occurs can vary.

Your doctor will give you suggestions for improving your bladder control.
Over the next few months, you and your physician will be assessing any side
effects and working to improve problems with erectile dysfunction.

Notify your physician to report any of the following:

Fever and/or chills
Redness, swelling, or bleeding or other drainage from the incision
site
Increase in pain around the incision site
Inability to have a bowel movement
Inability to urinate once catheter is removed

Your doctor may give you additional or alternate instructions after the
procedure, depending on your particular situation.

Radical prostatectomy: MedlinePlus Medical Encyclopedia

Radical prostatectomy (prostate removal) is surgery to remove all of the prostate gland and some of the tissue around it. It is done to treat prostate cancer.

There are 4 main types or techniques of radical prostatectomy surgery. These procedures take about 2 to 4 hours:

Retropubic — Your surgeon will make a cut starting just below your belly button that reaches to your pubic bone. This surgery takes 90 minutes to 4 hours.
Laparoscopic — The surgeon makes several small cuts instead of one big cut. Long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts. This allows the surgeon to see inside your belly during the procedure.
Robotic surgery — Laparoscopic surgery is performed using a robotic system. The surgeon moves the instruments and camera using robotic arms while sitting at a control console near the operating table. Not every hospital offers robotic surgery.
Perineal — Your surgeon makes a cut in the skin between your anus and the base of the scrotum (the perineum). The cut is smaller than with the retropubic technique. This type of surgery often takes less time and causes less loss of blood. However, it is harder for the surgeon to avoid damaging the nerves around the prostate or to remove nearby lymph nodes with this technique. This surgery is rarely done.

For these procedures, you may have general anesthesia so that you are asleep and pain free. Or, you will get medicine to numb the lower half of your body (spinal or epidural anesthesia).

The surgeon removes the prostate gland from the surrounding tissue. The seminal vesicles, two small fluid-filled sacs next to your prostate, are also removed.
The surgeon will take care to cause as little damage as possible to the nerves and blood vessels.
The surgeon reattaches the urethra to a part of the bladder called the bladder neck. The urethra is the tube that carries urine from the bladder out through the penis.
Your surgeon may also remove lymph nodes in the pelvis to check them for cancer.
A drain, called a Jackson-Pratt drain, may be left in your belly to drain extra fluid after surgery.
A tube (catheter) is left in your urethra and bladder to drain urine. This will stay in place for a few days to a few weeks.

Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. This is called localized prostate cancer.

Your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your doctor may talk with you about other treatments that could be good for your cancer. These treatments may be used instead of surgery or after surgery has been performed.

Factors to consider when choosing a type of surgery include your age and other medical problems. Radical prostatectomy is often done on healthy men who are expected to live for 10 or more years after the procedure.

Risks of this procedure are:

Problems controlling urine (urinary incontinence)
Erection problems (impotence)
Injury to the rectum
Urethral stricture (tightening of the urinary opening due to scar tissue)

You may have several visits with your health care provider. You will have a complete physical exam and may have other tests. Your provider will make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being controlled.

If you smoke, you should stop several weeks before the surgery. Your provider can help.

Always tell your provider what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the weeks before your surgery:

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other blood thinners or drugs that make it hard for your blood to clot.
Ask which drugs you should still take on the day of your surgery.
On the day before your surgery, drink only clear fluids.
Sometimes, you may be asked by your provider to take a special laxative on the day before your surgery. This will clean the contents out of your colon.

On the day of your surgery:

Do not eat or drink anything after midnight the night before your surgery.
Take the drugs you have been told to take with a small sip of water.
You will be told when to arrive at the hospital. Be sure to arrive on time.

Prepare your home for when you come home after the surgery.

Most people stay in the hospital for 1 to 4 days. After laparoscopic or robotic surgery, you may go home the day after the procedure.

You may need to stay in bed until the morning after surgery. You will be encouraged to move around as much as possible after that.

Your nurse will help you change positions in bed and show you exercises to keep blood flowing. You will also learn coughing or deep breathing to prevent pneumonia. You should do these steps every 1 to 2 hours. You may need to use a breathing device called an incentive spirometer to keep your lungs clear.

After your surgery, you may:

Wear special stockings on your legs to prevent blood clots.
Receive pain medicine in your veins or take pain pills.
Feel spasms in your bladder.
Have a Foley catheter in your bladder when you return home.

The surgery should remove all of the cancer cells. However, you will be monitored carefully to make sure the cancer does not come back. You should have regular checkups, including prostate specific antigen (PSA) blood tests.

Depending on the pathology results and PSA test results after prostate removal, your provider may discuss radiation therapy or hormone therapy with you.

Prostatectomy – radical; Radical retropubic prostatectomy; Radical perineal prostatectomy; Laparoscopic radical prostatectomy; LRP; Robotic-assisted laparoscopic prostatectomy; RALP; Pelvic lymphadenectomy; Prostate cancer – prostatectomy; Prostate removal – radical

Bathroom safety for adults

Indwelling catheter care

Kegel exercises – self-care

Prostate brachytherapy – discharge

Radical prostatectomy – discharge

Suprapubic catheter care

Surgical wound care – open

Urinary incontinence products – self-care

Urine drainage bags

When you have nausea and vomiting

When you have urinary incontinence

Costello AJ. Considering the role of radical prostatectomy in 21st century prostate cancer care. Nat Rev Urol. 2020;17(3):177-188. PMID: 32086498 pubmed.ncbi.nlm.nih.gov/32086498/.

Ellison JS, He C, Wood DP. Early postoperative urinary and sexual function predicts functional recovery 1 year after prostatectomy. J Urol. 2013;190(4):1233-1238. PMID: 23608677 pubmed.ncbi.nlm.nih.gov/23608677/.

Li-Ming S, Otto BJ, Costello AJ. Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 156.

National Cancer Institute website. Prostate cancer treatment (PDQ) – health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated October 14, 2022. Accessed February 1, 2023.

Schaeffer EM, Partin AW, Lepor H. Open radical prostatectomy. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 155.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Prostatectomy ▷ methods, definition and specialist

A prostatectomy is an operation to remove the prostate gland. There are various surgical methods by which a complete or partial resection of the prostate is performed. Since this is a complex procedure that has long-term consequences for those who have it, there is a need for research to develop new, more gentle methods. The choice of procedure in which the patient can achieve the best results always depends on the individual situation and the experience of the surgeon.

Prostatectomy is the standard treatment for the following conditions:

Prostate cancer

: For malignant prostate carcinoma, radical prostatectomy is the standard urological procedure. The type of operation and access primarily depends on the wishes of the patient and the experience of the surgeon.
Enlargement of the prostate (prostatic hyperplasia)

: for benign prostatic hyperplasia (prostate), partial prostatectomy (partial removal of the prostate gland) is often performed.

Prostatectomy is divided into partial (partial prostatectomy) and complete removal of the organ (radical prostatectomy).

Radical Prostatectomy: An Overview of Surgical Techniques

There are open surgical methods and minimally invasive procedures for complete removal of the prostate gland.

Open Operations

Radical retropubic prostatectomy (RPP)
Radical perineal prostatectomy (RPPP)

Minimally Invasive Surgery

Laparoscopic transperitoneal radical prostatectomy
Endoscopic Extraperitoneal Radical Prostatectomy
Robotic Radical Prostatectomy (RARP) (da Vinci® System)

)

RP is performed from the side of the patient’s abdomen (incision in the lower abdomen), and RP is performed from the side of the perineum, that is, in the area between the scrotum and anus (= incision between the anus and the penis). Retropubic prostatectomy is the most common option. A surgical technique such as robotic radical prostatectomy is gaining more and more importance.

In a radical prostatectomy, the prostate gland is removed along with the seminal vesicles, vas deferens, and internal urethral sphincter. The urethra, which passes through the center of the prostate, must be incised and sutured again. Depending on the risk of metastasis, nearby lymph nodes in the pelvis are removed.

Radical prostatectomy is used in the treatment of prostate tumors. If prostate cancer is limited to the gland and surrounding lymph nodes, there is a real chance of recovery after removal of the organ.

Partial Prostatectomy: Surgical Techniques

When partially removing the prostate, two methods are mainly used.

transurethral resection of the prostate (TURP, “cutting” enlarged prostate tissue through the urethra),
transurethral incision of the prostate (TUIP).

These procedures easily eliminate benign prostatic hyperplasia (prostate enlargement), however, side effects are quite common. If a man often suffers from urinary tract infections or bladder stones, there is a need for these operations.

The TURP procedure, which is currently the standard treatment for hyperplasia, uses thin surgical instruments that are advanced up to the prostate through the urethra. The prostate surrounds the urethra, therefore, it is very convenient to get to the inside of the gland transurethral (through the urethra). Benign changes in the prostate are usually found inside the gland, while malignant changes are mostly outside, so access through the urethra in the case of removal of prostate carcinoma is impractical. In TURP, enlarged gland tissue is cut and removed with an electrical wire loop.

In TUIP, one or two incisions are made in the prostate and the space for the compressed urethra is enlarged. This intervention rarely causes bleeding and is applicable only for mild prostate enlargement and may require a second procedure.

Side effects after partial prostatectomy, especially after TURP, are unfortunately quite common. For example, retrograde ejaculation (dry ejaculation) is common. In this case, due to damage to muscle structures, an erroneous redirection of sperm towards the bladder may occur. Retrograde ejaculation does not cause pain or changes in sensation during orgasm, but it reduces the patient’s fertility. Erectile function may also worsen after TURP, however, long-term problems are rare. Another consequence of TURP is frequent inflammation of the urinary tract and sometimes urinary incontinence (loss of control over urination).

Since the prostate is in close proximity to various structures and organs, radical prostatectomy is an extremely complex operation. The gland is difficult to access from the outside and is entwined with a thin network of nerves, which, in particular, are responsible for erectile function and urinary retention. The surgeon always strives to preserve the nerves and therefore erectile function and the ability to control urination, but this is not always possible. Depending on the spread of the tumor and the experience of the surgeon, up to 80% of men remain permanently impotent.

A temporary side effect is urinary incontinence after radical prostatectomy (unintentional loss of urine). More than half of men suffer from it within a certain period of time (weeks/months). Only 5-10% of patients develop permanent urinary incontinence.

An experienced surgeon compares different surgical methods based on their results and complication rates. During laparoscopic and robotic operations, blood loss, the amount of painkillers, and the patient’s stay in the hospital are reduced, but the time of the procedure itself increases, and the technique and its mastering by the doctor become more complicated.

Recent studies show that potency (erectile function) and continence (urinary retention) tend to deteriorate with laparoscopic (minimally invasive) surgery. There are fewer long-term side effects (loss of continence and potency) with robotic laparoscopic surgery than with laparoscopic surgery.

After a radical prostatectomy, the ability to have children is usually lost, since the seminal vesicles are removed during the operation. When planning children, the patient should consider freezing sperm before surgery.

As an alternative to partial prostatectomy, there is the possibility of laser or thermal exposure (

TUIA – transurethral needle ablation of the prostate

). With this therapy, the prostate can be successfully reduced. Currently, these therapeutic approaches are not included in standard treatment, but their initial results are very satisfactory and commensurate with TURP.

Alternatives to radical prostatectomy for prostate cancer are universal. Possible methods of treatment always depend on the stage of the disease, the experience of the doctor and, most importantly, on the wishes of the patient. So at an early stage there is a “wait and see” tactic in which active and careful control is exercised.

In addition, there is the possibility of radiation, hormonal therapy, chemotherapy, immunotherapy,

HIFU therapy

And

radionuclide therapy (PSMA)

. Doctors often use a combination of several of these treatment options. Complete cure of the tumor, as a rule, is possible only with surgical removal or radiation therapy.

Radical prostatectomy

Information for patients

Radical prostatectomy is a surgical treatment aimed at removing the prostate gland with seminal vesicles in prostate cancer, which is the “gold standard” for the treatment of localized prostate cancer.

Types of radical prostatectomy

Retroperitoneal – performed by an open and endoscopic method with small incisions above the pubis using magnifying binocular loupes or endoscopic equipment.
Laparoscopic – performed using access through the abdominal cavity using endoscopic equipment and the use of 5 – 6 ports for access to the prostate gland, and in recent years, robot-assisted laparoscopic prostatectomy has gained popularity.

The use of endoscopic and laparoscopic techniques allows minimizing the number of postoperative complications, reduces the length of inpatient stay, reduces postoperative pain and blood loss during surgery.

Operational milestones

Surgical treatment is performed under anesthesia and lasts 3-6 hours. The first step, as a rule, is the removal of lymph nodes for staging the process. Further, depending on the technique, the direct removal of the prostate gland is performed. The final step to restore the patency of the urinary tract is a vesicourethral anastomosis, which requires the installation of a urethral catheter for 7-10 days.

Rehabilitation

After surgical treatment, patients require inpatient treatment for 4-7 days, depending on the severity of the condition. With early discharge, the removal of the urethral catheter is performed on an outpatient basis. Urination disorders in the form of frequent urination, urinary incontinence usually resolve on their own in a period of several weeks to several months.

Monitoring patients with tumors of the genitourinary system requires a meeting with a specialist once every 6 months for the first 2 years, and then annually until the end of life for early diagnosis of possible recurrence of tumors.

At the Medical Center “Consultant” you can screen for prostate cancer with a map of further treatment. Radical prostatectomy is the “gold standard” treatment for localized prostate cancer.

Our urologists, oncologists conduct active dispensary monitoring of patients in the postoperative period and, if necessary, carry out and, if necessary, treat postoperative complications and relapses.

“Consultant” Medical Center

* The prices indicated on the site are not a public offer. The cost of services is set and paid according to the price list of the MC “Consultant”, valid at the time of the provision of the relevant service.