OVERVIEW
Radical prostatectomy is the procedure of surgical excision of the prostate gland completely, lymph nodes or the vas deferens (ducts for ejaculation). This is done to prevent the spreading of any cancerous tissue from the prostate to other parts of the body. The procedure can be done either as an open surgery or by laparoscopic means and even by robotic mediation. The patient can recover fully within a few weeks to a month and can even undergo light exercise like walking soon and go on to live long.
Types
Laparoscopic radical prostatectomy / Robotic / Open Radical Prostectomy
BODY LOCATION
Laparoscopic radical prostatectomy is conducted in the prostate gland and the surrounding areas.
HOW IS IT PERFORMED?
There are mainly two types of procedure for radical prostatectomy:
1. Open radical prostatectomy
An incision is made at the lower abdominal area, and through this pore, the prostate and surrounding tissues are dissected from the body.
2. Robotic radical prostatectomy
Several very fine pores of diameter less than 0.1 cm are made on the lower abdomen, and the surgeon removes the prostate through robot mediated controls and 3D camera vision. The prostate and tissue specimens are removed through a small bag through one expanded pore.
Both the methods can be done by sparing the nerve bundles that control natural erection in males so as to prevent impotence post operation. But it can only be done when the cancer has not metastasized outside the prostate gland.
PREPARATION
Pre-Operative tests: The doctor will monitor the physical conditions as well as the previous medical history of the patient. The tests done before surgery are blood tests (like Prostate Specific Antigen or PSA, blood sugar, blood pressure, etc.), urine tests, transrectal USG and biopsy of the prostate gland, and also cystoscopy (visual examination of the urethra and bladder). Pelvic and lower abdominal MRI or and bone scan is also be recommended PSMA PET Scan is done to rule out metastasis.
When to get admitted to the hospital: Generally on the day of the surgery
Medication: Certain medications like blood thinners, pain killers, etc. would be restricted by the doctor before the surgery
Diet before surgery: Bowel prep diet is to be followed before surgery. This includes clear liquid meals and medications that help to clear the bowel and enema drugs that help to clear constipation
PROCEDURE TYPE
Radical prostatectomy can be done both by open surgical method as well as by non-invasive methods like Robotic.
FOLLOW UP
- Post-surgical follow-ups include pain medications through IV channels, followed by oral pain killer tablets.
- The doctor will suggest trying to walk by gradually stirring the feet and slowly the lower portion of the body post surgery.
- A liquid diet is mostly recommended during the hospital stay with semisolid foods.
- A drain is attached to the site of incision for removing excess fluid. The drain is removed after 1-2 days.
- Patients are generally discharged after two to three days after surgery, provided that all tests show positive results.
- Patients are discharged with a catheter attached to the bladder and a urine bag for urine disposal. The catheter should be cleaned occasionally, and any unnatural blood clots must be reported. This is removed after 5-14 days or as the doctor deems fit.
- Urine incontinence will continue even after catheter removal extending up to a year, during which the patient may use adult diapers.
RISKS
The risks associated with radical prostatectomy are as follows :
- Occasional bleeding
- Blood clotting
- Infection of the urinary tract
- Erectile dysfunction
- Urinary incontinence
- Hernia
- Breathing problems
- Lymphocele (Lymph filled cysts) may occur
- Contraction of the urethral and bladder opening
RECOVERY
Recovery after radical prostatectomy is a gradual process. Fatigue is common, but exercises like light yoga, walking, and meditation can help in healing, though heavy exercises are to be avoided.
Sexual healing can take months, and the doctor may prescribe certain erectile medications.
Urinary incontinence will slowly subside with regular workouts for bladder control.
Patients can go back to normal activities after 1-2 weeks post surgery, which may extend up to 4 weeks in case of open radical surgery.
Regular hospital checkups and PSA tests are to be done to look out for any cancerous reoccurrences.
Patients should communicate with friends and family and may even enroll to support groups to cope with the emotional turmoil.
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