Nerve-Spanning Prostatectomy

What is a Prostatectomy?

A prostatectomy is the surgical removal of the prostate. The idea: “remove the cancerous organ to treat the patient.” Prostate surgery (prostatectomy) will help only those patients who have prostate cancer confined to the prostate and therefore no spread of cancer outside the prostate gland. In intermediate or high risk prostate cancer, radiographic imaging is used to check that the disease has not metastasized out of the prostate gland.

Radical prostatectomy is the removal of the entire prostate gland and possibly the seminal vesicles and surrounding nerves and veins. The part of the urethra travelling through the prostate gland is also removed. The two ends of remaining urethra are reattached in a connection called the anastomosis. Excising part of the urethra may lead to a penile shrinkage or shortening and incontinence.

What is the purpose of a prostatectomy?

The reason to perform a prostatectomy is to attempt to remove and cure prostate cancer. Prostatectomy can be an appropriate treatment for low, intermediate, and high risk cancer. Patients need to be adequately fit to undergo this major surgery.

Types of Prostate Surger

There are three types of prostate surgeries: retropubic, perineal, and laparoscopic/robotic. They are classified according to the incision site. All three can accommodate a “nerve sparing” or carefully dissecting the erectile nerves off of the prostate during removal.

  • Retropubic: The retropubic incision is made in the center of the lower abdomen and could be called open prostate surgery. The incision is from 8 to 10 centimeters long. The advantages of this technique include Pelvic lymph node dissection (PLND) and nerve-sparing.

  • Perineal: The 4 centimeter perineal incision is made in the perineum which comprises muscles and exterior skin between the scrotum and anal sphincter. Surgeons cannot perform the PLND during this procedure but is considered acceptable because PSA testing, DRE findings, and Gleason scoring are excellent indicators of lymph node metastasis.

  • Laparoscopic and Robotic: The laparoscope is a slender, tube-like instrument which allows the surgeon to see inside the abdominal cavity and excise the prostate through a series of small incisions rather than a long single one. Therobotic procedure uses the same incisions and tools but a surgeon uses robotic arms controlled by a console to perform the surgery remotely. From the patient’s point of view, the two are virtually identical.

What are common symptoms following my prostatectomy?

By the time you are discharged from the hospital, you should be independent in activity and with good pain control with the help of pain medication. A small amount of bleeding or blood stain on the surgical gauze dressing is expected. Sometimes the incision may separate slightly before healing. There may be some swelling, bruising, and firmness at the site of the incisions.

Excising part of the urethra may lead to a penile shrinkage or shortening. All prostate cancer treatments affect sexual potency and may cause erectile dysfunction. Surgeons try to preserve nerve function through the nerve-sparing technique. Nerve-sparing prostatectomy can be used only for patients who have small, localized tumors that do not touch the neurovascular nerve bundles. The technique helps men regain erectile function more quickly afterwards if they were potent beforehand.

Urinary incontinence (leakage of urine) is very common after surgery and often improves with pelvic muscle exercises and time. Men often need to use protective pads for urinary leakage until they rehabilitate the urinary sphincter muscle. It may take 12 to 18 months for full improvement. Some patients may have permanent incontinence. Rarely the leakage can be severe.

When should I seek advice from my physician?

You should contact your physician if you develop any of the following:

  1. Fevers that are consistently above 101 degrees Fahrenheit.
  2. Drainage of pus.
  3. Large amounts of continuing bleeding and swelling
  4. Uncontrolled pain or nausea.
  5. Shortness of breath
  6. Chest Pain
  7. Swelling in one leg more than the other
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