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Alternative Names
radical retropubic prostatectomy, radical perineal prostatectomy
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Definition
A radical prostatectomy is the removal of the entire prostate, including its
capsule, as well as the seminal vesicles. The prostate is a gland that surrounds the neck
of the bladder and the urethra in a male. The seminal vesicles lie behind the bladder and
near the prostate. They secrete a thick fluid that forms part of the semen.
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Who is a candidate for
the procedure?
This procedure is one of the treatments for prostate cancer. Men with prostate
cancer who have an estimated life expectancy of 10 years or more and who have localized
disease may be cured by this surgery.
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How is the
procedure performed?
The procedure is done under general or regional anesthesia.
General anesthesia means the person is put to sleep with medications. Regional anesthesia
means the person will be awake, but numb below the waist. A medication may be given to
make the person drowsy.
There are two distinct approaches to radical prostatectomy:
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The most common approach is radical retropubic prostatectomy. For this procedure,
an incision is made below the navel extending to just above the pubic bone to remove the
prostate.
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In the radical perineal prostatectomy, a smaller curved incision is made between
the anus and the base of the scrotum. The prostate is brought out from underneath the
pubic bone.
There are advantages and disadvantages to each approach. The
first approach has the advantage of allowing the surgeon to take a lymph node sample at
the same time as prostate removal. The perineal approach has a slightly shorter recovery
time.
After removal of the prostate, the urethra is sewn to the bladder neck. This repair is
done with sutures, or stitches, over a urinary catheter, which is a narrow tube that is
passed through the urethra into the bladder. Drains are placed around the site, and the
skin is closed.
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What happens right
after the procedure?
After the surgery, the man will be taken to the surgery recovery room to be
watched closely for a short time. Vital signs, blood pressure, pulse, and breathing will
be checked frequently. Urinary output will be monitored closely. The urine will be bloody
initially following this procedure.
The man is usually sent home with the urinary catheter in place 2 to 4 days after surgery.
This catheter is removed 1 to 3 weeks after the procedure.
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What happens later at home?
Instructions are given to the man and his family regarding care of the urinary
catheter. Visiting nurses are often available to help. Dressings are kept on the wounds
until they have dried up completely.
The primary means of assessing for recurrent disease following radical prostatectomy is
with the prostate specific antigen blood test, or PSA. The PSA level should fall to near
zero levels following this procedure.
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What
are the potential complications after the procedure?
Acute complications include bleeding, infection, damage to the rectum, and
allergic reaction to anesthesia.
The primary long-term complications are erectile dysfunction and urinary incontinence. The
incidence of erectile dysfunction varies widely. Surgeons are now using techniques to
spare the nerves that control erectile functioning. This decreases the incidence of
impotency.
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