Retropubic radical prostatectomy

Localized prostate cancer can be cured by radical prostatectomy. Most men will resume normal activities within a few months of surgery.

The prostate is a gland that surrounds the urethra, the urinary canal. It is located between the bladder and its controlling muscle, the urethral sphincter. Its main role is the production of semen that is ejaculated during the male orgasm. Each vas deferens transports sperm from the testes to the prostate. Erecting nerves responsible for erection are located on both sides of the prostate.

Prostate cancer can spread to surrounding tissues or spread to other parts of the body. Microscopic examination of prostate biopsies can diagnose cancer and make the prognosis of the tumor. This is called the tumor grade or Gleason scale.

If indicated, additional tests may be done to determine the extent or stage of the cancer. Your prostate cancer seems to be limited to the gland, but there is always the possibility of microscopic, undetectable spread.

You have discussed with your urologist some therapeutic options such as:

  • Observation without treatment (sometimes called “active observation”),
  • Surgical removal of the prostate, and,
  • Radiotherapy (external and / or implantation of radioactive granules, ie brachytherapy).

Each option has its advantages and disadvantages.

Radical prostatectomy means the complete removal of the prostate and the seminal glands attached to it, the seminal vesicles, for the purpose of curing prostate cancer. Radical prostatectomy is indicated for men with localized prostate cancer, good health, and a life expectancy of at least 10 years.

Pre-operative preparation

Laboratory tests can be done pre-operatively.

One could recommend an intestinal preparation before your surgery. The prostate is confined to the intestines. In the rare event of intestinal trauma during surgery, the risk of serious complications is reduced when the intestine is empty. Your urologist will inform you of the intestinal preparation that is indicated. You may be asked to drink an evacuating solution, give you antibiotics and / or an enema.

To prevent the risk of bleeding and any suspected drug interactions, it is recommended that you discontinue aspirin, ibuprofen, anticoagulants, and any vitamins or natural supplements at least one week before surgery. Other drugs should be continued normally. Do not hesitate to consult your urologist if you have questions about your medications.

You must be fasting without drinking or eating a few hours before the operation.

To the hospital

Most patients are admitted to the hospital on the morning of the operation. A nurse will prepare you for the operating room and answer your questions. You may be asked to wear compression stockings to prevent blood clots in your legs.

You will then be taken to the operating room where the anesthesiologist, the doctor who will ensure your comfort during the operation, will install the necessary equipment to monitor your vital signs. You will then proceed to your anesthesia. Radical prostatectomy is usually done under general anesthesia (you are asleep). In some cases, epidural anesthesia is done. This procedure involves inserting a small plastic tube in the lower back, through which a drug is injected to remove the pain.

An incision is made at the bottom of the abdomen, under the umbilicus. When PSA or biopsies suggest that the disease may be more extensive, the pelvic lymph nodes are taken for immediate examination. If there is cancer in the lymph nodes, a cure for cancer by radical prostatectomy is unlikely. We can then decide to stop the surgery and consider another form of treatment.

In the absence of an obvious expansion of cancer, the prostate is highlighted and released from its surrounding structures. The urethra is divided under the end of the prostate preserving the sphincter muscle as much as possible. The prostate and seminal vesicles are removed from the bladder and removed. We will try to preserve the erector nerves if complete removal of the cancer is ensured.

The urethra is sutured around the neck of the bladder around a catheter passed through the bladder penis and retained by a balloon. This catheter should remain in place for up to three weeks to ensure the tightness of the urinary tract. The abdominal incision is closed in several planes using sutures. Metal clips are often used to close the skin. The operation lasts an average of two to four hours.

After the surgery

Once completed, you will be taken to the recovery room where nurses will monitor your vital signs until you are stabilized, usually after one or two hours. You will then be taken to a care unit to continue your recovery.

At first, you will be attached to several tubes: an oxygen tube (passed through the nose), an intravenous catheter (in the arm), a catheter to drain the bladder (passed through the penis) and an abdominal drain to evacuate the fluid formed at the surgical site. All these tubes, with the exception of the bladder catheter, will be removed in the following days as recovery progresses.

Excellent control of postoperative pain can be achieved in a variety of ways, including the administration of analgesics with a small tube inserted into the lower back (epidural analgesia). Another possibility is patient-controlled analgesia (PCA). At the touch of a button, the patient can self-administer a small amount of intravenous analgesic with a pump. These techniques may be combined with other drugs in the form of injections, tablets or suppositories.

After a major operation, intestinal transit may take a few days to return to normal. Your eating habits will gradually resume, initially with liquids and later with solid foods.

The rapid recovery of activities after surgery promotes a quick recovery. You may be asked to sit or stand on the day of the surgery; walking is planned on the first postoperative day. Breathing and leg exercises can be taught.

By the time you can hydrate yourself, feed yourself and take care of yourself, you will be discharged from hospital, usually three to five days after the operation.

Risks and complications

Any major surgery, including radical prostatectomy, carries associated risks. In the short term, hemorrhage may require a blood transfusion or, an infection, the use of antibiotics. Surgical trauma could lead to cardiac or pulmonary complications. The formation of blood clots in the legs could put your life at risk if they go back to the lungs. Every precaution is taken to avoid such problems.

In the longer term, among men who have undergone radical prostatectomy, many will lose their natural erections. Today treatments to restore erections are available when needed. Although the sensation of orgasm usually remains unchanged, ejaculations will disappear as a result of the removal of the prostate and seminal glands. The absence of sperm will make you infertile.

Several men will have more or less significant urine loss after radical prostatectomy. In most cases, the problem of incontinence decreases with time and exercise. Some, on the other hand, will have permanent urine loss and will have to wear protection indefinitely. Surgery is rarely indicated to restore urine control.

Whatever treatment you receive for your prostate cancer, there is always a risk of recurrence. Regular monitoring is recommended.