Dr. Nitin Negi

Radical Prostatectomy

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 or 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.

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.

Description

There are 4 main types or techniques of radical prostatectomy surgery. These procedures take about 3 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: Sometimes, 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 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 spare the nerves around the prostate or to remove nearby lymph nodes with this technique.

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 bladder to drain urine. This will stay in place for a few days to a few weeks.