Radical Prostatectomy Surgery

Overview and Procedure Details

Radical prostatectomy is a surgical procedure involving the complete removal of the prostate gland, and sometimes nearby lymph nodes or vas deferens, to prevent the spread of prostate cancer. The procedure can be performed via open surgery, laparoscopic methods, or robotic assistance.

Patients typically recover within a few weeks to a month and may gradually resume light activities, such as walking, while maintaining a healthy lifestyle.

Types of Radical Prostatectomy

Laparoscopic Radical Prostatectomy
Robotic Radical Prostatectomy
Open Radical Prostatectomy

Body Location and Procedure Type

Body Location: Prostate gland and surrounding areas.
Procedure Type: Open or minimally invasive (robotic or laparoscopic).

Preparation for Radical Prostatectomy

Pre-Operative Tests

Blood tests: Prostate-Specific Antigen (PSA), blood sugar, and blood pressure.
Urine analysis.
Imaging: Transrectal ultrasound (USG), prostate biopsy, pelvic MRI, bone scans, and PSMA PET scans to detect metastasis.
Cystoscopy: Visual examination of the urethra and bladder.

Hospital Admission

Usually required on the day of surgery.

Medications

Blood thinners and certain other medications are restricted before surgery.

Dietary Guidelines

A bowel prep diet is recommended, including clear liquids and medications to cleanse the bowel. Enema drugs may also be advised.

Radical Prostatectomy Surgical Approaches

Open Radical Prostatectomy
- A single incision is made in the lower abdomen to remove the prostate and surrounding tissues.
Robotic Radical Prostatectomy
- Multiple small incisions (less than 0.1 cm) are made for robotic tools and a 3D camera to facilitate precision surgery.
- Specimens are removed through an expanded incision.

Both methods may involve nerve-sparing techniques to reduce the risk of post-surgical impotence, provided the cancer is confined to the prostate gland.

Recovery After Radical Prostatectomy

Physical Recovery
- Fatigue is common; light activities like walking or yoga can aid healing.
- Heavy exercise should be avoided for a few weeks.
Sexual Recovery
- Healing may take months, with medications prescribed for erectile function.
Urinary Incontinence
- Improves over time with bladder control exercises, though adult diapers may be needed temporarily.
Return to Activities
- Normal activities may resume 1–2 weeks after surgery, extending to 4 weeks for open procedures.
Monitoring
- Regular PSA tests and checkups are necessary to detect any recurrence of cancer.

Follow-Up Care

Post-Surgical Management
- Pain management with IV or oral medications.
- Gradual physical activity, starting with light movements.
Diet
- Liquids and semi-solid foods during hospital stay.
Drain and Catheter Care
- A drain to remove excess fluid is typically removed after 1–2 days.
- A urinary catheter is retained for 5–14 days post-surgery, depending on the doctor’s recommendation.
Discharge
- Most patients are discharged within 2–3 days, subject to satisfactory recovery.

Risks Associated With Radical Prostatectomy

Potential risks include:

Bleeding
Blood clots
Urinary tract infections
Erectile dysfunction
Urinary incontinence
Hernia
Breathing difficulties
Lymphocele (lymph-filled cysts)
Urethral or bladder contraction

Radical prostatectomy is a reliable procedure with a clear recovery pathway. Proper preparation, adherence to post-surgical guidelines, and regular follow-ups are essential for effective healing and long-term health.

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