What is a Radical Prostatectomy?

Madeleine A.

A radical prostatectomy is a major surgical procedure usually performed to remove the entire prostate gland, the seminal vesicles – which are two glands that play a role in semen production – and the vas deferens, the cord which transports sperm from the testicles to the urethra. A radical prostatectomy generally is done to remove the entire malignant prostate gland. This procedure aims to remove the gland before it can metastasize, or spread to other body parts.

Anatomical model of the human body
Anatomical model of the human body

The radical prostatectomy procedure usually is performed under general or regional anesthesia, and may take up to four hours to complete. If the patient receives general anesthesia, he will not be conscious during the procedure. A regional anesthetic would leave the patient conscious but numb below the waist. Most common radical prostatectomy procedures involve an incision beginning below the navel, extending to just past the pubic bone.

Another variation of this procedure involves an incision being made between the anus and the scrotum. The prostate gland subsequently is excised from beneath the pubic bone. After the prostate gland is removed, the urethra is sutured to the bladder neck over a catheter. A catheter is a flexible tube that is inserted through the urethra and into the bladder. Surgical drains usually are placed around the operative site and the incision is closed.

A less invasive procedure called laporoscopic radical prostatectomy uses an instrument called a laparoscope that is inserted into the abdominal area through a small incision in the navel. The laporoscope gives the surgeon a view of the internal organs and eliminates the need for a large incision. Typically, four additional incisions are created to accommodate additional surgical instruments during the procedure. This procedure can last up to eight hours and normal activity typically can resume in about two to four weeks.

Side effects of a radical prostatectomy may include impotence and incontinence. Generally, patients who may be appropriate for this procedure are men whose prostate cancer is confined to the gland and has not spread beyond it. Appropriateness for the procedure also includes men who have no contraindications to general anesthesia, and safely can tolerate a lengthy surgical procedure.

Typically, men who may have at least seven to ten years of life left also make good candidates because they may live long enough to recuperate from the surgery and enjoy the benefits. Usually, individuals who should not consider radical prostatectomy are those patients whose cancer has spread beyond the prostate gland. The list also includes most men whose general state of health makes it risky to undergo the procedure, and those who may be at risk for postoperative complications.

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