Radical Prostatectomy

Who is a candidate for a radical prostatectomy?

Radical prostatectomy may be an option for you if you fit into one of the following categories:

• You are an otherwise healthy patient under 75 years old
• You have prostate cancer that has not spread outside of the prostate and other treatments are not options

Risks associated with a radical prostatectomy

Research shows that less than 10 percent of patients experience side effects after a radical prostatectomy. The most common complications after a radical prostatectomy are associated with damaging the nerves that travel through the prostate to the penis.

Complications include:

• Urinary incontinence — leaking of urine affects approximately 5 percent of patients under 75.
• Erectile dysfunction — some patients will experience erectile dysfunction, but you can still have sex using medications.
• Sterility — during a radical prostatectomy, the nerve connection between the testicles and urethra is cut, which cuts off the channel for the sperm flow to the penis.

Other complications of a radical prostatectomy include:

• Bleeding
• Change in penis length
• Urinary leaks
• Infection
• Blood clots that can lead to more serious complications such as pulmonary embolism, heart attack or deep vein thrombosis
• Lymphedema that is associated with removing the lymph nodes during a radical prostatectomy

What to expect during a radical prostatectomy

There are four types of radical prostatectomy. Your Mercy Health surgeon will evaluate your case and determine the most appropriate type of radical prostatectomy for you.

The four most commonly used types of radical prostatectomy include:

Retropubic

During a radical prostatectomy with retropubic approach, your doctor will make an incision below your belly button to the pubic bone. Once the prostate is exposed, it will be removed. Depending on the complexity of your case, the surgery can take as little as 90 minutes to as long as four hours. This is the most commonly used radical prostatectomy surgery.

Laparoscopic

During a laparoscopic radical prostatectomy, your surgeon will make a few small incisions and place surgical instruments into the incisions. The surgeon will then insert a video camera into one of the incisions, which will provide better visibility to see the prostate. Once the surgeon has located the prostate, he or she will remove the prostate along with some of the tissue around it.

Robotic surgery

Laparoscopic surgery can be performed robotically. In a robotic-assisted laparoscopic prostatectomy, your surgeon will move the surgical instruments using robotic arms as he or she sits at a computer near the patient.

Perineal

During a radical prostatectomy with perineal approach, your surgeon will make an incision in the perineal area (skin between your anus and scrotum) to access the prostate. Although this procedure is less invasive, takes less time and causes less blood loss, it is challenging to cut around the nerves in the prostate or to remove any lymph nodes near the prostate.

Recovery from a radical prostatectomy

You will need to stay in the hospital for as long as three days after a radical prostatectomy. The catheter used during the procedure may need to stay in after discharge for as long as a few weeks.

Before discharge, your doctor will provide detailed instructions including:

• How to care for your incisions
• How long it may take for urinary and sexual function to return to normal
• How to care for the catheter
• When you can return to normal activity level

If you experience any of the following symptoms, call your doctor right away:

• Fever and/or chills
• Increased pain, redness, swelling or bleeding from the area of the incisions
• Trouble having a bowel movement or urinating (after catheter is removed)

If your prostate cancer has been cured after a radical prostatectomy, you will still need to schedule regular follow-up visits with your doctor to ensure the cancer has not returned.