Open Radical Prostatectomy for Prostate Cancer

prostatecomy

Radical Prostatectomy is a surgical procedure to remove the entire prostate to cure prostate cancer.

Radical prostatectomy is a surgical procedure to remove the entire prostate to cure prostate cancer.

What Happens During the Surgery?

  • The surgery is done under general anesthetic and takes approximately 1.5 to 2 hours.
  • It is done through an incision from your pubic bone up about 10-15cm.
  • This will be closed with absorbable sutures that are under the skin
  • You will have a Foley catheter in your penis to drain the bladder when you wake up from surgery
  • You may have a small drain tube exiting the side of your belly for a day or two after surgery

What Happens Afterwards?

  • You’ll stay in hospital 1 to 2 days after surgery, assuming there are no complications.
  • The drainage tube will be removed before your discharge. The catheter will stay in for 1-2 weeks after surgery.
  • After leaving hospital you’ll be told to take ibuprofen and Tylenol for any general pain.
  • In the first six weeks you shouldn’t take in any vigorous exercise of lift anything heavier than 30 pounds to prevent abdominal tightening.
  • Expect to take 4-6 weeks off work.
  • There are no dietary restrictions, but patients should increase their fluid intake if they see any blood in their urine.

Appointments with Your Doctor

  • 1-2 weeks after surgery your doctor will call you in to remove the urinary catheter and discuss the pathology results.
  • Your PSA will then be checked at 3 months and 6 months after surgery.
  • The ongoing postoperative monitoring for cancer after surgery will depend on your particular pathology

What You Shouldn’t Worry About

You will notice some changes in your body immediately after surgery. There are some scenarios where you shouldn’t call the hospital. These are a natural part of the body’s healing processes.

  • Swelling and bruising around the penis and scrotum areas.
  • Pain around the incision area. This includes coughing when trying to sit up. Use the prescribed pain medication for this.
  • Intense sensation to urinate or the passing of blood. These are side effects of the surgery and will disappear in time.
  • Blood or any clots appearing in the catheter bag. As long as the catheter is still draining this is a good sign.
  • You might feel like you need to nap almost constantly. This is because the body is directing its energy towards healing itself.

Reasons to call the office or go to the emergency department

  • A fever of >38.5 that does not resolve rapidly with Tylenol
  • Inability to urinate or a blocked catheter
  • It is important that no one other than your urologist removes you catheter unless directed by your urologist
  • Pain in your chest or difficulty breathing
  • Nausea and Vomiting with an inability to pass stool or gas.

Long term issues after surgery.

  • Erectile dysfunction (ED)
    • The rate of ED depends on your pre-operative erectile function and the extent of your disease.
    • On average 50% of patients need some form of medication to achieve a satisfactory erection 1 year after surgery.
    • With medication 95% of patients are able to achieve an erection at 2 years after surgery if nerves were spared.
  • Incontinence
    • The involuntary loss of urine is common immediately after the catheter is removed
    • This will improve over the next 12 to 24 months.
    • On average 5% of patients need further intervention to treat ongoing incontinence 1 year after surgery
  • Cancer recurrence
    • You will be followed closely with regular PSA tests and imaging to watch for recurrence of your prostate cancer.
    • The risk of recurrence depends on your pathology
    • If a recurrence does occur there are many treatment options available that will be discussed at that time

Michelle Strovski, Maple Ridge Urology, Serving Maple Ridge, Coquitlam, Mission, Abbotsford, Langley, and Vancouver.