What is Radical Prostatectomy

Radical prostatectomy is a procedure to remove the entire prostate gland and the seminal vesicles. This procedure is done to treat prostate cancer that has not spread to other parts of the body (metastasized).

The goal of the procedure is to remove all cancer cells and prevent prostate cancer from metastasizing.

During a radical prostatectomy, the lymph glands may also be removed from the pelvis and tested for cancer cells.

Lymph glands are part of the body’s disease-fighting system (immune system). The pelvic lymph glands are the first place that may be affected by prostate cancer metastasis.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Any prostate infections you have had.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs, such as:
  • The tubes that drain urine from the kidneys to the bladder (ureters).
  • The bladder.
  • The urethra.
  • The large or small intestines.
  • The rectum.
• Inability to control when you urinate (incontinence). Usually, this is temporary.
• Inability to get or sustain an erection that allows you to have sexual intercourse (erectile dysfunction).
• Blockage (obstruction) of the large or small intestines.
• Narrowing or scarring of the urethra (stricture), which may block the flow of urine.
• Blood clots in the legs.
• Formation of a sac (cyst) in the pelvis that is filled with fluid from the lymph glands (lymphocele).

What happens before the procedure?

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may have an exam or testing, such as:
  • MRI.
  • CT scan.
  • Bone scan.
• You may have a blood sample taken.
• Plan to have someone take you home after the procedure.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair will be removed from your surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
• A thin, flexible tube (catheter) will be inserted through your urethra and into your bladder to drain your urine.
• This procedure may be performed using one of the following techniques:
  • Radical retropubic prostatectomy. During this type of procedure, an incision will be made in your abdomen, starting right below your belly button and ending at your pubic bone.
  • Laparoscopic radical prostatectomy. This is a type of minimally invasive surgery. Instead of one large incision, 4–5 small incisions will be made in your abdomen. A thin, lighted tube with a tiny camera on the end (laparoscope) and other surgical instruments will be put through your incisions to perform the procedure.
  • Robot-assisted laparoscopic prostatectomy. This is a type of laparoscopic procedure in which surgical instruments will be controlled with the help of a robotic arm.
  • Radical perineal prostatectomy. During this type of procedure, an incision will be made in the skin between your anus and the base of your scrotum (perineum). If your lymph glands will be removed, a second incision will be made in your abdomen.
• Your prostate and seminal vesicles will be removed. When this happens, your urethra will be cut and separated from your bladder.
• Your pelvic lymph glands may be removed.
• Your urethra will be reconnected to your bladder. This will be done so that your catheter stays in place inside of your urethra.
• A small tube (drain) may be placed in your incision to help drain fluid from your surgical site.
• Your incision will be closed with stitches (sutures), skin glue, or adhesive strips. Medicine may be applied to your incision.
• A bandage (dressing) will be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV tube.
• You will have some pain. Pain medicines will be available to help you.
• You will have a catheter draining urine from your bladder.
• You may have fluid coming from a drain in your incision.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will be encouraged to move around as much as possible.

Radical Prostatectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild pain in your lower abdomen.
• Blood and small clots in your urine for up to 3 weeks.
• A need to urinate more frequently than usual (bladder spasms). This may last for up to 2 weeks.

After your catheter is removed, it is common to have:

• A burning sensation when you urinate. This may last for up to 2 weeks after your catheter is removed.
• Difficulty controlling when you urinate (incontinence). You may leak urine occasionally.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Incision care and drain care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision site and drain site every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• If you have a drain, follow instructions from your health care provider about how to care of it. Do not remove the drain tube or any dressings around the tube opening unless your health care provider approves.

Catheter Care

• Always wash your hands with soap and water before and after touching your penis, your catheter, and your urine collection bag. If soap and water are not available, use hand sanitizer.
• Empty your collection bag every 3 hours during the day, or as often as told by your health care provider.
• Clean the tip of your penis with soap and water twice a day, or as often as told by your health care provider.
• Apply ointment to the tip of your penis only as told by your health care provider.
• You will need to visit your health care provider to have your catheter removed.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that this is safe.
• Do not ride in a car for more than 1 hour at a time for 1 month after your procedure, or for as long as told by your health care provider.
• Avoid sitting for a long time without moving. Get up and move around at least every few hours. You may start to exercise more as you start to feel better, or as told by your health care provider.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• Do not drink alcohol.
• Drink enough fluid to keep your urine clear or pale yellow.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Do not engage in sexual activity until your health care provider says it is safe for you.
• Do not strain to have a bowel movement.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have any of the following around your incision area, drain area, or catheter insertion site:
  • Redness, swelling, or pain.
  • Fluid or blood.
• Your incision area, drain area, or catheter insertion site feels warm to the touch.
• You have problems with your catheter or your drain.
• You pass urine around your catheter instead of through your catheter.
• You become constipated. Symptoms of constipation may include:
  • Having fewer than three bowel movements in a week.
  • Difficulty having a bowel movement.
  • Stools that are dry, hard, or larger than normal.

Get help right away if:

• You have pus or a bad smell coming from your incision area, drain area, or catheter insertion site.
• You have a fever.
• You have pain that gets worse.
• Your catheter falls out.
• You are unable to urinate or to pass urine through your catheter.
• You have bright red blood in your urine.
• You have large blood clots in your urine.
• You develop:
  • Chest pains.
  • Shortness of breath.
  • Swelling or pain in your legs.

Summary

• After your procedure, it is common to have mild pain in your lower abdomen, blood and small clots in your urine, and a need to urinate more frequently.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Follow your health care provider’s instructions on how to take care of your incision and drain areas.
• Do not take baths, swim, use a hot tub, or engage in sexual activity until your health care provider approves.
• Get help right away if you get a fever, develop chest pain, have shortness of breath, or your catheter falls out.