Prostatectomy

Prostatectomy is a surgical removal of the partial or complete prostate which may be performed to treat prostate cancer or benign prostatic hyperplasia.

Some facts about Prostatectomy:

• It is often necessary to have a prostate biopsy prior to having a prostatectomy.
• The prostate gland surrounds the neck of bladder and urethra o a a man and is about the size of a walnut.
• It is made up of three lobes, a center lobe with one lobe on each side and with ducts that opens into the prostatic portion of the urethra.
• It is partly muscular and partly glandular.
• The primary function of the prostate gland is to secrete a slightly alkaline fluid that forms part of the seminal fluid or semen.
• The muscular glands of the prostate help to propel the prostate fluid, with sperm that was produced in the testicles, into the urethra during orgasm.
• The prostate gland plays an important role in both sexual and urinary function o male.
• It is likely for a man to encounter some type of prostate problem in his lifetime as the prostate gland becomes enlarged as a man ages.
• Common problems like Benign prostatic hyperplasia (BPH), Prostatism, Prostatitis and Prostatalgia may occur in men of all ages which doesn't require a radical prostatectomy.
• Prostate cancer is the most common form of cancer in men over the age of 50.
• Radical prostatectomy can also be performed when the men is unable to completely empty the bladder.
• Recurrent bleeding from the prostate, Bladder stones with prostate enlargement, Very slow urination, Hydronephrosis which is increased pressure on the ureters and kidneys from urinary retention are some of the less common reasons for radical prostatectomy.
• Urinary incontinence, urinary leakage or dribbling, erectile dysfunction, sterility, lymphedema, and change in penis length are some of the risk associated with radical prostatectomy.

Preparation for Prostatectomy:

• A physical examination in addition to a complete medical history will be performed by your doctor to ensure you are in good health before you undergo the procedure.
• Some blood tests and other diagnostic tests may also be conducted.
• You will be asked to fast for about eight hours before the procedure
• You should inform your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).
• All medications including prescribed and over the counter and herbal supplements that you are taking should be notified to your doctor before the procedure.
• Your doctor should also know about any history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting as it may be necessary for you to stop these medications prior to the procedure.
• A sedative prior to the procedure will be given to help you relax.

Procedure for Prostatectomy:

• The prostate gland can be removed in many different ways when there is cancer.
• The prostate gland and some tissue around the gland, including the seminal vesicles, are removed during a radical prostatectomy.
• A radical prostatectomy (RP), with either a retropubic or perineal approach can be performed in surgical removal.
• The entire prostate gland will be removed in Radical prostatectomy.
• As much function as possible of the prostate gland can be preserved with Nerve-sparing surgical removal.
• Some part of the prostate gland will be removed in Transurethral resection of the prostate, which can be performed through the penis with an endoscope.
• A small, flexible tube with a light and a lens on the end will be used for an endoscope.
• Prostate cancer does not cure with Transurethral resection of the prostate. But, the obstruction can be removed while the doctors plan for definitive treatment.  
• Another method that can be used for the removal of the prostate gland is Laparoscopic surgery, which can be done either manually or by robot.

There are there different types of radical prostatectomy. These include:

Radical prostatectomy with retropubic (suprapubic) approach:

• Radical prostatectomy with retropubic (suprapubic) approach is the most common surgical approach used by urologists to remove the prostate gland.
• The lymph nodes from around the prostate gland, in addition to the prostate gland will be removed by the urologists if there's reason to believe the cancer has spread to the lymph nodes.
• Surgery may be discontinued if it is found that cancer in the lymph nodes has spread beyond the prostate gland as it won't treat the cancer adequately. Additional treatments may be used in such situation.

Nerve-sparing prostatectomy approach:

• The nerves are handled during Nerve-sparing prostatectomy approach and may not function properly for a while after the procedure.
• It may not be possible to maintain the nerve function or structure if the cancer is tangled with the nerves.
• Sometimes nerves will be cut in order to remove the cancerous tissue.
• However, the man will be unable to have an erection if both sides of the nerves are cut or removed.
• The man may have less erectile function, but will possibly have some function left if only one side of the bundle of nerves is cut or removed.
• Function of the prostate gland may remain normal if neither nerve bundle is disturbed during surgery.
• Sometimes, it may takes months to know whether a full recovery will occur after surgery.

Laparoscopic radical prostatectomy:

• Several small cuts will be made by the surgeon and long, thin tools are placed inside the cuts during a Laparoscopic radical prostatectomy.
• A thin tube with a video camera (laparoscope) will be put inside one of the cuts and instruments through others which helps the surgeon see inside during the procedure.

Robotic-assisted laparoscopic prostatectomy:

• It is called as Robotic-assisted laparoscopic prostatectomy when laparoscopic surgery is done using a robotic system.
• The robotic arm will be moved by the surgeon while sitting at a computer monitor near the operating table.
• Not every hospital can do robotic surgery as special equipment and training is required for this procedure.

Radical prostatectomy with perineal approach:

• Radical prostatectomy with perineal approach is used less frequently than the retropubic approach as the nerves can't be spared as easily, or the lymph nodescan not be removed by using this surgical technique.
• This may be an option if the nerve-sparing approach or lymph node removal isn't required as this procedure takes less time.
• Perineal prostatectomy may be used if other medical conditions are ruled out using a retropubic approach.
• There is a smaller, hidden incision for an improved cosmetic effect with the retropubic approach.
• There is generally less pain and recovery time in case of retropubic approach as major muscle groups are avoided in this surgery.