55840 Prostatectomy, retropubic radical, with or without nerve sparing

Name of the Procedure:

Prostatectomy, Retropubic Radical

• Common Names: Radical Prostatectomy, Retropubic Prostatectomy
• Medical Terms: Retropubic Radical Prostatectomy, Radical Prostatectomy with or without nerve sparing

Summary

A retropubic radical prostatectomy is a surgical procedure to remove the entire prostate gland along with some surrounding tissue and lymph nodes. It can be performed with the aim of sparing the nerves that control erectile function, depending on the patient’s condition and cancer spread.

Purpose

This procedure is primarily used to treat localized prostate cancer. The goal is to completely remove cancerous tissue to stop the spread of the disease, potentially curing the patient or significantly extending survival.

Indications

• Diagnosed localized prostate cancer
• Elevated PSA (Prostate-Specific Antigen) levels
• Biopsy-confirmed prostate cancer Patients who are generally healthy enough for major surgery and have a life expectancy that would benefit from the surgery are considered appropriate candidates.

Preparation

• Patients are instructed to fast (not eat or drink) for several hours before the surgery, usually starting from the night before.
• Medication adjustments may be required, particularly for blood thinners.
• Preoperative tests such as blood work, electrocardiogram (ECG), and imaging studies are typically performed.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to induce sleep and ensure they do not feel pain.
2. Incision: A surgical incision is made in the lower abdomen.
3. Prostate Removal: The prostate gland, along with some surrounding tissues and possibly lymph nodes, is surgically removed.
4. Nerve Sparing: When possible, the surgeon will attempt to spare the neurovascular bundles that control erectile function.
5. Closure: The incision is closed with sutures or staples. Tools: Scalpels, retractors, suction devices, surgical sutures, possibly laparoscopic or robotic surgical systems if minimally invasive techniques are used.

Duration

The procedure typically takes 2 to 4 hours.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Lead Surgeon: A urologist or urologic oncologist specializing in prostate surgeries.
• Assistant Surgeons: As needed.
• Anesthesiologist: Responsible for administering anesthesia and monitoring the patient.
• Nurses and Surgical Technicians: Assist with the procedure and patient care.

Risks and Complications

• Common Risks: Bleeding, urinary incontinence, erectile dysfunction, infection.
• Rare Risks: Deep vein thrombosis, pulmonary embolism, damage to surrounding organs. Complications will be managed based on severity and may involve additional treatments or surgeries.

Benefits

• Potential cure for localized prostate cancer.
• Reduction or elimination of cancer symptoms.
• Improved long-term survival rate if cancer is caught early. Benefits are often realized over weeks to months post-operatively as the patient recovers.

Recovery

• Hospital Stay: Typically, 1-3 nights in the hospital.
• Post-operative Care: Includes pain management, catheter care, wound care.
• Recovery Time: Full recovery may take several weeks to a few months.
• Restrictions: Limited heavy lifting and physical exertion for several weeks.
• Follow-up: Regular appointments to monitor recovery and PSA levels.

Alternatives

• Radiation Therapy: Non-surgical option that uses high-energy beams to kill cancer cells.
• Watchful Waiting/Active Surveillance: Monitoring cancer closely without immediate active treatment.
• Hormone Therapy: Medications to limit the hormone that fuels cancer growth.
• Cryotherapy: Freezing and destroying cancerous tissues. Each alternative has its own set of benefits and risks, which should be discussed with a healthcare provider.

Patient Experience

Patients can expect to be under general anesthesia during the procedure, so they will not feel or remember it. Post-operatively, there may be pain and discomfort at the incision site, which is managed with pain medications. A catheter is typically placed during recovery to help with urination and will be removed after a few days to weeks. Emotional support and counseling may be beneficial due to the impacts on sexual and urinary functions.