Name of the Procedure:

Prostatectomy, Perineal Radical
Common name(s): Radical perineal prostatectomy (RPP).
Technical/Medical terms: Perineal radical prostatectomy.

Summary

Radical perineal prostatectomy is a surgical procedure to remove the entire prostate gland through an incision made in the perineum (the area between the scrotum and anus). It is mainly performed to treat localized prostate cancer.

Purpose

Radical perineal prostatectomy is aimed at treating prostate cancer that is confined to the prostate gland. The primary goal is to completely remove the cancer along with the prostate, potentially curing the condition and preventing its spread.

Indications

• Diagnosed localized prostate cancer.
• Patients with symptoms such as urinary difficulties, erectile dysfunction, or elevated prostate-specific antigen (PSA) levels.
• Suitable candidates are typically men who are healthy enough to undergo surgery and have cancer that has not spread beyond the prostate.

Preparation

• Patients may be instructed to fast for several hours before the surgery.
• Medication adjustments, such as blood thinners, may be necessary.
• Pre-operative tests may include blood work, imaging tests (like MRI or CT scans), and a prostate biopsy, if not already performed.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Positioning: The patient is positioned on their back with legs apart.
3. Incision: A small incision is made in the perineum.
4. Exposing the Prostate: The prostate is carefully dissected and exposed through the incision.
5. Prostate Removal: The prostate gland is detached from the bladder and urethra, and then removed from the body along with some surrounding tissue to ensure no cancer cells are left behind.
6. Reconstruction: The bladder neck is reattached to the urethra to restore the pathway for urine.
7. Closing the Incision: The incision is then closed with sutures.

Duration

The procedure typically takes about 2-3 hours to complete.

Setting

This surgery is performed in a hospital setting, typically in an operating room.

Personnel

• Surgeons specializing in urology or oncological surgery.
• Anesthesiologists to administer and monitor anesthesia.
• Surgical nurses and assistants to support the procedure.

Risks and Complications

• Common risks: Bleeding, infection, and pain at the incision site.
• Potential complications: Urinary incontinence, impotence or erectile dysfunction, injury to surrounding organs and tissues, and blood clots.

Benefits

• Potential cure for localized prostate cancer.
• Reduction of symptoms and prevention of cancer spread.
• Improved quality of life and overall health outcomes.

Recovery

• Patients may need to stay in the hospital for a few days post-surgery.
• Instructions typically include managing pain, caring for the surgical site, and limitations on physical activity.
• Most patients can return to normal activities within 4-6 weeks.
• Follow-up appointments are crucial for monitoring recovery and assessing for any signs of cancer recurrence.

Alternatives

• Radiation therapy: Non-surgical option that uses high-energy rays.
• Active surveillance: Monitoring the cancer closely without immediate treatment.
• Hormone therapy: May be used in conjunction with other treatments.
• Each alternative has its own set of pros and cons, which should be discussed with a healthcare provider.

Patient Experience

• During the procedure, the patient is completely asleep under anesthesia.
• Post-operatively, there might be pain and discomfort, typically managed with pain medications.
• Patients may experience emotional and physical adjustments as they recover.
• Measures to ensure comfort include pain management strategies and support from the healthcare team.