Name of the Procedure:

Prostatectomy, Retropubic Radical, with or without Nerve Sparing; with Lymph Node Biopsy(s) (Limited Pelvic Lymphadenectomy)

Summary

A retropubic radical prostatectomy is a surgical procedure to remove the prostate gland and some surrounding tissue through an incision in the lower abdomen. This may include nerve-sparing techniques to preserve sexual function, and also involve the removal and testing of nearby lymph nodes for cancer.

Purpose

This procedure is performed to treat prostate cancer confined to the prostate gland and surrounding tissues. The goal is to remove the cancerous tissue, possibly preserving erectile function if nerve-sparing techniques are used, and to check the spread of cancer to the lymph nodes.

Indications

• Diagnosis of localized prostate cancer
• Elevated PSA levels
• Biopsy-confirmed prostate cancer
• No contraindications for major surgery

Preparation

• Fasting as directed, typically from midnight before the surgery
• Discontinuation of certain medications, such as blood thinners, as instructed
• Preoperative evaluations, including blood tests, imaging studies, and a physical examination

Procedure Description

1. Under general anesthesia, an incision is made in the lower abdomen.
2. The prostate gland is carefully separated from surrounding tissues.
3. Nerve-sparing techniques may be used to preserve erectile function.
4. Nearby lymph nodes are biopsied to check for cancer spread.
5. The prostate gland and selected tissues are removed.
6. The incision is closed with sutures or staples.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeon specialized in urology and oncology
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Common: Bleeding, infection, urinary incontinence, erectile dysfunction
• Rare: Deep vein thrombosis, pulmonary embolism, damage to surrounding organs, prolonged recovery

Benefits

• Removal of prostate cancer
• Potential for preserving erectile function if nerve-sparing is successful
• Confirmation of cancer spread, guiding further treatment

Recovery

• Hospital stay of 1 to 3 days
• Catheter for urinary drainage for approximately 1-2 weeks
• Gradual return to normal activities over 4 to 6 weeks
• Follow-up appointments for monitoring and removal of the catheter

Alternatives

• Radiation therapy: Non-invasive but may not be suitable for all patients
• Hormone therapy: Can shrink or slow cancer growth but not curative
• Watchful waiting/Active surveillance: Suitable for slow-growing cancers but involves regular monitoring

Patient Experience

• Likely to feel tired and sore post-surgery
• Pain managed with medications
• Possible temporary urinary incontinence and erectile dysfunction
• Gradual improvement in symptoms with recovery and rehabilitation