55845 Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

Name of the Procedure:

Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes.

Summary

A retropubic radical prostatectomy is a surgical procedure designed to remove the prostate gland and some surrounding tissue through an incision in the lower abdomen. It may also involve sparing nerves to preserve erectile function and includes the removal of lymph nodes in the pelvis.

Purpose

The procedure is primarily used to treat localized prostate cancer. It aims to remove cancerous tissue to prevent the spread of the disease and improve long-term survival rates, while potentially preserving important nerve functions.

Indications

• Diagnosed localized prostate cancer.
• Elevated Prostate-Specific Antigen (PSA) levels.
• Biopsy results showing aggressive prostate cancer cells.
• Other treatments (such as radiation or hormone therapy) have failed or are unsuitable.

Preparation

• Fasting from midnight before the surgery.
• Cessation of specific medications like blood thinners.
• Pre-operative assessments including blood tests, imaging studies, and a possible electrocardiogram (EKG).
• Consents and pre-surgical consultations with the healthcare team.

Procedure Description

1. Administer general anesthesia.
2. Make an incision in the lower abdomen.
3. Disconnect the prostate gland from the bladder and urethra.
4. Remove the prostate and surrounding affected tissues.
5. Perform nerve-sparing techniques if applicable to preserve erectile function.
6. Conduct a bilateral pelvic lymphadenectomy to remove external iliac, hypogastric, and obturator lymph nodes.
7. Close the incision with sutures.

Tools include surgical instruments for dissection and removal, a laparoscope if minimally invasive techniques are used, and equipment for administering anesthesia.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Performed in a hospital operating room.

Personnel

• Urologists or specialized surgeons.
• Surgical nurses.
• Anesthesiologist.
• Operating room technicians.

Risks and Complications

• Common risks: bleeding, infection, urinary incontinence, erectile dysfunction.
• Rare risks: injury to surrounding organs, blood clots, prolonged recovery time.
• Management includes antibiotics for infection, physical therapy for incontinence, and medications or therapies for erectile dysfunction.

Benefits

• Potentially complete removal of localized cancer.
• Long-term cancer control and survival.
• Preservation of urinary and sexual function if nerve-sparing techniques are successful.
• Benefits may be realized within a few weeks to months post-surgery.

Recovery

• Hospital stay of 1-3 days.
• Catheterization for urinary drainage for 1-2 weeks.
• Avoid strenuous activities for at least 4-6 weeks.
• Follow-up appointments for monitoring PSA levels and recovery progress.
• Instructions for pain management and gradual return to normal activities.

Alternatives

• Radiation therapy (External Beam or Brachytherapy).
• Active surveillance for less aggressive cancer.
• Hormone therapy.
• High-Intensity Focused Ultrasound (HIFU).
• Pros and cons depend on cancer stage, patient's health, potential side effects, and personal preferences.

Patient Experience

Patients will be under general anesthesia during the procedure, resulting in no pain during surgery. Postoperatively, they may experience discomfort, managed with pain medication. There may be temporary issues like urinary incontinence and erectile dysfunction, with most symptoms improving over time. Supportive measures include physical therapy and counseling.