- radical retropubic prostatectomy
- radical perineal prostatectomy
A radical prostatectomy is the removal of the entire prostate and the seminal vesicles. The prostate is a gland that goes around the neck of the bladder and the urethra in a male. The seminal vesicles lie behind the bladder and near the prostate. Both the prostate and the seminal vesicles secrete fluids that form the semen. The vas deferens, the tube that carries sperm from the testicles, is cut in order to remove the seminal vesicles,
Who is a candidate for the procedure?
A radical prostatectomy is one of the treatments for prostate cancer. It may be done on men with localized cancer who have an estimated life expectancy of 10 years or more.
How is the procedure performed?
A radical prostatectomy is done under general or regional anesthesia. General anesthesia means the person is put to sleep with medicines, feels no pain, and has no awareness of the procedure. Regional anesthesia means the person will be awake, but numb below the waist. A medicine may be given to make the person drowsy.
There are two distinct approaches to radical prostatectomy:
- The most common approach is radical retropubic prostatectomy. For this procedure, the incision made to remove the prostate starts below the navel and extends to just above the pubic bone.
- In the radical perineal prostatectomy, a smaller, curved incision is made between the anus and the base of the scrotum. The prostate is brought out from underneath the pubic bone.
There are advantages and disadvantages to each approach. The retropubic approach allows the surgeon to take a lymph node sample at the same time as prostate removal. The perineal approach has a slightly shorter recovery time. After removal of the prostate, the urethra is sewn to the bladder neck. This repair is done with sutures, or stitches, over a urinary catheter. The catheter is a narrow tube that is passed through the urethra into the bladder. Drains are placed around the site. Then the skin is closed.
Alternative approaches to prostatectomy involve laparoscopy, with or without robotic-assistance. The surgery is performed through small incisions in the abdomen and the abdomen is distended with a gas. Monitors are used for visualization while the procedure is performed through instruments passed through the small incisions. Long-term controlled trials have not yet been performed to show any improvement in outcomes.
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Smith's General Urology, Tanagho et al, 1992