The prostate gland is located below the urinary bladder in the male pelvis. It surrounds the urethra, which carries urine from the bladder to the penis.
A radical prostatectomy is a surgical procedure to remove part or all of the prostate gland and some of the tissue around it. This operation is carried out to remove prostate cancer. Prostatectomy can be done in several ways, depending on the condition and treatment recommended by the doctor.
The operation can be performed by open surgery or laparoscopic surgery. Laparoscopic surgery involves making small incisions, and was traditionally performed by hand. A laparoscope, which is a lighted viewing instrument, is inserted into one of the incisions. Through the other incisions, the surgeon is able to reach and remove the prostate using specialised tools.
However, with the advancements in technology, doctors can now perform the surgery with much more precision through robot-assisted radical prostatectomy, whereby the doctors guide robotic arms that hold the surgery instruments.
A less often used procedure is the simple prostatectomy, which may be used to treat a blocked urethra caused by enlargement of the prostate, which is known as benign prostatic hyperplasia (BPH). Simple prostatectomy to treat BPH may not require the removal of the entire prostate. The surgery eases urinary symptoms and complications resulting from blocked urine flow by removing just the obstructive part of the prostate that’s blocking the flow of urine.
There is a higher risk of complications connected to simple prostatectomy. Compared to other procedures to treat BPH, simple prostatectomy requires a longer recovery time as well.
Several small incisions are made in the patient’s lower abdomen. The surgeon sits at a console, controlling instruments attached to a robot, also known as a computer-assisted mechanical device. The surgeon’s hand movements can control the robotic device well, producing precise responses. The robot is designed to be sensitive to the movement of the surgeon’s hands.
Prostatectomy is often carried out as a treatment for localized prostate cancer, whereby the entire prostate, seminal vesicles and some surrounding tissue, including lymph nodes, are removed. This treatment may be used alone, or in conjunction with radiation, chemotherapy and hormone therapy.
All forms of surgery have associated risks. Risks connected to radical prostatectomy include bleeding, urinary tract infection, urinary incontinence, erectile dysfunction, injury to the rectum, narrowing of the urethra or bladder neck, and formation of cysts containing lymph.
Simple prostatectomy has a higher risk of complications and a longer recovery time than other enlarged prostate procedures. Risks associated with simple prostatectomy include bleeding, injury to adjacent structures, urinary incontinence, dry orgasm, erectile dysfunction (impotence), and narrowing (stricture) of the urethra or bladder neck.
One of the serious side effects of radical prostatectomy is erection problems. The nerves that control a man’s ability to have an erection are located next to the prostate gland. During surgery, they are often damaged or removed. Sometimes, these nerves can be spared during surgery to preserve erections.
Before surgery, the doctor may want to check inside the patient’s urethra and bladder with a visual scope. This is called cystoscopy. It enables the doctor to check the size of the prostate and examine the urinary system. According to necessity, other tests, such as blood tests or tests to specifically measure the prostate and to measure urine flow, might be performed.
Patients should discuss their food and medications with their doctor. It is important that the doctor is made aware of any prescription or over-the-counter medications or supplements taken, especially blood-thinning medications, such as warfarin or clopidogrel, and non-prescription pain relievers. Any medication allergies or reactions to medications should also be made known to the doctor.
Fasting before the surgery is an important step that must be observed. It is likely that the doctor will ask the patient not eat or drink anything after midnight. On the morning of the operation, the patient will only take the medications prescribed by the doctor with a small sip of water.
Patients may also be instruction to clear their bowels (enema) before the procedure. The surgeon may give the patient a kit and instructions for the enema.
Patients should always follow the advice of their doctors before the surgery. If in doubt, always ask for clarification.
What should patients bring to the hospital? The usual items to pack are a list of medications, eyeglasses, hearing aids, dentures, personal care items (comb, shaving equipment, toothbrush), and comfortable loosefitting clothing. Patients are also recommended to bring items to help them relax, such as books and portable music players.
Last but not least, patients must remember not to wear jewellery, eyeglasses, contact lenses and dentures into surgery.
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