Radical prostatectomy requires some preparation, the purpose of which is, essentially, to reduce the risks for the patient.
At the end of the procedure, there is a period of hospitalization, the duration of which varies depending on the surgical technique used.
The post-operative phase includes the use of the bladder catheter for a few weeks and a gradual resumption of simpler daily activities.
What is the Prostate and What Functions does it cover: a brief review
The prostate (or prostate gland) is the unequal exocrine gland of the male genital system, located in the pelvis, just below the urinary bladder and in front of the rectum.
Similar in shape and size to a chestnut, the prostate surrounds the male urethra in the tract of the latter between the internal urethral sphincter muscle and the external urethral sphincter muscle; the relationship of the prostate with the male urethra, however, is not limited to proximity: the prostate gland, in fact, emits channels, called prostatic ducts, which open on the male urethra, thus putting the two anatomical structures in communication.
The prostate secretes part of the liquid component of the sperm; alkaline in nature and whitish in color, this liquid component has the function of neutralizing the acidic environment of the female vagina, in order to protect the spermatozoa (which would otherwise be affected by the aforementioned environmental conditions) and prolong their life inside the genital system of the woman.
For further information: Prostate: Anatomy and Function neuro-vascular structures and adjoining neuro-vascular structures.
Radical prostatectomy should not be confused with partial prostatectomy (or simple prostatectomy), which consists of the partial removal of the prostate organ.
For further information: Prostatectomy and Simple Prostatectomy considered at medium-high risk, without metastases and without spread of tumor cells to neighboring tissues (excluding lymph nodes).
Radical prostatectomy could also be used in patients with prostate cancer considered to be at low risk; in these circumstances, however, the intervention is only a possible therapeutic solution within a shortlist of other potential therapeutic approaches, such as radiotherapy or simple active surveillance of the neoplasm.
Radical prostatectomy, on the other hand, is not canonically included among the treatment options for prostate cancers considered to be at high risk, with metastases spread outside the prostate gland; in such cases, the only situation that could induce doctors to evaluate the use of radical prostatectomy is the presence of a total obstruction of the urinary tract, obstruction due to the tumor mass.
How to determine the level of risk of a prostate cancer?
To define the level of risk of prostate cancer, the patient must be subjected to a biopsy and examinations of imaging, such as CT and magnetic resonance, which clearly show a "possible spread of the neoplasm.
For further information: Prostate Cancer: Causes and Symptoms and at an ECG.
Subsequently, the doctor who should perform the procedure also subjects him to a scrupulous physical examination and a "thorough medical history, in order to further investigate the information relating to his general state of health and to provide clear indications on the pre-operative precautions to be taken. to adopt.
The knowledge of the patient's general state of health is essential to establish his suitability for the intervention.
During the medical history, the doctor wants to know above all if the patient: suffers from some coagulation disease; takes anticoagulant drugs and / or particular food supplements; is allergic to commonly used medicines, anesthetics and / or sedatives; smokes; etc.
Radical Prostatectomy: Pre-operative Precautions
Here are the main ones:
- On the day of surgery, have a complete fast for at least 8 hours. This means that if the procedure is set for the morning, the last meal allowed is that of the previous evening.
Imposed by anesthesia, the 8-hour fast generally does not include water; the patient, in fact, has the possibility to consume it up to a few hours before the operation.
Failure to comply with the fast leads to the postponement of the radical prostatectomy to another date. - If the patient is on anticoagulant drug therapy (eg warfarin), he must temporarily suspend this treatment to avoid excessive bleeding during and after surgery.
- If the patient is a smoker, he must stop smoking, at least temporarily. Smoking increases the risk of various complications, including post-operative infections.
- For the return home, get help from a family member or friend. After the surgery, it is highly likely that the patient feels confused, unresponsive, weak and tired; therefore, he is not very autonomous and needs support (eg: it is strongly advised against driving a vehicle).
Any other pre-operative indications depend on the patient and his specific health conditions.
or epidural anesthesia.
All three variants allow the patient not to feel pain, but only general anesthesia also involves falling asleep (both with spinal and epidural anesthesia, the patient remains conscious).
"Open" radical prostatectomy (traditional surgical technique)
Radical prostatectomy performed with traditional surgical technique involves making a single large incision in an area below the navel or at the level of the perineum (ie between the scrotum and anus).
In the case of a sub-umbilical incision, the procedure is called a retropubic radical prostatectomy; in the case of an incision at the perineal level, however, the procedure is currently called radical perineal prostatectomy.
Through the opening resulting from the incision, the surgeon accesses the pelvic area and carries out the partial or total removal of the prostate.
If the prostate cancer has spread to nearby lymph nodes or neighboring neuro-vascular structures, the removal could also involve these elements; in such situations, clearly, the operation will be more invasive.
Retropubic Radical Prostatectomy
In retropubic radical prostatectomy, the surgeon makes the abdominal incision just above the prostate and from there directly reaches the prostate, in order to remove it totally or partially.
Perineal Radical Prostatectomy
Distinguished by the incision of the perineal area, radical perineal prostatectomy is a rarely used approach, as it has some limitations: in fact, it does not allow the elimination of abdominal lymph nodes and neuro-vascular structures possibly affected by neoplastic cells.
Radical Prostatectomy with Laparoscopic Technique
Laparoscopy (or laparoscopic technique) is a minimally invasive surgical procedure, characterized by the making of 3-4 small incisions (1 centimeter) at the abdominal level and by the use of an exploratory probe known as a laparoscope.
During laparoscopic radical prostatectomy procedures, the surgeon usually makes 4 small incisions in the abdominal area; then, he uses these small openings to introduce the laparoscope into the pelvic cavity, with which he observes the inside of the pelvic cavity itself, and the surgical instruments useful for removing the prostate.
The small size of the incisions that distinguish radical prostatectomy with laparoscopic technique guarantees an easier and quicker post-operative recovery.
Robotic (or Robot-assisted) Laparoscopic Radical Prostatectomy
Thanks to the advancement of medical technologies, for some years now, surgeons have been able to perform laparoscopic radical prostatectomy with the support of a robotic instrument (robotic or robot-assisted radical laparoscopic prostatectomy).
It is, in effect, an alternative procedural approach to laparoscopic radical prostatectomy.
The peculiarity of this variant is that the surgeon carries out the operations on the prostate by guiding a robot, which, in fact, takes the place of the specialist doctor's hands.
The robotic variant of laparoscopic interventions ensures high precision and even faster recovery times.
.After the radical prostatectomy procedures, the use of the bladder catheter is foreseen, to allow the patient to urinate; the period of use of the bladder catheter varies from 2 to 3 weeks, for operations with classic surgical technique, to 7-10 days, for laparoscopic procedures.
Radical prostatectomy: how is the patient after the procedure?
It is normal for the patient to experience pain in the surgical incisions after radical prostatectomy, especially when walking.
If the pain is severe, the surgeon may prescribe a pain reliever to be administered via an intravenous line applied to the arm.
It should also be noted that in the first 24-48 hours following the procedures under general anesthesia, the patient may experience weakness, headache, confusion and slow reflexes: these are all normal effects of anesthetic practice, which vanish in a short time. weather.
Radical Prostatectomy: Recovery at Home
After the days of hospitalization, recovery must continue at home.
For patients returning from radical prostatectomy, the classic medical indications to follow at home include:
- Avoid tiring activities (eg lifting weights), but practice some short walks, even at home;
- Don't drive to the doctor's "way";
- Take a pain reliever if you are in pain
- Eat in a healthy way;
- Gradually return to your normal daily routine;
- Refrain from sexual activity until otherwise indicated by the attending physician.
Radical Prostatectomy and Follow-up
After radical prostatectomy, a follow-up program is envisaged, which is based on periodic precautionary checks, useful for monitoring the effects of the intervention over time and also for promptly identifying any relapses.
These controls include:
- Physical examination;
- PSA measurement;
- Digital rectal examination.
Radical Prostatectomy and Sexual Activity
Radical prostatectomy has more or less profound repercussions in the sexual field:
- The patient may suffer from erection problems (erectile dysfunction) for several months (even 12-18 months); in some cases, this problem is permanent.
- The ability to ejaculate changes permanently, with the patient no longer emitting semen or emitting only a small amount.
However, prostatectomy generally involves a condition of permanent sterility. - For some time, the patient may no longer feel the same sexual interest as they did before the surgery.
Radical Prostatectomy: Recovery Times
Men who have undergone radical prostatectomy need 4 to 12 weeks to feel better and to resume the simplest daily activities with confidence.
Shorter recovery times characterize interventions with less invasive techniques (laparoscopy); conversely, longer recovery times are typical of operations with traditional surgical technique.
Specific Risks of Radical Prostatectomy
- Erectile dysfunction;
- Urinary infection;
- Urinary incontinence;
- Urethral stricture;
- Lymphocele and lymphedema;
- Damage to the rectum (due to the proximity of the rectum and prostate).
- Radical prostatectomy is contraindicated when the tumor has spread to the rest of the body.
- The perineal approach is contraindicated in patients whose fertility is still potentially high (for example, because they are still relatively young).
