Radical retropubic prostatectomy
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Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. It is most often used to treat individuals who have early prostate cancer. Radical retropubic prostatectomy can be performed under epidural anesthesia and requires blood transfusion less than one-fifth of the time. Radical retropubic prostatectomy is associated with complications such as urinary incontinence and impotence.
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[edit] Description
Radical retropubic prostatectomy can be performed in several different ways with several possible associated procedures. The most common approach is to make an incision in the skin between the umbilicus and the top of the pubic bone. The pelvis is then explored and the important structures such as the urinary bladder, prostate, blood vessels, and nerves identified. The blood vessels leading to and from the prostate are then divided and tied off. The prostate is removed from the urethra on one side and the bladder on the other and the bladder and urethra are reconnected. Recovery typically is rapid; individuals are able to walk and eat within 24 hours after surgery. A catheter through the penis into the bladder is typically required for at least a week after surgery. A surgical drain is often left in the pelvis for several days to allow drainage of blood and other fluid. Additional components of the operation may include:
- Lymphadenectomy - Prostate cancer often spreads to the lymph nodes in the early stages. Removal of select lymph nodes in the pelvis allows microscopic evaluation for evidence of cancer within these nodes. If cancer is found in the lymph nodes, different therapies may be offered
- Nerve-sparing surgery - Select individuals will be eligible for nerve-sparing surgery. Nerve-sparing surgery attempts to protect the nerves which control ejaculation. These nerves run next to the prostate and are often destroyed during surgery, leading to impotence. If the cancer is clinically unlikely to have spread beyond the prostate, nerve-sparing surgery should be offered to minimize impotency.
[edit] Indications
Radical retropubic prostatectomy is typically performed in men who have early stages prostate cancer. Early stage prostate cancer is confined to the prostate gland and has not yet spread to other parts of the body. Attempts are made prior to surgery, through medical tests such as bone scans, computed tomography (CT), and magnetic resonance imaging (MRI), to identify cancer outside of the prostate. Radical retropubic prostatectomy may also be used if prostate cancer has failed to respond to radiation therapy.
[edit] Complications
The most common serious complications of radical retropubic prostatectomy are loss of urinary control and impotence. As many as forty percent of men undergoing prostatectomy will be left with some degree of urinary incontinence, usually in the form of leakage with sneezing, etc. (stress incontinence). Impotence is most common when nerve-sparing techniques are not used. Although erection and ejaculation are affected, penile sensation and the ability to achieve orgasm remain intact. Therefore, use of medications such as sildenafil (Viagra) may restore some degree of potency.
Continence and potency may improve depending on the amount of trauma and the patient's age at the time of the procedure, but progress is frequently slow. Potency is greatly affected by the psychological attitude of the patient. The sensation of orgasm is substantially altered and no semen is produced. Marital counseling focusing on the changes can be effective in restoring potency or maintaining a satisfactory spousal relationship if impotence continues.
[edit] References
Klein, EA, Jhaveri, F, Licht, M. Contemporary technique of radical prostatectomy. In: Management of Prostate Cancer, Klein, EA (Ed), Humana Press, New Jersey, 2000
