Radical perineal removal of the prostate

What is this?

Removal of the whole prostate gland and seminal vesicles for cancer of the prostate with tying of the vas deferens through an incision beneath the scrotum

What alternatives are there?

Active monitoring (watchful waiting), external beam radiotherapy, brachytherapy, hormonal therapy, the retropubic or laparoscopic telescopic or minimally-invasive) approach; more recently a robotic operation (the da Vinci procedure)

What to expect before procedure

You will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins. An enema will be given a few hours before you go to the operating theatre

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. A horseshoe-shaped incision is made in the skin between the scrotum and the anus (the perineum). The prostate is then detached from the urethra (water pipe) and bladder, after division of its blood supply. The urethra is re-joined to the bladder over a catheter and a tube drain is inserted.

After the procedure

You will be able to take clear fluids immediately after the surgery and mobilise the next day. The drain will be removed after 48-72 hours and the catheter will remain in place for 3 weeks. The average hospital stay is 4 days.

Potential side effects