Radical retropubic removal of the prostate gland for prostate cancer

What is this?

Removal of the whole prostate gland, seminal vesicles and the draining nodes for cancer of the prostate, as well as tying of the vas deferens, through an incision in the lower half of abdomen

What alternatives are there?

Active monitoring (watchful waiting), external beam radiotherapy, brachytherapy, hormonal therapy, the perineal 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?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies. In this operation, the whole prostate gland and the two sacs behind the prostate (the seminal vesicles) are removed completely through an incision in the lower part of your abdomen. The bladder is then joined to the water pipe (urethra) which runs along the penis. In some circumstances, lymph glands close to the prostate may be sampled at the start of the operation; very rarely, If these obviously contain cancer, the operation may be discontinued and you will be treated in other ways.. The operation takes between 3 and 3œ hours to complete.

After the procedure

After the procedure, you will have a tube coming out of your abdomen which drains fluid away from the operation site and is removed after 48-72 hours. You will also have a catheter draining urine from the bladder which is removed 2-3 weeks after surgery. You will usually be able to go home after 5-7 days and arrangements will be made for you to be re-admitted for removal of your catheter. The average hospital stay is 5-7 days.

Potential side effects