This operation involves removing the entire prostate gland including some of the nearby tissue. If the cancer is only present inside this gland, then this surgery should remove all the cancerous tissue. As a result life expectancy is increased and may be similar to patients who have never had prostate cancer. However in a some patients the cancer can return.
There are two common types of procedure:
- Retropubic - where the surgeon removes the prostate through an incision in the lower abdomen
- Perineal - where the incision is made between the scrotum and the anus.
Newly developed laparoscopic methods make it a quick procedure and nerve-sparing and seminal vesicle-sparing techniques help to preserve sensation and sexual function.
After the prostate gland has been removed, the urethra (or urinary passage) will be reconnected to your bladder and a catheter (which is a tube to drain the bladder) will be inserted. You should be able to go home a few days after your operation, with the catheter in place. You will have to return to hospital about two weeks later to have the catheter removed. You may well have pain for some days after your operation. The use of painkillers should help to ease this.
Radical prostatectomy can cause problems with bladder control (incontinence) and in getting erections (impotence). Difficulty in controlling water for a few days after the removal of the catheter is relatively common but many people regain bladder control fairly quickly. Some patients experience slight leakage of urine, particularly on straining, exercising, coughing etc. A few patients may have more serious problems and will need to wear a pad.
This operation is most commonly performed to treat benign, not malignant, enlargement of the prostate. However, it is sometimes carried out in men with cancer of the prostate, to remove the part of the tumour, which is blocking the flow of urine down the penis. A telescopic tube is passed down your penis. An instrument attached to the tube is used to remove the blockage. After the operation, you will have a catheter in your bladder so that your urine can be drained into a collecting bag. To prevent blood clots blocking the catheter, bladder irrigation may be used, which will mean that fluid is passed into your bladder and drained out through the catheter. You should be discharged from hospital after three or four days.
Although some men experience slight difficulty in controlling their urine afterwards and a small proportion of men may find that the operation has an effect on their erections, the long-term complications from this operation are less marked. One effect that most men undergoing trans-urethral resection of the prostate experience is "retrograde ejaculation" where despite normal erections and experiencing a normal orgasm, the semen which is normally discharged at this time will gather in the bladder (and is subsequently passed in the urine), so that the orgasm is "dry".
An operation called an orchidectomy (sometimes also known as an orchiectomy) may be carried out to slow down the growth of your cancer, particularly if the cancer is at an advanced stage. This will involve removing part of, or all of the testicles (castration). This will reduce the level of the male hormone, testosterone and as a result orchidectomy may also be referred to as hormonal therapy.
A small incision will be made in the scrotum (the sac which holds the testicles) and the testicles are removed. You should be able to return home around three days after your operation.
Most men who undergo surgical castration will experience a loss of sexual desire and impotence. In addition, hot flushes frequently occur. Surgery is permanent and the effects cannot be reversed. |