Surgery Overview

A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery. Or it may be done by laparoscopic surgery through small incisions.

Laparoscopic surgery may be done by hand. But some doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

Open surgery

In open surgery, the surgeon makes an incision to reach the prostate gland. Depending on the case, the incision is made either in the lower belly or in the perineum between the anus and the scrotum.

When the incision is made in the lower belly, it is called the retropubic approach. In this procedure, the surgeon may also remove lymph nodes in the area so that they can be tested for cancer.

When the incision is made in the perineum, it is called the perineal approach. The recovery time after this surgery may be shorter than with the retropubic approach. If the surgeon wants to remove lymph nodes for testing, he or she must make a separate incision. If the lymph nodes are believed to be free of cancer based on the grade of the cancer and results of the PSA test, the surgeon may not remove lymph nodes.

Laparoscopic surgery

For laparoscopic surgery, the surgeon makes several small incisions in the belly. A lighted viewing instrument called a laparoscope is inserted into one of the incisions. The surgeon uses special instruments to reach and remove the prostate through the other incisions.

Robotic-assisted laparoscopic radical prostatectomy is surgery done through small incisions in the belly with robotic arms that translate the surgeon's hand motions into finer and more precise action. This surgery requires specially trained doctors.

The main goal of either open or laparoscopic surgery is to remove all the cancer. Sometimes that means removing the prostate and the tissues around it, including a set of nerves to the penis that affect the man's ability to have an erection. Some tumors can be removed using a nerve-sparing technique. This means carefully cutting around those nerves to leave them intact. Nerve-sparing surgery sometimes preserves the man's ability to have an erection.

What To Expect After Surgery

Prostatectomy usually requires general anesthesia and a hospital stay of 2 to 4 days. A thin, flexible tube called a catheter usually is left in your bladder to drain your urine for 1 to 3 weeks. Your doctor will give you instructions about how to care for your catheter at home. Bladder control can be poor for a few months after the catheter is removed.