When the radical perineal prostatectomy
is used as a prostate cancer treatment an incision is
made in the perineum, which is the muscles and exterior
skin between the scrotum and the anal sphincter. The
radical perineal prostatectomy, when compared to the
retropubic procedure, tends to involve less blood loss
and trauma for the patient. Their recovery times also
tend to be shorter. Due to the site of the incision,
however, the regional lymph nodes cannot be removed and
examined for metastasis to the lymph nodes. During the
retropubic prostatectomy a pathologist will examine
nodes for cancer extension. Only if the lymph nodes
are free from extension will the surgery continue. Most
cancer patients today fortunately have a less than
1 percent chance of lymph node extension; the perineal
prostatectomy is therefore an acceptable alternative
to the retropubic procedure.
Before undergoing surgery, patients may go onto a liquid
diet, eat nothing after midnight the night before the
operation, take laxatives, or have an enema, all of
which should clear the rectum. Patients usually stop
taking anti-inflammatory drugs 7 to 10 days before the
surgery. Those who are prescribed these medications
for other medical conditions should speak with the prescribing
physician. Patients who have had unusual bleeding during
other medical procedures should notify their surgeons.
Some doctors will encourage patients to bank 1 or 2
pints of blood within 30 days of the prostatectomy.
A patient’s own blood is the best and least expensive
if he should require a transfusion.
During Prostate Surgery
During the prostatectomy, the patient is placed in the
high lithotomy position, which places the feet in stirrups
and extends them up in the air to elevate the legs above
the head. This position gives the surgeon a clear view
of the incision site. Many hospitals will shave the
perineum in preparation for the surgery. The surgeon
makes an incision length-wise across the perineum and
uses a self-retaining perineal retractor to hold the
incision open. The surgeon then gradually detaches the
prostate gland from the surrounding organs and tissues.
In the perineal prostatectomy, the nerve-sparing technique
is difficult to perform. As in the retropubic surgery,
the surgeon will have to sever the urethra above and
below the prostate gland.
If the disease has not affected
the neurovascular bundles, the surgeon will leave them
intact in hopes of preserving the erectile function.
Patients whose Gleason scores and PSA levels indicate
that they may be a candidate for nerve-sparing prostatectomy
should speak with their surgeon. Men for whom maintaining
sexual potency is a priority should speak frankly with
their surgeons about previous success with the technique.
High success rates in the nerve-sparing prostatectomy
are directly correlated with the surgeon’s experience.
Men who are interested in the nerve-sparing technique
should also be aware that the prostatectomy changes
the flow of blood to the penis and may negatively affect
sexual potency despite nerve-sparing technique.
After the prostate gland is removed
the surgeon closes the incision and leaves a drain that
will empty the surgical area of excess fluid. Perineal
prostatectomy patients usually have their drains removed
when they are discharged after 2 or 3 days. A catheter
is inserted into the urethra and is removed after 1
to 3 weeks.
After the surgery the patient is encouraged to begin
moving around as soon as he is conscious. Movement will
help prevent deep venous thrombosis or blood clots in
the legs, which could potentially cause a heart attack,
stroke, or pulmonary embolism. Doctors may prescribe
stool softeners or laxatives to help with bowel movements.
Patients should not have to strain to move their bowels;
the rectal tissue will be thin, delicate, and prone
to injury for the next 3 months.
Patients should not lift anything over 1 pound for the
next 6 weeks. The strain of lifting may cause a perineal
hernia. More seriously, lifting could damage the new
connection between the urethra and the bladder called
the anastomosis. Long term complications could result
from damaging the anastomosis.