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Pre-operative Care
When radical retropubic prostatectomy is used
as a prostate
cancer treatment, an incision is made in the lower
abdomen. Retropubic means that the prostate gland is
located behind the pubic arch which is made up of the
pubic bones. The retropubic prostatectomy is designed
to move the gland out from behind the arch.
Prostate
cancer patients will usually do one of several things
to make the procedure easier and lower their risks of
complications. Some patients should go onto a liquid
diet, eat nothing after midnight the night before the
procedure, take laxatives, have an enema, or some combination
of the four. Doing any of the above cleans the rectum
for the prostatectomy. Patients should also stop aspirin
or anti-inflammatory drugs, 7 to 10 days before the
procedure. Patients who have been prescribed these drugs
for other medical conditions should speak their doctors.
Patients should also notify their
doctors if they have ever experienced any unusual
problems with bleeding during medical procedures. There
is a possibility that a prostate cancer patient undergoing
prostatectomy will need a blood transfusion. Some doctors
encourage patients to try and bank 1 or 2 units of blood
within 30 days before their prostatectomies.
The Prostate Surgery
During the procedure, the patient is put under general
anesthesia. The surgeon makes an incision about 7 to
10 centimeters long in the center of the lower abdomen.
Usually, the surgeon will then remove the lymph nodes
which are then examined by a pathologist using a microscope.
If the pathologist finds cancer in the lymph nodes,
the surgery is stopped. The prostatectomy is not a useful
procedure for those whose cancer has metastasized out
of the prostate gland.
If the pathologist does not find
any evidence of prostate cancer metastasis to the lymph
nodes, the surgery will continue. The surgeon cuts the
veins that travel over the urethra and prostate gland
to prevent blood from obscuring the view. The surgeon
then cuts the urethra above and below the prostate gland.
Later, the urethra is reattached to the bladder, which
may cause a shortening of the penis. The surgeon then
removes the prostate gland. If the prostate cancer does
not appear to have spread into the neurovascular bundles,
the surgeon will attempt to spare one or both. This
technique is called nerve-sparing prostatectomy and
increases the likelihood that the patient will be able
to maintain potency after the surgery. If the prostate
cancer has spread to the nerve bundles, the surgeon
will remove them. The surgeon will also remove the overlying
veins, seminal vesicles, and vas deferens.
Post-operative Prostatectomy
Care
After the prostatectomy, drains are left in the area
for 3 to 5 days or until only minimal fluid is flowing
through. A catheter is inserted to drain urine for the
next 2 to 3 weeks. A typical hospital stay lasts 2 to
3 days, depending on how soon a patient can eat and
move his bowels regularly. Patients are encouraged to
begin moving as soon as possible after the surgery to
decrease the risk of blood clots in the legs. Doctors
usually prescribe stool softeners or laxatives to help
with bowel movements. The rectum is now thin and delicate
and at risk for injury for the next three months.
Patients who have undergone prostatectomy as a prostate
cancer treatment are not to lift anything over 10 pounds
for the next 6 weeks. Lifting or straining could cause
a hernia at the incision site. More importantly, lifting
could tear the new connection between the bladder and
the urethra.
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