Medication Guide App

Perineal Prostatectomy

WHAT YOU SHOULD KNOW:

  • A perineal prostatectomy, also called a radical perineal prostatectomy, is surgery to remove your prostate gland. Your prostate gland is the male sex gland that makes the fluid part of your semen (fluid containing sperm). Your prostate gland is found below your bladder and surrounds the top of your urethra. Your urethra is a tube that carries urine outside your body. You may need a perineal prostatectomy if you have prostate cancer. Cancer occurs when abnormal cells grow and divide without control or order, often making too much tissue (tumor). With prostate cancer, the abnormal cells grow inside your prostate gland. A perineal prostatectomy is normally done when the cancer has not spread outside your prostate gland.



  • During surgery, an incision (cut) is made in your perineum. The perineum is the area between the penis and anus (where bowel movements pass out of your body). Your caregiver removes your prostate gland through the cut. Lymph nodes near your prostate gland may also be removed. Lymph nodes are small lumps of tissue that help fight infection. A perineal prostatectomy may help treat your cancer. A perineal prostatectomy may decrease the risk that your cancer will spread. The surgery may cure your prostate cancer.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During surgery, your nerves, bowel, rectum, and other organs and tissues may be damaged. Blood vessels may be damaged causing you to bleed more than expected and need a blood transfusion. After surgery, you may have pain. You may get an infection in your wound or urinary tract. Your urethra or bladder neck may narrow, and block the flow of your urine. The muscle at the base of your bladder may shorten and weaken, causing you to leak urine. Urine leakage may be temporary (short-term) or permanent. You may leak bowel movements (BMs), and a fistula (abnormal connection) may form between your bowel and urethra.

  • After surgery, you may have trouble having an erection (hardening of your penis). You may have trouble ejaculating (release of sperm), and ejaculating may be painful. You may get a blood clot that causes pain and swelling, and blocks blood flow in your body. The blood clot may break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke and can be life-threatening. Even with surgery, your cancer may not be completely removed. The cancer may spread, or it may come back.

  • Without surgery, your cancer may spread to other areas of your body. Once cancer spreads, it may be harder to treat. Prostate cancer can be life-threatening, and you may die without surgery. Talk with your caregiver if you have questions or concerns about your condition, surgery, or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).

  • Medicines:

    • Enema: You may get an enema (liquid medicine put in your rectum) to help clean out your bowel. Your rectum is the lowest section of bowel that holds your stool until you have a bowel movement (BM).

    • Antibiotics: Antibiotics may be given to help prevent an infection caused by germs called bacteria.

  • Pre-op care: You may get medicine right before your surgery to make you feel relaxed and sleepy. You are taken to the surgery room where you will lie on your back.

  • Anesthesia: Anesthesia medicine makes you comfortable during your surgery. Caregivers work with you to decide which anesthesia is best for you. You may have one of the following:

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

    • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

  • Blood transfusion: You may need a blood transfusion if you lose a lot of blood during surgery. During a blood transfusion, you get whole blood, or parts of blood, through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile virus.

During your surgery:

  • Supports will hold up your feet and legs, and padding is put under your lower back and buttocks. Your caregiver cleans any remaining BM out of your rectum. Your perineum, anus, and scrotum (skin sac that holds the testicles) are shaved and cleaned. If lymph nodes will be removed, they are taken out before your prostate gland is removed. One or more small cuts are made in your lower abdomen, and a laparoscope is inserted. A laparoscope is a long metal tube with a camera and a light on the end. One or more lymph nodes may be removed and sent to a lab to check for cancer.

  • To remove your prostate gland, an upside-down U-shaped cut is made in your perineum. Outer layers of skin, fat, muscle, and tissue are cut and secured out of the way. Your prostate gland is moved away from your rectum and nearby tissues. Your caregiver cuts your prostate gland away from your urethra. Your prostate gland is then cut away from your bladder neck and removed through the cut in your perineum. The bladder neck is where the bottom of your bladder meets your urethra. Your bladder neck and urethra are sewn back together.

  • A catheter (long, bendable tube) is put in your urethra and into your bladder to drain your urine. A balloon on the end of the catheter is filled with liquid. The balloon holds the catheter in place inside your bladder. A drain (thin, rubber tube) is placed in your cut to remove blood and fluid. Your cut is stitched closed and your wound (surgery area) is covered with a bandage. The prostate tissue that was removed is sent to a lab for tests.

After your surgery:

You are taken to a room to rest until you are awake. Do not get out of bed until your caregiver says it is okay. Once caregivers see that you are not having any problems, you will be taken to your hospital room.

  • Activity: Caregivers may help you get out of bed to walk later in the day after your surgery. Ask caregivers if there are exercises that you can do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Call your caregiver before getting out of bed for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.

  • Bladder catheter: You will have a catheter in your bladder after surgery. The catheter is attached to a bag that collects your urine. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter, because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink, because this will block the flow of urine.

  • Blood and urine output: Your caregivers will measure the amount of blood and urine that flows from your wound drain and catheter. The drain in your wound is removed when blood and fluid stop flowing from it.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Medicines:

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

    • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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