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.

Getting Ready

Before your surgery:

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • Tell your caregiver if you have hip or spine problems. Hip or spine problems may not allow you to be in the position needed for a perineal prostatectomy.

  • Your caregiver may start you on hormone therapy if your prostate gland is very large. The hormone therapy may help decrease the size of your prostate gland before your surgery. Ask your caregiver for more information about hormone therapy and if you need it before surgery.

  • You may need blood and urine tests, a transrectal ultrasound, and cystoscopy. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

  • You will need to be on a clear liquid diet the day before your surgery. You may drink clear liquids, including water, broth, apple juice, or lemon-lime soft drinks. You may also suck on ice chips or eat gelatin. Ask your caregiver for more information about a clear liquid diet.

The night before your surgery:

  • You may need to drink a special liquid the night before your surgery that cleans out your bowel. Ask your caregiver for directions about eating and drinking.

The day of your surgery:

  • Write down the correct date, time, and location of your surgery.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

  • You may be given 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).

  • You may be given antibiotic medicine to help prevent an infection caused by germs called bacteria. You may have antibiotic medicine before and after your surgery.

  • You may be given pressure stockings to wear before your surgery. These tight elastic stockings help keep blood from staying in your legs and causing blood clots.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

Treatment

What will happen:

  • You will be taken to the surgery room where you will lie on your back. You will be given anesthesia medicine to keep you comfortable during your surgery. Supports will hold up your feet and legs, and padding will go under your lower back and buttocks. Your caregiver will clean any remaining BM out of your rectum. Your perineum, anus, and scrotum (skin sac that holds the testicles) will be shaved and cleaned. If lymph nodes will be removed, a small cut will be made in your abdomen. The lymph nodes will be removed before taking out your prostate gland. Once the lymph nodes are removed, they are sent to a lab to test for cancer.

  • To remove your prostate gland, an upside-down U-shaped cut will be made in your perineum. Outer layers of skin, fat, muscle, and tissue will be cut and secured out of the way. Your prostate gland will be moved away from your rectum and nearby tissues. Your caregiver will cut 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 will be sewn back together.

  • A catheter (long, bendable tube) will be 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) will be placed in your cut to remove blood and fluid. Your cut will be stitched closed and your wound (surgery area) will be covered with a bandage. The prostate tissue that was removed will be sent to a lab for tests.

After your surgery:

You will be taken to a room to rest until you are awake. Caregivers will check your drain and catheter for blood and urine. You may be given medicine to decrease or take away your pain. 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You are late or cannot make it to your surgery.

  • You have a fever.

Seek Care Immediately if

  • You are urinating very little or not at all.

  • You have new or increased abdomen or pelvic pain.

© 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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