Radical prostatectomy

Alternative Names: Prostatectomy - radical; Radical retropubic prostatectomy; Radical perineal prostatectomy; Laparoscopic radical prostatectomy; LRP; Robotic-assisted laparoscopic prostatectomy; RALP; Pelvic lymphadenectomy

Radical prostatectomy is surgery to remove all of the prostate gland and some of the tissue around it, to treat prostate cancer.

See also: Prostate resection - minimally invasive

Description of Procedure

There are four main types of radical prostatectomy surgery. These procedures take about 3 to 4 hours:

• Radical retropubic prostatectomy: Your surgeon will make a cut starting just below your belly button and reaching to your pubic bone. The entire surgery should take 90 minutes to 4 hours.
• Laparoscopic radical prostatectomy: The surgeon makes several small cuts instead of one big cut. Long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts. This helps the surgeon see inside your belly during the procedure.
• Robotic-assisted laparoscopic prostatectomy: Sometimes laparoscopic surgery is done using a robotic system. The surgeon moves the robotic arm while sitting at a computer monitor near the operating table. Not every hospital can do robotic surgery.
• Radical perineal prostatectomy: Your surgeon makes a cut in the skin between your anus and base of the scrotum (the perineum). The cut is smaller than with the retropubic technique. This makes it harder for the surgeon to spare the nerves around the prostate, or to remove nearby lymph nodes. Perineal surgery usually takes less time than the retropubic way. There is also less blood loss.

For these procedures, you will be asleep (under general anesthesia) or receive medicine to numb the lower half of your body (spinal or epidural anesthesia).

• The surgeon removes the prostate gland from the surrounding tissue. The seminal vesicles, two small fluid filled sacs next to your prostate, are sometimes also removed.
• The surgeon tries carefully not to damage nerves and blood vessels.
• The surgeon reattaches the urethra to a part of the bladder called the bladder neck. The urethra is the tube that carries urine from the bladder out through the penis.
• Many surgeons will also remove lymph nodes in the pelvis to check for cancer.
• The surgeon may leave a drain, called a Jackson-Pratt drain, in your belly to drain extra fluids after surgery.
• A tube or urinary catheter is left in your bladder to drain urine.

Risks of Radical prostatectomy

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Blood loss
• Breathing problems
• Heart attack or stroke during surgery
• Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney
• Reactions to medications

Risks of this procedure are:

• Difficulty controlling bowel movements (bowel incontinence)
• Difficulty controlling urine (urinary incontinence)
• Erection problems (impotence)
• Injury to the rectum
• Urethral stricture (tightening of the urinary opening due to scar tissue)

Review Date: 9/26/2011
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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