A prostatectomy is a procedure to remove all or part of the prostate gland. It is usually performed to treat prostate cancer or other conditions of the prostate including the inability to fully empty the bladder, recurrent bleeding from the prostate, bladder stones causing prostate enlargement, or pressure on the kidneys from urinary retention. Prostate cancer is the most common form of cancer for men older than fifty and the third leading cause of death from cancer.
The prostate gland surrounds the neck of the bladder and the urethra. It is a muscular gland, composed of three lobes. Its ducts open into the urethra. The prostate gland is part of the male reproductive system. Its primary function is to release alkaline fluid which forms part of the seminal fluid. The prostate helps to send prostate fluid and sperm into the urethra. It also plays an important role in the urinary process.
The prostate gland often becomes enlarged with age. In some cases, this is not problematic, but in others, it can lead to serious health problems. Some prostate problems do not require prostatectomy.
A prostate biopsy is usually carried out to assess whether surgical intervention is required. Advanced robotic technology has allowed for a more detailed examination of the prostate. A full health assessment will also be carried out to identify whether a patient is a suitable candidate for prostatectomy.
If a prostatectomy is necessary, a surgical incision is made and some or all of the prostate is removed. The incision can be made in the lower abdomen or in the area between the scrotum and the rectum.
There are different surgical methods for radical prostatectomy. The radical prostatectomy involves and removal of the entire gland. Your surgeon will try to spare the nerves as much as possible during the procedure in order to maintain as much function as possible. It can be performed using a perineal incision or a retropubic incision.
If the procedure is being performed because of prostatic cancer, surrounding lymph nodes will also be removed and tested to assess whether cancer has spread. If it has, other treatment methods will be identified.
A procedure called Transurethral Resection may also be used. It is performed through the penis with an endoscope, a flexible tube with a lens at the end which the surgeon uses to see the obstruction that must be removed. Once the immediate obstruction is removed, this may return to normal function, or further treatment may be required.
It is also now possible to perform prostatectomy with the minimally-invasive laparoscopic method. This involves smaller incisions and the surgeon operating through them rather than fully opening the surgical area. Laparoscopic prostatectomy can be performed manually or with robotic equipment.
You will meet with your medical team for an initial consultation. This will involve a complete medical history and a physical examination. It may also include some tests. You should provide information on any medications you are taking or any allergies you have. You may be required to pause certain medications for a period before the procedure. You will be required to fast for 8-12 hours before the surgery. Prostatectomy can be performed under general or local anaesthesia. It requires an inpatient stay.
After the procedure, dressing will be applied and medication may be prescribed to manage any pain in the days after surgery. If a drain is used to prevent fluid build-up at the site of the operation, it will be removed the day after surgery.
A urinary catheter may also be used and will remain in place for up to three weeks after surgery. Your medical team will provide advice on issues such as driving and physical work. You should notify them of any issues that may arise after surgery, such as excessive or persistent pain or any sign of infection.
Prostatectomy is associated with some substantial impacts and risks. As radical prostatectomy removes a man’s ability to produce semen, it causes sterility. It is also possible for radical prostatectomy to make it permanently impossible for the patient to achieve an erection. In some cases, this function will only be reduced. In others, normal function may gradually return. Nerve-sparing methods make impotence less likely but it is still possible.
The procedure may also lead to urinary incontinence. This is more common in older patients and may improve over time. Lymphedema, the accumulation of fluid in soft tissue, can also occur. This condition causes swelling. This is a rare and treatable side-effect. Prostatectomy also carries the standard risks of surgery such as infection, bleeding, and reaction to anaesthesia. These are also rare side-effects.
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