Radical Prostatectomy, Procedure, Benefits and Postoperative Recovery

Introduction

Radical prostatectomy, also known as radical prostatectomies or radical prostatectomies, is a surgery that removes the prostate gland and surrounding tissue. It is usually performed to treat localized prostate carcinoma. The recovery and outcomes have significantly improved with the advancements of techniques like robotic-assisted surgeries. This blog describes the procedure, its benefits, and the recovery in detail.

What Is Radical Prostatectomy

The radical prostatectomy is the definitive surgery to treat prostate cancer. This is especially true when the cancer is contained within the prostate gland. The prostate, seminal glands, and surrounding lymph nodes are removed during the surgery.

Radical Prostatectomy Types

1. Open Radical Prostatectomy :- Performed by a single large abdominal incision.

2. Laparoscopic prostatectomy :- Uses small incisions with long instruments.

3. Robotic Assisted Laparoscopic Surgery (RALP) :- Surgeons use robotic arms to achieve better results and faster recovery.

Indications of Surgery

• Localized or locally advanced prostate carcinoma

• PSA (Prostate-Specific Antigen) levels rising

• Gleason scores indicate aggressive cancer

• Radiation or hormone therapy fails

Preoperative Preparation

• Complete physical evaluation

• Blood and Urine Tests

• Imaging: MRI or CT scans of the pelvis

• Anesthesia evaluation

• Stopping blood thinners

• Instructions for bowel preparation and fasting

The Surgical Procedure: Step by Step

1. Anesthesia Administration :- In most radical prostatectomy surgeries, general anesthesia is used. This means the patient will be completely unconscious and pain-free throughout the operation. A tube is placed into the windpipe to help the patient breathe, and vital signs are monitored closely. In some rare cases, spinal or epidural anesthesia combined with sedation may be used, especially in patients who are not suitable candidates for general anesthesia. The goal of anesthesia is to ensure no sensation or awareness and maintain stable physiological functions during surgery.

2. Incision :- The type of incision depends on the surgical approach:

• Open Radical Prostatectomy :- A single large incision is made in the lower abdomen (from below the belly button to the pubic bone). This allows the surgeon to directly access the prostate gland and surrounding structures.

• Laparoscopic/Robotic-Assisted Prostatectomy :- Several small keyhole incisions are made to insert a camera and surgical tools. While not always involving a large open cut, these techniques still follow the same internal steps but are less invasive.

The purpose of the incision is to give the surgeon clear visibility and access to the prostate, bladder, urethra, and adjacent nerves and vessels.

3. Prostate Removal :- Once the prostate is exposed, the surgeon carefully separates and removes the prostate gland from the surrounding tissues. This step involves:

• Detaching the prostate from the bladder at the top

• Detaching it from the urethra at the bottom

• Removing seminal vesicles, which are glands connected to the prostate

• Preserving or removing surrounding lymph nodes, depending on cancer spread

Extreme precision is required to avoid damaging nearby nerves, blood vessels, and muscles. The entire prostate is removed to ensure complete cancer excision.

4. Nerve-Sparing Technique :- Where possible, the surgeon will use a nerve-sparing approach. The neurovascular bundles, which are delicate nerve fibers on both sides of the prostate, are responsible for erectile function.

• If the cancer has not spread to these areas, the surgeon will preserve the nerves.

• In cases where cancer is close to or invading the nerves, partial or full removal may be necessary.

Preserving these nerves greatly improves the chances of recovering sexual function after surgery. However, even with nerve sparing, full recovery may take time and additional therapy.

5. Reconnecting the Urethra :- After removing the prostate, the surgeon will need to reconnect the urinary system.

• The bladder neck (the part of the bladder that connects to the urethra) is carefully sutured to the remaining urethra.

• This step restores the urinary flow and ensures that urine can pass from the bladder through the urethra.

The connection must be watertight and tension-free to prevent urine leakage and promote healing. This is a critical step for maintaining continence (bladder control).

6. Drain and Catheter Placement :- To allow for proper healing and drainage:

• A Foley catheter (a thin, flexible tube) is inserted through the penis into the bladder. It will remain in place for about 7–14 days.

• The catheter drains urine continuously while the urethral connection heals.

• A surgical drain may also be placed in the abdominal area to remove excess fluids, blood, or lymph that accumulate after surgery. This prevents complications such as infection or fluid buildup.

Proper drainage ensures a clean healing environment and helps monitor for post-surgical bleeding or leaks.

7. Closure :- Once the prostate has been removed, nerves assessed or preserved, and connections completed, the surgeon will close the incisions:

• For open surgery, the large abdominal incision is closed using surgical sutures (stitches) or staples. Sometimes surgical glue is used to seal the skin.

• For laparoscopic/robotic surgeries, small port sites are closed using absorbable sutures and covered with adhesive bandages.

The closure step ensures that the skin and muscle layers heal properly, prevents infection, and minimizes scarring. Patients are then moved to the recovery room for close observation.

Recovery after Radical Prostatectomy

1. Hospital Stay:

• Usually, a 1-3 day turnaround is normal

• Pain relief via medication

• Catheter remains for 7-14 days

2. At Home:

• Avoid strenuous activities for 4-6 weeks

• Continue to walk and move gently

• Follow the instructions for catheter care

Benefits of Radical Prostatectomy

1. Complete Removal of Cancerous Tissue :- The entire prostate gland and affected tissue are surgically removed, reducing the chances of leaving any cancer behind.

2. Accurate Stage of Disease :- Surgery allows doctors to closely examine the prostate and nearby tissues, providing a more accurate understanding of how advanced the cancer is.

3. Potentially Curative :- For many men with early-stage prostate cancer, radical prostatectomy can completely cure the disease by eliminating all cancer cells.

4. Long-term Cancer Control :- Surgery offers long-lasting control by removing the cancer source, keeping PSA levels low, and reducing the risk of recurrence.

5. Improved Survival in Localized Cases :- Men with localized cancer often experience better long-term survival compared to other treatments, especially when diagnosed early.

Complications and Risks

• Urinary Incontinence

• Erectile Dysfunction 

• Infection and Bleeding

• Stricture or scarring in the urethra

• Lymphedema (if lymph nodes removed)

Follow-Up Care

• PSA monitoring is initially every 3 to 6 months.

• Imagine if PSA levels rose

• If needed, psychological counseling is available

Conclusion

Many men with prostate cancer can save their lives by undergoing a radical prostatectomy. Modern surgical advances have significantly reduced the risk of complications. Patients can make informed treatment decisions if they understand the entire process, from diagnosis to recovery.