Prostatectomy (Radical retropubic)
Summary: Removal of the whole prostate gland, seminal vesicles and the draining nodes for cancer of the prostate, as well as tying of the vas deferens, through an incision in the lower half of abdomen.
Contents:
- What does the procedure involve?
- What are the alternatives to this procedure?
- What should I expect before the procedure?
- What happens during the procedure?
- What happens immediately after the procedure?
- What should I expect when I get home?
- What else should I look out for?
- Are there any other important points?
- Is there any research being carried out in this field?
- Who can I contact for more help or information?
- Can I obtain a printed version of this information?
- Side effects & risks
What does the procedure involve?
Removal of the whole prostate gland, seminal vesicles and the draining nodes for cancer of the prostate, as well as tying of the vas deferens, through an incision in the lower half of abdomen.
What are the alternatives to this procedure?
Active monitoring (watchful waiting), external beam radiotherapy, brachytherapy, hormonal therapy, the perineal or laparoscopic telescopic or minimally-invasive) approach; more recently a robotic operation (the da Vinci procedure).
What should I expect before the procedure?
You will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse.
You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins. An enema will be given a few hours before you go to the operating theatre.
Please be sure to inform your Urologist in advance of your surgery if you have any of the following:
- an artificial heart valve
- a coronary artery stent
- a heart pacemaker or defibrillator
- an artificial joint
- an artificial blood vessel graft
- a neurosurgical shunt
- any other implanted foreign body
- a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
- a previous or current MRSA infection
- high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies.
In this operation, the whole prostate gland and the two sacs behind the prostate (the seminal vesicles) are removed completely through an incision in the lower part of your abdomen. The bladder is then joined to the water pipe (urethra) which runs along the penis. In some circumstances, lymph glands close to the prostate may be sampled at the start of the operation; very rarely, If these obviously contain cancer, the operation may be discontinued and you will be treated in other ways..
The operation takes between 3 and 3½ hours to complete.
What happens immediately after the procedure?
After the procedure, you will have a tube coming out of your abdomen which drains fluid away from the operation site and is removed after 48-72 hours. You will also have a catheter draining urine from the bladder which is removed 2-3 weeks after surgery.
You will usually be able to go home after 5-7 days and arrangements will be made for you to be re-admitted for removal of your catheter.
The average hospital stay is 5-7 days.
What should I expect when I get home?
A 6-week convalescent period is usually necessary after surgery. Patients often feel tired and weak for several months.
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.
If you have problems with your catheter (especially If it falls out), ask your GP to contact the on-call urologist as soon as possible. If you become unable to pass urine once the catheter has been removed, you should return immediately to the Hospital for further treatment.
Are there any other important points?
After this procedure, there is about a 50% chance that you will lose your erections (see above) and, even If these are preserved, the ability to ejaculate is lost. You will not, of course, be able to father children.
Up to 30% of patients develop some small degree of urinary leakage (often leaking a drop or two when standing from a seated position with a full bladder). This is usually only a small amount of leakage when you cough, strain or are active. To improve urinary control, pelvic floor exercises are helpful; you will have been instructed in how to do these prior to your surgery and it is beneficial to start the exercises in the period between your initial discharge and your re-admission for catheter removal. The control steadily improves over the first year after surgery but a small proportion (3-5%) have long-lasting poor control.
It will be at least 14-21 days before the final pathology results on your prostate become available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.
You will be followed up closely after your operation, chiefly by means of the prostate blood test (PSA). If this level rises, it indicates a return of the cancer and will require further treatment in the form of radiotherapy or drugs.
Driving
It is your responsibility to ensure that you are fit to drive following your surgery. You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than 3 months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.
Is there any research being carried out in this field?
Yes. As part of your operation, various specimens of tissue will be sent to the Pathology department so that we can find out details of the disease and whether it has affected other areas. This information sheet has already described to you what tissue will be removed.
We would also like your agreement to carry out research on that tissue which will be left over when the pathologist has finished making a full diagnosis. Normally, this tissue is disposed of or simply stored. What we would like to do is to store samples of the tissue, both frozen and after it has been processed. Please note that we are not asking you to provide any tissue apart from that which would normally be removed during the operation.
We are carrying out a series of research projects which involve studying the genes and proteins produced by normal and diseased tissues. The reason for doing this is to try to discover differences between diseased and normal tissue to help develop new tests or treatments that might benefit future generations. This research is being carried out here in Cambridge but we sometimes work with other universities or with industry to move our research forwards more quickly than it would If we did everything here.
The consent form you will sign from the hospital allows you to indicate whether you are prepared to provide this tissue. If you would like any further information, please ask the ward to contact your Consultant.
Who can I contact for more help or information?
Oncology Nurses
- Bladder cancer Nurse Practitioner (cystectomy patients) -
01223 586748 - Bladder cancer Nurse Practitioner (haematuria, chemotherapy & BCG) - 01223 274608
- Prostate cancer Nurse Practitioner - 01223 216574
- Uro-Oncology Clinical Nurse Specialist (kidney patients) - 01223 257167
Non-Oncology Nurses
- Urology Nurse Practitioner (incontinence, urodynamics, catheter patients) - 01223 274608 or 586748
Patient Advice & Liaison Centre (PALS)
- Telephone +44 (0)1223 216756 or 257257
- PatientLine *801 (from patient bedside telephones only)
- E mail PALS
- PALS, Box No 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
Chaplaincy and Multi-Faith Community
- Telephone +44 (0)1223 217769
- E mail the chaplain
- The Chaplaincy, Box No 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
MINICOM System ("type" system for the hard of hearing)
- Telephone +44 (0)1223 274604
Access Office (travel, parking & security information)
- Telephone +44 (0)1223 586969
Can I obtain a printed version of this information?
Yes. You can print this Infosheet by using the print option on your browser or by clicking the "Print Infosheet" button at the top of this page.
If you wish to obtain the formal, printed version from Addenbrooke's or Hinchingbrooke, please contact your Consultant or Specialist Nurse.
To obtain this information in other languages, large print or audio format, e-mail Patient Information at Addenbrooke’s or telephone +44(0)1223 216032.
common Side-effects (greater than 1 in 10)
- Temporary insertion of a bladder catheter and wound drain
- High chance of impotence due to unavoidable nerve damage (60-90%). The risk of this happening will depend on your previous erections and also on whether the surgeon has decided to remove one or both
- Inability to ejaculate or father children because the structures which produce seminal fluid have been removed (occurs in 100% of patients)
- Urinary incontinence (temporary or permanent) requiring pads or further surgery (3-30%)
- Minor problems with urinary leakage
occasional Side-effects (between 1 in 10 and 1 in 50)
- Scarring at the bladder exit resulting in weakening of the urinary stream requiring further surgery (approximately 14%)
- Serious urinary incontinence (temporary or permanent) requiring pads or further surgery (2-5%)
- Blood loss requiring transfusion or repeat surgery
- Discovery that cancer cells have already spread outside prostate needing observation or further treatment
- Apparent shortening of the penis; this is the result of prostate gland removal causing upward movement of the urethra to allow re-joining to the bladder neck
- Further treatment at a later date, If required, including radiotherapy of hormonal therapy
- Lymphatic collection in the pelvis if lymph node sampling is performed
- Development of a hernia in the groin at least 6 months after the operation
rare Side-effects (less than 1 in 50)
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)
- Pain, infection or hernia in the area of the incision
- Rectal injury needing temporary colostomy
Hospital-acquired infection (overall risk for Addenbrooke’s Urology)
- Colonisation with MRSA - 0.14% (1 in 700)
- Clostridium difficile bowel infection - 0.04% (1 in 2500)
- MRSA bloodstream infection - 0.08% (1 in 1250)
(These rates may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalisation or after multiple admissions)
