Radical Retropubic Removal of the Prostate Gland with Pelvic Lymph Node Dissection

The Procedure

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 the abdomen.

Radical Retropubic Removal of the Prostate Gland with Pelvic Lymph Node Dissection
After the Procedure

After the procedure, you will have a tube coming out of your abdomen which drains the 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 generally removed 2-3 weeks after surgery.

You will usually be able to go home after 3-7 days and arrangements will be made for you to be re-admitted for removal of your catheter.

Side Effects

Most procedures have a potential for side-effects and these are outlined below.

Common (greater than 1 in 10)

  • Temporary insertion of a bladder catheter and wound drain.
  • High chance of impotence due to unavoidable nerve damage (30-90%)
    The chance of this happening will depend on your age, previous erections and also on whether the surgeon has decided to remove one or both nerves because the tumour was extending into them. This will have been discussed with you beforehand.
  • No semen is produced during an orgasm. Infertility is a result.
  • Urinary incontinence (temporary or permanent) requiring pads or further surgery (3-30%).
  • Minor problems with urinary leakage.

Occasional (between 1 in 10 & 1 in 50)

  • Scarring at the bladder exit resulting in weakness of the urinary stream requiring further surgery (5-10%).
  • 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 the prostate needing observation or further treatment.
  • Further treatment at a later date, if required, including radiotherapy of hormonal therapy.
  • Lymphatic collection in the pelvis if lymph node sampling is performed.

Rare (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.
Going Home

A 6 week convalescent period is usually necessary after surgery. Patients often feel tired and weak for several months. Patients must avoid heavy lifting for 3 months and driving for 4-6 weeks.

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 (2-5%) have long-lasting poor control.

It will be at least 7-14 days before the final histopathology results of your prostate become available. It is normal practice for the results of all biopsies to be discussed in detail at a Multi-Disciplinary Meeting (MDT) before any other treatment decisions are made. You and your doctor will be informed of the results of 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.

If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your specialist or GP.

If you have problems with your catheter, (especially if it falls out), call the specialist’s rooms for advice. Alternatively ring the emergency department to contact the on-call urologist as soon as possible.

If you become unable to pas urine once the catheter has been removed, you should return immediately to the hospital for further treatment.

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