What is a radical prostatectomy?
A radical prostatectomy involves removing the prostate, seminal vesicles and pelvic lymph nodes. This operation can be performed either as open surgery via an incision in the abdomen (abdominal, retropubic) or via an incision in the perineum (perineal). At our clinic, we perform open surgery using a retropubic incision. This approach has become the established international standard. This surgery is performed under a general anaesthetic.
Alternatively, the operation can be performed using keyhole surgery. Conventional keyhole surgery (laparoscopy) has now given way to robot-assisted keyhole surgery. We routinely offer robot-assisted prostatectomy using the DaVinci® system as an alternative to open surgery.
You can find further information at Robot-assisted surgery
To enable the urethra to heal undisturbed, all patients undergoing surgery will have a urinary catheter for 6–8 days after the operation. On average, patients spend a total of 10 days in hospital.
It is often possible to preserve the nerves and blood vessels needed to produce an erection. To ensure that none of the cancer is left behind, however, in more advanced cancers it may be necessary to remove these nerves and blood vessels. We always try to preserve the nerves required for an erection where it is safe to do so. Our clinic carries out around 150 radical prostatectomies a year. Whether surgery is required and, if it is, what the most appropriate surgery is will be discussed with you in detail.
What are the risks of radical prostatectomy?
As with any operation, radical prostatectomy can have side effects and carries risks. By preparing for and performing surgery carefully, these can, however, be minimised. A doctor will provide you with detailed information about the procedure well in advance.
Possible complications include severe bleeding during or after the operation which may require a blood transfusion, wound infection, fever, injury to adjacent organs or organ systems, scarring where the bladder is sutured to the urethra which may cause a weaker flow of urine when passing water.
Immediately after the operation patients will continue to experience urgency and sometimes some leakage for a few days or weeks, but this usually responds well to drug treatment.
Complete urinary incontinence (a permanent state of leaking urine involuntarily during even mild physical activity) is much less common and may be able to be corrected via a second small operation if necessary. In mild cases, injecting collagen into the urethral sphincter may be sufficient. In severe cases, an artificial urethral sphincter will need to be implanted. Severe incontinence requiring treatment occurs in only around 1% of patients undergoing this type of surgery.
This surgery does, however, cause infertility, as the seminal vesicles are removed along with the prostate, and both vasa deferentia also have to be severed (as in a vasectomy).
Even where the blood vessels and nerves needed for an erection are preserved, patients may be able to achieve only a limited or no erection. This condition may be temporary or permanent. This problem can, however, be effectively treated with drugs.
Removal of lymph nodes can cause lymphatic fluid to accumulate in the lower abdomen. This rarely causes any problems. In rare cases where one leg swells up, this should be checked without delay to ensure that this is not due to a blood clot in a leg vein (deep vein thrombosis or DVT). If a thrombosis has occurred, it will require immediate treatment.
Sometimes, especially in locally advanced, more aggressive prostate cancers, to prevent cancer recurrence patients may require additional radiotherapy or drug treatment after surgery.