Open Radical Prostatectomy

• Open Radical Prostatectomy is a surgical procedure for prostate cancer involving the complete removal of the prostate gland.
• The procedure typically requires a hospital stay of a few days, followed by a recovery period that can last several weeks to months.
• Potential risks include urinary incontinence, erectile dysfunction, bleeding, and infection, which are discussed thoroughly with patients.
• Patient selection and surgical expertise are crucial for optimizing outcomes and managing potential complications.

What is Open Radical Prostatectomy?

Open Radical Prostatectomy is a traditional surgical approach for treating localized prostate cancer. This procedure involves making an incision in the lower abdomen to directly access and remove the entire prostate gland, along with the seminal vesicles and sometimes nearby lymph nodes. The primary goal is to remove all cancerous tissue, thereby curing the cancer or preventing its spread. It is typically recommended for men with prostate cancer that is confined to the prostate or has only minimally spread beyond it, and who have a life expectancy of at least 10 years.

Prostate cancer is a significant health concern globally. According to the American Cancer Society, prostate cancer is the second most common cancer in American men, after skin cancer. While treatment options vary, open radical prostatectomy remains a well-established and effective method for many patients, especially those with intermediate or high-risk localized disease.

The Open Radical Prostatectomy Procedure and Recovery

The open radical prostatectomy procedure begins with the patient under general anesthesia. A surgeon makes an incision, usually from the navel to the pubic bone, to gain direct access to the prostate. The prostate gland, along with the seminal vesicles (glands that produce semen) and often a portion of the vas deferens, is carefully dissected and removed. In some cases, nearby lymph nodes may also be removed to check for cancer spread. After the prostate is removed, the bladder is reconnected to the urethra, and a catheter is typically inserted to drain urine while the connection heals.

The open radical prostatectomy recovery time varies among individuals but generally involves a hospital stay of 3 to 7 days. During this time, pain management, catheter care, and early mobilization are key. Once discharged, patients are advised to avoid heavy lifting and strenuous activities for several weeks. The urinary catheter usually remains in place for 1 to 3 weeks. Full recovery, including the return to normal activities and management of potential side effects, can take several months. Physical therapy, especially pelvic floor exercises, is often recommended to aid in regaining bladder control.

Key aspects of the recovery process include:

• Catheter Care: Learning how to manage and care for the urinary catheter at home.
• Pain Management: Using prescribed medications to control post-operative discomfort.
• Activity Restrictions: Avoiding strenuous activities, heavy lifting, and prolonged sitting to promote healing.
• Pelvic Floor Exercises: Starting Kegel exercises as advised by a healthcare professional to improve urinary control.
• Follow-up Appointments: Regular visits with the surgeon and oncologist to monitor recovery and cancer status.

Risks of Open Radical Prostatectomy Surgery

Like any major surgical intervention, there are potential risks of open radical prostatectomy surgery. Patients are thoroughly informed about these risks before deciding on the procedure. Common risks include bleeding, which may necessitate a blood transfusion, and infection at the surgical site or in the urinary tract. There is also a small risk of damage to surrounding organs or nerves during the operation.

Long-term complications can include urinary incontinence and erectile dysfunction. Urinary incontinence, ranging from occasional leakage to more significant issues, can occur due to the proximity of the prostate to the urinary sphincter. Erectile dysfunction is also a common side effect, as the nerves responsible for erections run close to the prostate and can be affected during surgery. While nerve-sparing techniques aim to preserve these nerves, their success depends on the extent of the cancer and the individual’s anatomy. Other less common risks include bowel complications, lymphocele (a collection of lymph fluid), and stricture (narrowing) of the urethra where it was reconnected to the bladder.