Prostatectomy Surgery Options in India : Types of Prostatectomy

A surgical approach to treating prostate cancer will remove all or part of the prostate. Typically, men with early-stage disease or cancer that’s confined to the prostate will undergo radical prostatectomy—removal of the entire prostate gland, plus some surrounding tissue. Other surgical procedures may be performed on men with advanced or recurrent disease.

In the most common type of prostatectomy—radical retropubic prostatectomy—an incision is made in the abdomen and the prostate is removed from behind the pubic bone. The surgeon then stitches the urethra directly to the bladder so urine is able to flow. 

Because it typically takes a few days for the body to get used to this new setup, the surgeon will insert a catheter, or tube, into the bladder. Urine will flow automatically out of the bladder, down the urethra, and into a collection bag without the need for conscious control of the sphincter. The catheter is usually kept in place for about a week to 10 days.

Another type of surgery, known as radical perineal prostatectomy, which includes removal of tissues near the gland, usually cures prostate cancer if the surgery removes all the malignant cells. The incision is usually made through the lower abdomen (retropubic) but also can be made in the groin (perineal). Typically, general anesthesia is used and the patient remains in the hospital for two to four days following surgery. Full recovery may require one month or more. 

Partial prostatectomy is generally a treatment for enlargement of the prostate, which is common after age 50. It can also be used to reduce pain and ease urination in men with advanced prostate cancer.

Complications from prostatectomy are those associated with any surgery, including infection and bleeding. Other complications vary depending on the age and health of the man, type of surgery and experience of the surgeon. Two primary concerns men have about radical prostatectomy are the possibilities of impotence and incontinence. Patients can retain sexual function if nerves are not injured during the surgery. Urinary incontinence is usually temporary but bladder problems can continue for years. Radical prostatectomy does cause sterility, but there are procedures that may allow a man to father children, if desired.

Procedure

Before the procedure the bladder and urethra may be numbed (local anesthesia), body below the waist may be numbed (regional anesthesia), or the patient may be completely asleep (general anesthesia). The procedure itself usually takes about 45 minutes. The doctor inserts a cystoscope (a thin, tubelike telescope) through the urethral opening in the penis and into the urethra. The doctor can view the urethra and prostate, either through the cystoscope or on a video monitor. The laser is inserted through the cystoscope to the area of the prostate. The laser is then used to destroy excess prostate tissue.

Following prostatectomy will vary depending on the type of surgery performed: -

• Radical prostatectomy (retropubic or perineal) : - This surgery may require the patient to stay hospitalized for two or three days and miss work for three to five weeks. The catheter may remain for one to three weeks. When the patient urinates, the fluid flows through the plastic tube and collects in a bag for disposal.

• Laparoscopic prostatectomy : - Long-term experience with laparoscopic prostatectomy is not yet available. This surgery may require a hospital stay of only one day. Some physicians and patients report that it involves fewer complications, less pain and faster recovery than open surgery.

• Partial (simple) prostatectomy (transurethral resection of the prostate [TURP] or transurethral incision of the prostate [TUIP]) : - Generally, a patient is discharged from the hospital after a day or two and can return to work in a week or two. A catheter placed through the urethra is used for a few days to drain urine from the bladder. TUIP does not always require a hospital stay.
  

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