Page 1 - Radical Prostatectomy
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Urological Health


                                Radical prostatectomy








        Localized prostate cancer may be cured by radical prostatectomy. Within a few months of
        surgery most men will be able to resume their usual lifestyle.


           he prostate is a gland wrapped around the urethra,     Preoperative preparation
        Tthe urine channel, between the bladder and its
        control muscle, the urethral sphincter. Its main function   Preoperative laboratory tests will be obtained as
        is to produce part of the semen ejaculated at male        necessary. A “bowel prep” may be recommended
        orgasm. Each vas deferens carrying sperm from the         before your surgery. The prostate lies immediately next
        testicles connects to the prostate. The nerves carrying   to the bowel. In the rare event of a bowel injury during
        signals to produce erections run on either side of the    surgery, a clean bowel may reduce the risk of serious
        prostate.                                                 complications. Your urologist will instruct you on the
                                                                  form of bowel prep required. This may involve drinking
            Side view of male lower urinary anatomy               a cleansing solution, taking antibiotic tablets and/or
                                                                  enemas.

                                                   Roula Drossis  If you are taking blood thinners, you should discuss this
                                                                  with your urologist.  You may be asked to stop taking
             bladder                                              aspirin, ibuprofen, blood thinners and any vitamin or
                                             seminal
                                             vesicle              herbal supplements before surgery to reduce the risk
             sphincter                       prostate             of bleeding and unexpected drug interactions. Other
                                                                  medications should be continued as usual. Please
                                             rectum               ask your urologist if you have any question regarding
             urethra                         erectile             medications. You will be asked not to eat or drink for
                                             nerve                several hours before your operation.
                                                                  At the hospital
        Cancer may develop in the prostate from which it can
        grow into surrounding tissues or spread to other parts of   Most men are admitted to hospital on the morning of
        the body. Microscopic examination of prostate biopsies    surgery. A nurse will prepare you for the Operating Room
        confirms the suspicion of cancer and allows some          and answer your questions. You may be fitted with tight
        prediction of the tumour’s expected behaviour. This is    stockings or given medications to prevent the formation
        known as the tumour grade or Gleason score.               of blood clot in the legs.

        Additional investigations may be performed, when          You will be taken to the Operating Room where the
        necessary, to determine the extent or stage of the        anesthesiologist, the doctor responsible for keeping you
        cancer. Your prostate cancer appears to be confined       comfortable during surgery, will attach instruments to
        to the prostate, although there is always a chance of     monitor your vital functions. Your anesthetic will then
        undetectable, microscopic spread.                         be given. Radical prostatectomy normally is performed
                                                                  under general anesthesia (you are “put to sleep”).
        You have discussed several treatment options with your
        urologist, including:                                     There are several surgical approaches to remove the
        • observation with possible delayed treatment             prostate. Either an incision is made in the lower abdomen
          (sometimes called watchful waiting or active            below the navel or it is performed using small “keyhole”
          surveillance),                                          incisions (laparoscopically). When the PSA blood test
                                                                  or biopsies suggest a higher risk of cancer spread,
        • surgical removal of the prostate, or,                   pelvic lymph nodes may be removed for immediate
        • radiation therapy (by external beam and/or              examination. In the presence of cancer in these lymph
          implantation of radioactive pellets, brachytherapy).    nodes, cure of prostate cancer by radical prostatectomy
                                                                  is not likely. In the absence of obvious tumour spread, the
        Each option has its own advantages and risks.             prostate is exposed and freed from surrounding structures.
                                                                  The urethra is divided below the tip of the prostate
        Radical prostatectomy involves the complete removal       preserving as much of the sphincter control muscle as
        of the prostate. This option is appropriate for men with   possible. The prostate and seminal vesicles are separated
        localized prostate cancer, good general health and a life   from the bladder and removed. An attempt to spare
        expectancy of at least ten years.                         the erection nerves may be made, unless this could risk
                                                                  leaving cancer behind.



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