Prostatectomy

About Prostatectomy

Radical prostatectomy removes the entire prostate gland and the seminal vesicles, usually together with nearby lymph nodes, as a treatment for prostate cancer that is confined to the prostate, one of the most common cancers in men. Surgical approaches include open retropubic and perineal operations, laparoscopic surgery and robot assisted laparoscopic prostatectomy, which has become the dominant approach in many countries since the early 2000s. The anatomical nerve sparing technique was developed by the American urologist Patrick Walsh in the early 1980s, based on detailed study of the nerves responsible for erections that run alongside the prostate. During the operation the prostate is freed from the bladder neck and urethra, the dorsal venous complex is controlled, the vas deferens and seminal vesicles are divided, and the bladder is reconnected to the urethra in a vesicourethral anastomosis. A urinary catheter is left in place while this connection heals. Lymph nodes are removed for intermediate and higher risk disease. The main long term effects are urinary incontinence, which usually improves over the following months but persists in a minority, and erectile dysfunction, the likelihood of which depends on age, prior function and whether the nerves can be preserved. Other complications include narrowing at the bladder neck and, rarely, rectal injury. For low risk prostate cancer, active surveillance has become a common alternative to immediate treatment, and radiation therapy is another standard option for localized disease.