Radical removal of the prostate means the removal of the prostate, seminal vesicles and lymph nodes of the pelvis on both sides through an open operation (abdominal or perineal). It is indicated in cases of cancer of the prostate which is discovered early. The operation may affect continence and erection. It results into some change in the life quality of the patient.

Who qualifies for the operation?

Patients who have cancer of the prostate which is restricted to the gland itself. The lymph nodes of the pelvis should not be affected. There should be no distant disease as to the bones or liver. The general condition of the patient should permit the anaesthesia and the operation.

How does the operation work?

The procedure is done under general anaesthesia. The patient lies on his back. The incision is done in the lower abdomen to reach the prostate extra peritoneal. The great artery and vein of the pelvis are identified. The lymph nodes of the area are identified and removed for a rapid pathological microscopic evaluation (frozen section). If the pathologist see cells of cancer inside the lymph nodes, the operation is not completed (the testis is then removed for hormonal treatment). If the lymph nodes are free, then the operation is progressed. First the prostate and its capsule are prepared free with attention to the nerves and vessels running on its sides. The floor of the pelvis is prepared free at the region of the neck of the bladder. The gland and the seminal vesicles and the seminal string are removed as one structure. Careful attention is paid to the apex of the gland as it lies on the pelvic floor (the area of the valve controlling continence). Care must also be given to the nerves running alongside of the prostate in a trial to spare potency. After removal of the gland, the bladder  neck is reattached to the urethra. A catheter is put to the bladder through the abdominal wall and another through the urethra. Drains are put inside the pelvis and are diverted to the abdominal wall. The pelvis is examined to guarantee the control of bleeding. The wound is closed in layers.

How to prepare yourself for the operation?

This operation is not an ambulant surgery. You must stay for 10 days in the hospital. The preparation for the operation still remains the same as for any other operation.


Frequently asked questions (FAQ):
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1. What are the indications for removal of the prostate?
   
   A small gland where the tumour is confined to it. There should be no distant metastasis in the lymph node or other organs, in particular the liver and bones. The general condition of the patient should also permit the operation. The disease must be histologically confirmed.
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2. Are there any other treatment options to avoid the operation?
   
   Yes, brachytherapy is a new treatment modality which is still under scientific investigations but the last publications are encouraging.
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3. What is the management if the disease is advanced?
   
   The treatment must be hormonal deprivation through the removal of the testis or the injection of hormone analogues which stop the production of the male hormone.
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4. What are the complications of the radical prostatectomy?
   
   The most important ones which have implications on the quality of life are the inability to control urine (incontinence) and loss of erection (impotence). Incontinence is a rare occasion. It happens if the disease is present in the apex of the prostate so that the radical removal of the gland may affect the floor of the pelvis and the muscle controlling continence. The nerves of erection run along the sides of the gland. Their injury in radical surgery results in impotence.
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5. Is there a solution for impotence?
   
   Yes, the implantation of penile prosthesis whether semi rigid or hydraulic is a good well known solution which guarantees a high quality of life.
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6. Is it possible to have a normal feeling and orgasm during sex?
   
   Yes, the feeling is normal but the orgasm is dry as the removal of the prostate, seminal vesicles and a part of the seminal string, stops the production of semen and sperms.
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7. What is the treatment of incontinence after the operation?
   
   If incontinence is partial, that is to say, it is merely loss of urine on sudden movements then the treatment is physiotherapy and electrical therapy. If the incontinence is complete, that is to say, it happens even during rest, then one has the choice between a condom urinal and the implantation of the so called Scott sphincter.
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8. What is condom urinal?
   
   It is a special condom connected to a catheter to collect the urine into a urine bag carried in the bag of a special legging.
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9. What is Scott sphincter?
   
   It is a device made of silicon. It is implanted around the urethra to close it under a certain pressure. It is controlled through a button inserted to the lower abdomen or between the testicles. If you press the button, the pressure inside the sphincter becomes minimal and you can evacuate the bladder in the usual way you used to. If you press another button, then the sphincter is closed again. It is inconspicuous and is clean and not smelly.
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10. What is the life expectation after radical prostatectomy?
    
    This is dependant on the stage of the disease and also the time of the operation.