Radical retropubic prostatectomy

Mainstay treatment

The first radical retropubic prostatectomy was performed as early as 1947.  During this surgical procedure, an incision is made from just below the man’s bellybutton to the top of the pubic bone (retropubic is a medical term that means behind the pubic bone).

This surgery for prostate cancer gives the surgeon easy access to the:

  • Lymph nodes
  • Nerves
  • Blood vessels

Value of lymph node access

Lymph nodes can be removed and examined, if it is suspected that the cancer has spread.

If lymph nodes are removed during surgery, and cancer is in them, the surgeon may not continue with the procedure because the cancer has already spread.

This is one of the unsettling unknowns going into surgery.  And it is why you may want a friend or family member there for support that day.

More about the surgery

After the prostate is removed, the surgeon will reconnect the urethra to the bladder.

The entire procedure for a radical retropubic prostatectomy can take from 90 minutes to up to four hours or more.

Some surgeons use general anesthesia to put a man to sleep. Others use spinal or epidural anesthesia that numbs the lower part of the body.

A man may also be asked to donate his blood before surgery.

These are all good questions to ask about before your loved one’s surgery.

A nerve-sparing approach

Dr. Patrick Walsh pioneered the technique of nerve-sparing radical retropubic prostatectomy.

The main goal of a “nerve-sparing” approach is to save the two nerve bundles that enable your loved one to have an erection. 

But if the cancer is growing in or near the bundles, be prepared that they will most likely be removed.

The chance of a man having normal erections is generally better with both nerve bundles than with just one bundle.

But even if both nerve bundles are saved, the surgery may still cause some damage.  This means that sexual recovery may take time, from several months to up to several years.  Every man is different.   

Studies show that younger men, who previously had no problems getting and maintaining an erection, may be less likely to have erection problems following surgery than older men.

If nerve bundles can't be saved

If both nerve bundles are removed, your loved one will be impotent (another term for this is erectile dysfunction).

This means your loved will not be able to get or maintain an erection for intercourse (some use the term “stuffable erection”).  

This is something that should be carefully discussed with the surgeon prior to surgery.  After surgery, some men may respond to:

Recovery after radical retropubic prostatectomy

A man’s hospital stay is generally 2 to 3 days after surgery and several weeks of recovery at home.

A catheter will be inserted into your loved one’s penis (while he is under anesthesia) to help drain urine from his bladder. 

The catheter must remain in place, typically for 1 to 2 weeks following radical retropubic prostatectomy.  It will also have to be emptied regularly.

Return to treatments
Radical perineal prostatectomy
Laparoscopic radical prostatectomy
Robotic-assisted laparoscopic radical prostatectomy

References:

GhavamianR. Radical retropubic prostatectomy for prostate cancer. http://emedicine.medscape.com/article/447439-overview. Accessed March 17, 2015.

Bostwick DG, Crawford DE, Higano CS, Roach M, eds. American Cancer Society’s Complete Guide to Prostate Cancer. Atlanta, GA: American Cancer Society Health Promotions; 2005.The American Cancer Society. Prostate Cancer. http://www.cancer.org. Accessed October 28, 2010.

Walsh PC. Guide to Surviving Prostate Cancer. New York, NY: Time Warner Book Group; 2001.

Always consult a medical professional.

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