Radical retropubic prostatectomy

During radical retropubic prostatectomy, an incision is made from just below the man’s bellybutton to the top of the pubic bone (retropubic means behind the pubic bone). This surgery for prostate cancer gives the surgeon easy access to the lymph nodes, nerves, and blood vessels. 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, which is why you may want a friend or family member there for support that day.

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. Your loved one may also be asked to donate his blood before surgery. These are all good questions to ask about before your loved one’s surgery.

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.

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

According to the American Cancer Society, the chance of a man having normal erections is generally better with both nerve bundles than just one bundle. But even if both nerve bundles are saved, the surgery may still cause some damage. This means your loved one may have difficulty getting or maintaining an erection for intercourse (some use the term “stuffable erection”) for months to several years following his surgery. He also may not not be able to have an erection on his own without the help of certain medications, injections, pellets, or pump devices.

The American Cancer Society also reports 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.

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. It must remain in place, typically for 1 to 2 weeks following radical retropubic prostatectomy.

Updated 10/10

Always discuss everything you read on this web site with a qualified medical professional.

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