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- Radical Perineal Prostatectomy
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Radical Perineal Prostatectomy
The radical perineal prostatectomy is an operation to remove the cancerous prostate gland, if testing shows that the cancer has not spread outside the prostate. The surgical alternatives to the perineal prostatectomy are the open radical retropubic prostatectomy, the laparoscopic radical prostatectomy, and the robotic assisted laparoscopic prostatectomy. The robotic assisted prostatectomy is described elsewhere on this website.
The open radical retropubic prostatectomy is performed through an incision made in the lower belly. The lymph nodes can be evaluated at the same time. The radical perineal prostatectomy is performed through an incision between the anus and the scrotum. If the chance is very high that the lymph nodes are cancer free based on the stage, the grade of the cancer, and the PSA test, the surgeon may find it not necessary to examine the lymph nodes. In this case, the perineal prostatectomy is an excellent option. The recovery time after the perineal approach is generally shorter than with the retropubic approach, and the discomfort is less with the perineal approach. So the perineal prostatectomy is a good minimally invasive option for a man with prostate cancer.
The radical perineal prostatectomy requires general anesthesia, and a hospital stay of 1 to 2 days. A foley catheter is left in the bladder to drain the urine for approximately 2 weeks. Postoperatively instructions are available on how to care for a urinary catheter, while at home.
Most of the time the radical prostatectomy provides effective treatment for clinically localized prostate cancer. Postoperatively, the patient will need to be followed closely with periodic physical examinations, and PSA lab tests. The PSA should drop nearly to zero (< 0.01), and this indicates that the cancer has been successfully treated with the use of surgery.
Long-term side effects include sexual or erectile dysfunction, and urinary incontinence. The nerves that control a man's ability to have an erection hug the back of the prostate gland. They are always at risk during any form of treatment for prostate cancer. During surgery the experienced surgeon will pay close attention to the nerves, and aim to preserve this tissue. Most men experience some erectile dysfunction immediately after surgery, but if the nerves have been preserved during surgery, the patient has a much better chance of recovering erectile function.
Urinary incontinence (leaking) is seen initially in many men when the foley is removed. This improves with time, and most men find that they are dry by 3 to 6 months after the date of surgery. The chance of full return to continence also improves with the use of kegel exercises.
For your upcoming surgery, you will be given a form with the date and time of surgery, and the time you should arrive at the George Washington University Hospital. Many patients park at a Metro stop and take the Metro train to Foggy Bottom/GWU, which is located in from of the hospital lobby. Alternatively, there is a parking garage on I Street, less than 1 block from the hospital.
On the day of surgery your surgeon will greet you in the pre-op area and answer any last minute questions that you may have. You will meet the anesthesia team, and several peri-operative nurses. You will also meet our resident house staff. These doctors will be involved in your hospital care, and you will most likely see them several times after your surgery has finished. It is a busy time, but your family will be able to stay with you for most of the preoperative time, until you are taken back to the operating room.
Postoperatively you will be given a prescription for pain pills and stool softeners. You may need to use the pain medication for several days, but we encourage you to quickly transition to Tylenol for pain control, and use the narcotic pain medication sparingly.
As with all prostatectomy operations there are risks associated with the procedure, which include, but are not limited to infection, bleeding, sexual dysfunction, and urinary incontinence (noted above), stricture/bladder neck contracture, chronic pain, recurrence of the cancer, damage to the urethra, bladder, ureters, vessels, nerves, penile shortening, as well as rectal injury, and complications related to anesthesia. Because of the risk of rectal injury it is important that the patient uses enemas to cleanse their rectum preoperatively. If a rectal injury is encountered in a properly prepared bowel, the injury is simply repaired, with out any long-term problems for the patient.
It is important for the patient to realize that they should feel a little better every day. If you experience a dramatic turn for the worse, such as increasing pain, nausea and vomiting, fevers (> 101 F) and chills, shortness of breath, chest pain, unilateral leg swelling, or a clogged urinary catheter the patient should return to the hospital emergency room (ER) right away for re-evaluation. On the other hand, the majority of patients do extremely well, and recover rapidly.
If you have a routine uncomplicated postoperative course, you should call the office to schedule a follow up appointment between 1 and 2 weeks following surgery. During the follow up appointment, we will evaluate how you are doing, exam your wounds, and review your pathology. We will also teach you how to perform a Kegel exercise, since this is important to achieving the best possible chance of urinary continence. Please bring your spouse or significant other to this visit, so they can help you learn these exercises. The first post-operative PSA will be performed at 3 months from the date of surgery. We will start working on erectile function at that visit.
Before choosing the surgeon who will perform a radical prostatectomy, it is important to look for a surgeon with a large experience, and excellent surgical success. This can help lower your risk of problems after the radical prostatectomy. The surgeons at the Urologic Surgeons of Washington have extensive surgical experience in the management of prostate cancer, and will be able to provide the best care possible.