Open Radical Prostatectomy

What is an open radical prostatectomy?

  • The removal of the whole prostate through a low abdominal incision
  • Often lymph nodes next to the prostate in the pelvis are also removed
  • Once the prostate has been removed the bladder is rejoined to the urethra.
  • A catheter tube is left in the penis across the join into the bladder.

Why do I need this?

  • The whole prostate is removed if cancer is found in the prostate and no other signs of cancer are found outside the prostate
  • It is then hoped that removal will cure the cancer

What are the risks?

Immediate risks

  • Bleeding may be a problem requiring blood transfusion.  If the risk is high, the patient’s own blood can be removed in the weeks before the operation and be used at the time of operation
  • Infection in the wound and in the chest may occur, and antibiotics are given
  • Deep vein thrombosis is a risk and blood thinners, stockings and leg muscle pumps are used to reduce the risk and especially to avoid any clot moving from the leg to the lungs.  This dangerous risk is called pulmonary embolus
  • Urine leak from where the bladder and urethra join may occur.  A tube, called a drain, is left in the cut after the operation. The drain both detects a leak and also fixes it by removing the leaking fluid

Long term risks

  • Incontinence. The water control muscle may be damaged by the operation.  Part of the muscle may be removed with the prostate.  At least half of all patients may notice leakage when the catheter is removed about 1-2 weeks after the operation.  With physio supervision it improves in up to 6 months.  In about 1 – 5% the leakage continues to be bad, requiring follow-up surgery to fix it
  • Erectile dysfunction. A web of nerves around the prostate stimulate extra blood into the penis to cause erections.  If the cancer is small these nerves may be left behind intact, allowing normal erections to continue.  If the cancer is large the nerves may need to be removed as well to ensure a complete cancer cure

 

What can I expect after surgery?

Immediate

  • The operation usually takes 2 hours and on waking up afterwards a drain tube and a catheter in the penis is usual.  These tubes are removed in the following days with the catheter coming out 1-2 weeks after the operation
  • Pain relief usually requires a morphine pump in the first 1-2 days and then oral pain medication in the next 1-2 weeks to follow

Long term

  • The main aim is to remove the entire cancer in the prostate.
  • In the first week a pathology report will give a good indication of success and a PSA blood test 6 weeks later, if under 0.1, is further indication

Regular PSA tests are needed into the future to ensure long term success