Prostate Cancer Surgery
Prostate cancer surgery can be used to remove all or part of the prostate. Typically, men with early-stage disease or cancer that is confined to the prostate will undergo radical prostatectomy, or surgical removal of the entire prostate gland plus some surrounding tissue. This procedure is described below. Other surgical procedures may be performed on men with advanced or recurrent disease.
In the most common type of prostatectomy, known as radical retropubic prostatectomy, an incision is made in the abdomen and the prostate is cut out from behind the pubic bone. After removing the prostate, the surgeon stitches the urethra directly to the bladder so urine is able to flow. (Review the roles of the prostate and the surrounding organs in the About the Prostate section.)
Because it typically takes a few days for the body to get used to this new setup, the surgeon will insert a catheter, or tube, into the bladder. With this in place, urine flows automatically out of the bladder, down the urethra, and into a collection bag without the need for conscious control of the sphincter. The catheter is usually kept in place for about a week to 10 days.
Another type of surgery, known as radical perineal prostatectomy, is performed less frequently these days. In this approach, the surgeon makes the incision in the perineum, or the space between the scrotum and the anus, and the prostate is removed from behind.
In a nerve-sparing prostatectomy, the surgeon cuts to the very edges of the prostate, taking care to spare the erectile nerves that run alongside the prostate. In cases when the nerves cannot be spared because the cancer extends beyond the prostate, surgically attaching, or grafting, nerves from other parts of the body to the ends of the cut erectile nerves might be possible.
In laparoscopic surgery, very small incisions are made in the abdomen, into which the surgeon inserts narrow instruments fitted with cameras and/or surgical tools, allowing the surgeon to visualize and operate on the internal structures without cutting open the entire abdomen. With a robotic interface, the surgeon maneuvers the robot’s arms, which in turn control the cameras and instruments inserted in the abdomen.
The Importance of Surgical Skill
Prostatectomy, like many surgical procedures, is very delicate work, and the difference between a good surgeon and a great surgeon can affect outcomes. When choosing a surgeon, at a minimum, ensure that he or she is someone in whom you have confidence, and someone who has enough experience to not only perform the operation, but to also make an informed clinical judgment and change course should the need arise.
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