In cases of prostate cancer, doctors frequently advise the patient to undergo a procedure known as radical retropubic prostatectomy. This surgery involves the removal of the prostate gland and surrounding tissue. During this procedure, the surgeon makes an incision in the lower abdomen from the navel to the pubic bone. This allows the surgeon access to the prostate gland which is located retropubically, that is, behind the pubic bone.
Prior to the surgery, your doctor will give you a list of do's and don'ts that you will have to follow. These include steps such as stopping taking aspirin or any anticoagulants, in case you are, a few days prior to the surgery.
The night before the surgery, a strong enema is administered to clean out the colon. You may be required to go on a liquid diet the day before and not allowed eat for at least 12 before the surgery.
After administering anesthesia, the surgeon makes an incision from the navel to the pubic bone. A bit of tissue on either side of the bladder may be removed and sent to the laboratory for analysis. This will tell your doctor if the cancer has spread to the surrounding tissue. If cancer cells are detected in the surrounding tissue and lymph nodes, the surgery is usually halted.
The urethra, a tube that carries urine from the bladder to the penis, is detached. The urethra runs right through the middle of the prostate and also serves as the conduit through which semen passes out of the penis during ejaculation. It is cut above and below the prostate and is only reattached after the prostate has been removed.
The nerves surrounding the prostate are responsible for erections and will be left untouched if the surgeon determines them to be cancer free. The prostate gland is then detached from the bladder and the urethra is then reattached to the bladder. A catheter is inserted into the penis and threaded through the urethra into the bladder. It is left in place until the healing process is complete.
The surgical area has to be drained of excess fluids such as blood and urine. For this purpose, drains will be left from the abdominal area for at least three to five days until such time as the fluid draining out is minimal.
The catheter left in the penis is left in place and will be only removed after the reconnection of the urethra to the bladder has healed completely. If removed prematurely, it can result in incontinence (involuntary urination) or an inability to urinate.
Laxatives are usually prescribed to soften the stools. This helps to prevent strain on the rectum which lies just below the prostate and is at risk of injury after the surgery.
The length of stay in the hospital will depend upon how soon your bowels start functioning again. Typically, this lasts for about 2 to 3 days.
On discharge you will be given detailed instructions on how to care for the catheter, the diet to be followed and exercises you will need to perform. You may also be prescribed painkillers and anti-inflammatory drugs for a short time.
A PSA test is usually administered about six weeks after surgery to check for the presence of cancer.
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