What is an Open Surgery Radical Prostatectomy?

Your doctor has recommended a procedure, Open Radical Prostatectomy to treat your prostate cancer.

Before we talk about the procedure, let’s review some information about the prostate and your medical condition.

The prostate is located under the bladder and behind the penis.

It is a walnut-sized gland that is part of the male reproductive system. It helps make semen.

The Urethra is a tube that carries both urine and semen to the penis.  It passes through the prostate which surrounds it like a donut.

Prostate cancer is the second most common cancer in men. It usually occurs in men age 50 and older and those men that have a family history, especially a father or brother with prostate cancer. But the highest risk is for men that are African American and over age 70

The treatment of your cancer will depend on many factors including the size, spread, and type of cancer, your age, and health.

The options that you may have considered are watch and wait, medication including hormones, radiation therapy, and/or surgery.

It is very important that you understand why this surgery has been recommended for you.  If you have questions, ask.

Radical Prostatectomy is surgery to remove the whole prostate gland, some nearby tissue and lymph nodes.  Everything removed is tested to be sure cancer has not spread.

This surgery is only used as a treatment if prostate cancer is still in the prostate.  If cancer has already spread, then surgery does not help and can cause serious problems when other treatments are used.

In fact, if during surgery, the surgeon finds that cancer has already spread and is outside of the prostate, the procedure is stopped and other more effective treatments for the situation are planned.

There are different ways to operate and remove a cancerous prostate. 

Your surgeon has recommended Open surgery to treat your medical condition.  A classic skin incision is made that allows the surgeon to see, feel and operate directly.  For some patients, open surgery can be the only way that their condition can be treated.  Certain medical problems make open surgery safer than the newer minimally invasive surgery that is done thru tiny incisions.  Open surgery usually has a longer hospital stay and recovery because of the larger incision.

Be sure you understand why this surgery has been recommended for you.

Now let’s talk a little more about what happens during an Open Radical Prostatectomy.

General anesthesia and medications to make you asleep and pain-free during your procedure are given.

An incision or cut is made in your lower abdomen for your surgeon to reach the prostate.

Retractors are used to help the surgeon to see,

The bladder is gently separated from the prostate

The connection of the prostate to the bladder is cut

And then the connection to the urethra,

The surgeon is careful to protect the nerves that control your erections and urination. However, damage to the nerves may be necessary or unavoidable in removing your prostate.

The prostate is removed

Finally, the bladder is stitched back to the urethra

The surgical area is carefully inspected for bleeding and a surgical drain is placed.

The incision is closed.

After surgery, “speak up” and tell someone on your care team if you have unexpected pain, dizziness, or trouble breathing.  You will have some discomfort but medication should help if you have pain.

Your risk of complication from this surgery is most related to your health before surgery, the size, and nature of your cancer, and the experience of your surgeon

Prostate cancer typically affects older men with other medical problems.   Your team will watch for early rare complications such as stroke, heart attack, blood clot, and internal bleeding.

Most patients stay in the hospital for 1-3 nights after surgery.  The drain is often removed before you are sent home.

The Foley will stay in place for about 1 to 3 weeks.

Incontinence, leaking urine is a known side effect of prostatectomy.  It is normal to have after your Foley is removed. You will need to wear a pad to stay dry.  Control of urine quickly over the following days, weeks, and months.

By 6 months, 20% or 1 in 5 men still have some urine leakage and 5% or 5 in 100 men have severe leakage.

Another side effect of this surgery is erectile dysfunction or ED.  All men will have trouble with their erections after prostate removal.  Half of men, 50% will eventually be able to have an erection but most will continue to have some permanent changes.  Time, exercise, medication, and surgery can help.

Call your doctor if you: cannot urinate, have a fever, redness or pus from your incision, worsening pain or bright red bleeding that doesn’t stop

Be patient as you heal.   Communicate your concerns with your surgeon.  If you do have long term side effects from your procedure, you can see improvement with time, further healing, medication, exercise, or more surgery.

To avoid cancellation or complications from anesthesia or your procedure, your Job as the Patient is to-

  • Not eat or drink anything after midnight, the night before surgery, not even a stick of gum
  • Take only medications you were told to on the morning of surgery with a sip of water
  • Ask when to stop your aspirin or blood thinners before surgery
  • Arrive on time

You should be ready to verify or confirm your:

  • list of medical problems and surgeries,
  • All of your  medications, including vitamins and supplements
  • current smoking, alcohol, and drug use
  • All allergies, especially to medications, latex, and tape

All surgery and anesthesia have a small but possible risk of serious injury, even some problems very rarely leading to death.

It is your job to speak up and ask your surgeon if you still have questions about why this surgery is being recommended for you, the risks, and alternatives.

This video is intended as a tool to help you to better understand the procedure that you are scheduled to have or are considering. It is not intended to replace any discussion, decision making or advice of your physician.