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Radical prostatectomy

What is prostate cancer?

Prostate is a walnut sized gland found only in men. It is situated in the lower pelvis below the bladder in front of the rectum. Bladder is the storage area for urine. Urine from bladder passes through urethra to penis from where it goes out. The beginning portion of the urethra passes through prostate. As the prostrate enlarges due to cancerous tumor the urethra is pinched off. Primary function of prostate is to produce a liquid which combines with sperm and becomes semen. Uncontrolled and abnormal growth of cells in the prostate is prostate cancer which easily spreads to other areas like bone or Lymph nodes.

Treatment for prostate cancer

Prostate cancer can be cured by removing the prostate gland surgically. But if a patient is not fit to undergo surgical procedures then radiation can be used to burn off the cancerous portion of the prostate gland. Radical prostatectomy is the name of the surgical procedure followed to remove the prostate gland and some nearby tissues.

Lap Radical prostatectomy

Removal of prostate gland using minimally invasive laparoscopic procedure has several advantages compared to the open surgery carried out for the above purpose. This surgical method gives better visibility of the prostate gland in the lower pelvis. Less blood loss and more accuracy in the repair of urethra and bladder are other advantages of this surgical procedure. The tube in the water passage inserted for surgery (catheter) in this procedure can be removed at an early date and the incontinence of urine is lesser in this procedure. As the wounds in this case are much smaller than that in open surgery post operative pain will be less, healing of wounds and return to normalcy will be very faster in this method.

Pre operative preparations

Your doctor will make complete health check up to find out the extent of cancer that has been afflicted and to see whether you have any problems with anesthesia. This will include blood test, ECG, chest X-ray etc. As a preliminary preparation the patient will have to stop smoking and walk at least for one hour everyday and eat a healthy and nutritional diet. Surgery will be carried out 6 weeks after biopsy. If any previous prostate surgery has been done then the present surgery will be carried out only after 12 weeks from the previous surgery. 3 units of blood will be kept ready for using in emergency situations. You will be admitted to the hospital on the previous day of the surgery. Laxatives will be given after admission and after this you are expected to eat light food only. On the day of surgery 6 hours fasting will be necessary. The exact period will be suggested by the anesthetist considering your health condition

Post operative care

The surgery will take 4 to 8 hours. After the surgery the patient will be brought to the recovery room where he will be under intensive care. One person will be allowed to meet the patient in the recovery room. On the next afternoon he will be shifted to his room. You will be able to sit up even though a little pain will be felt. A urethral catheter and a drain will be brought out through one of the holes used for the surgery. You will have to abstain from food for one or two days as per the instruction of the surgeon. The drains will be removed on the fifth day. On the 6th or 7th day the patient will be discharged from the hospital. Urethral catheter will be connected to a bag and it will still be there. You will be readmitted after one or two weeks for the removal of urethral catheter.

Urinary continence

As a part of the sphincter muscle will also be ablated during radiation therapy or surgery, there will be some urine continence after prostate cancer curative treatment . The remaining portion of the sphincter muscle will have to perform the function of the lost portion also. This can take from 3 to 12 month's time. In 30% of the patients the continence is immediate. On removal of urinary catheter which improves to 90 % within 3 months and goes on improving for the next two years. If the problem is not solved even after 3 years another surgery will have to be performed for solving the issue of continence. Nerves controlling penile erection are attached to prostate gland and are not visible to the naked eye. Though the surgical procedure is carried out sparing these nerves, at times damage to these nerves can occur resulting in impotence .

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