What Happens During a Radical... Health Article

On the day of your radical prostatectomy, you will be given a drug called an anesthesia. This makes you fall asleep and keeps you from feeling pain during the operation. You’ll get this from an anesthesiologist or a nurse anesthetist. Before surgery, you’ll meet the anesthesiologist. Then you can ask questions about the anesthesia and how it will affect you. What happens from that point depends on the kind of surgery you are having.

What Happens During a Radical Retropubic Prostatectomy

For this surgery, the doctor makes the cut in your lower abdomen. This is the approach that doctors use most often. If you’re having lymph nodes removed for a biopsy, your doctor can use the same cut.

The location of this cut may allow your doctor to do a nerve-sparing prostatectomy. That means there is less damage to the nerves and muscles that are involved in erections and continence. There are a couple of ways to do this. One way is to remove the bundle of nerves on only one side of your prostate and leave the ones on the other side alone. You may hear this called a unilateral nerve-sparing operation. Another way is to leave the nerve bundles on both sides alone. This is called a bilateral nerve-sparing operation. Neither of these types of surgery guarantees that you’ll be able to get an erection after surgery. Whether or not your surgeon can try to spare the nerves mostly depends on what he or she finds in the operating room. You can discuss the pros and cons of this surgery with your doctor.

What Happens During a Radical Perineal Prostatectomy

For this surgery, the doctor makes the cut in the skin between your scrotum and anus. Your doctor may suggest this method if you aren’t worried about nerve damage. It’s also sometimes used if you have another serious health problem, such as being overweight,  which could make it hard to do suprapubic radical prostatectomy.

This surgery takes more time than a retropubic one. It may also take a little longer if you’re having a lymph node dissection first. Plus you’ll need a separate cut to remove the lymph nodes.

It’s harder to spare the nerves involved with erections and continence with this cut than it is with a retropubic one. But it takes less time to recover from this surgery than a retropubic one.

What Happens During a Laparoscopic Radical Prostatectomy

This type of surgery is done less often than the other types. For this surgery, your doctor makes a few small cuts in your lower abdomen. The surgeon uses a tiny telescope called a laparoscope. If you’re having a lymph node biopsy, your doctor uses the scope to see how to remove them. If the cancer hasn’t spread to the lymph nodes, your doctor also uses the scope to help remove the prostate. If you’re not having a lymph node biopsy, your doctor directly removes the prostate and the surrounding tissue.

There are some benefits of this fairly new method.  It takes less time to recover because the cuts are so small. And there’s less scarring. A disadvantage is that you must have a skilled laparoscopy surgeon, and not every urologist is trained in this type of surgery. It also takes longer than the other types.