Get answers to your Robotic Prostatectomy questions.
An in-depth report on the causes, diagnosis, treatment, and prevention of prostate cancer.
In men whose cancer is confined to the prostate, surgical resection (radical prostatectomy) offers the potential for cure. Cure rates from initial surgery in men with localized cancer are about 90%, depending on tumor stage, tumor grade, PSA levels, and overall health of the patient. Research suggests that surgery provides long-term cancer control. Most patients can consider themselves disease-free if their PSA levels remain undetectable 10 years after surgery.
Radical prostatectomy is the surgical removal of the entire prostate gland along with the seminal vesicles (the vessels that carry semen) and surrounding tissue. The surgeon may also remove the pelvic lymph nodes. The incision can be made in one of the following regions:
The gland and other structures are then removed. The operation lasts 2 - 4 hours.
Laparoscopic Prostatectomy. Less invasive surgical techniques using laparoscopy have been developed for radical prostatectomy. These techniques use smaller incisions and allow faster recovery, but they require special surgical training. Laparoscopic surgery may also be done using a robotic system, which involves the surgeon directing a robotic arm through a computer monitor. Not every hospital can do robotic-assisted laparoscopic prostatectomy and these procedures are difficult to perform.
Nerve-Sparing Techniques. In the retropubic approach, the surgeon will attempt to spare the nerves that control erection:
Nerve-sparing techniques can improve quality of life, by decreasing the occurrence of incontinence and erectile dysfunction. In cases where the tumor lies too closely to the nerve, nerve-sparing techniques may not be possible.
Convalescence. Patients remain hospitalized for about 3 days after an open procedure or 2 days after less invasive procedure. Full recovery at home takes about 3 - 5 weeks. A temporary catheter used to pass urine is kept in place when the patient is sent home and is usually removed about 3 weeks after the open operation or 1 week after their robotic procedure. In general, younger patients with early-stage cancers recover fastest and experience the fewest side effects.
The main complications from radical prostatectomy are urinary incontinence and erectile dysfunction. Other complications include the usual risks of any surgery, such as blood clots, heart problems, infection, and bleeding.
Urinary Incontinence. Urinary incontinence is a common complication. When the urinary catheter is first removed following surgery, nearly all patients lack control of urinary function and will leak urine for at least a few days and sometimes for months. Normal urinary function usually returns within about 18 months. A percentage of men will continue to have small amounts of leakage with heavier exertion or possibly sexual activity.
If incontinence persists beyond a year, patients may require drug therapy or surgery. [For more information, see In-Depth Report #50: Urinary incontinence.]
Erectile Dysfunction. Erectile dysfunction after radical prostatectomy is caused by nerves that were damaged or removed during the surgery. Virtually all men will have problems with erectile dysfunction after surgery. It can take up to one to two years to recover erectile function after surgery. Because seminal glands are removed along with the prostate gland during surgery, men who regain sexual function will not produce semen during orgasm (“dry ejaculation”).
With the use of effective nerve-sparing techniques, men who were sexually active before surgery and are involved in an ongoing relationship seem to have a better chance of returned sexual function. Drugs such as sildenafil (Viagra) may help some men regain erectile function. Use of these drugs three times a week accompanied by sexual stimulation is now commonly recommended. Other treatments for erectile dysfunction (alprostadil injections, vaccum devices, penile implants) may also be options. [For more information, see In-Depth Report #15: Erectile dysfunction.]
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