Radical Prostatectomy and Its Side Effects


What is a Radical Prostatectomy?

Radical prostatectomy is the surgical procedure carried out to treat early and sometimes locally advanced prostate cancer. Only patients whose cancer is within the confinement of their prostate gland could expect a long-term recurrence free survival. A Radical prostatectomy involves removing the prostate gland and tissues surrounding it. This may include the seminal vesicles and lymph nodes draining the prostatic region, depending on the given situation.


Types of Radical Prostatectomy

Typically, there are two different radical prostatectomy approaches that surgeons recommend for the removal of the prostate:

Open Prostatectomy

Open prostatectomy is the traditional approach used to perform a radical prostatectomy. The surgeon performs the radical prostatectomy through a vertical 4–5-inch incision made right below the belly button. In some suitable patients, a radical prostatectomy could be performed through the perineum by making an incision between scrotum and anus.

Robot-Assisted Laparoscopic Prostatectomy

Laparoscopy is a more modern-day approach to performing the radical prostatectomy. It is divided into two categories: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy. Both these methods are minimally invasive and bring several other advantages, including significantly reduced blood loss, no blood transfusions, shorter hospital stays, and faster recovery rates. In a robot-assisted prostatectomy, the surgeon makes a few 4-6cm stab incisions in the patient's abdomen to remove the total prostate and uses a computer-assisted mechanical device (robot, a master slave system) to perform the surgery. The surgeon monitors the procedure from a nearby console where he controls the robot and the fine articulated instruments attached to it. This method gives room for more precision and dexterity than manual or conventional surgery. The robot on its own does not do anything, it is completely controlled by the surgeon. With the use of robotics, we have reached a high level of precision in the field of minimally invasive surgical procedures. A Robot-Assisted Prostatectomy, when compared to open surgery, has greatly reduced the need for blood transfusions as the blood loss is almost negligible. Moreover, since the wounds are very small and tissue damage is minimal, it has fewer post-op and wound related complications, yielding speedy recoveries and shorter hospital stays. Post-op complications like the incidence of incontinence and erectile dysfunction are also significantly reduced with robotic surgeries.


Side Effects of Open Prostatectomy

Although open prostatectomy is a reliable radical prostatectomy procedure to cure cancer, it is known for increased complications and longer recovery times. Some common risk factors associated with open prostatectomy include:

- Excessive bleeding

- Higher rate of Urinary incontinence

- Experiencing dry orgasms

- Higher incidence of Erectile dysfunction (impotence)


Side Effects of Robotic-Assisted Prostatectomy

The risk factors associated with robotic-assisted prostatectomy are similar to those of open prostatectomy. These include bleeding, infection, and adjacent tissue or organ damage. The most common side effects of robotic-assisted prostatectomy include the following:

Urinary Incontinence

Urinary incontinence is described as the inability to control urine. However, this condition tends to improve with time and may take as long 3-6 months. At times it may take 1-year for full recovery.

Erectile dysfunction

Erectile dysfunction or impotence could be a possible side effect of undergoing a robotic prostatectomy. The recovery time for this condition varies from patient to patient depending on their age, degree of preoperative sexual function, type and the location of prostate cancer and the type of nerve sparing performed a during the operation. The major focus for the surgeon performing a radical prostatectomy is on complete removal of the cancer to avoid any future recurrence, but newly-developed techniques help men return to near normal function.


Closing Thoughts

The frequency at which these side effects impact patients after radical prostatectomy is still not confirmed by doctors. However, it is observed that older men, in general, are more prone to facing these side effects, particularly urine incontinence. It is also possible to rehabilitate patients with post-operative erectile function with medicines, intra penile injections and other means. Please do consult your urologist to report your dysfunction before you accept it as a fait accompli. Make sure you continue your regular follow up as advised by your urologist to stay healthy and cancer free.

Disclaimer: This article is for informational purposes only. Book an appointment with your physician or healthcare expert and discuss these options. They will guide you further on which one would work best for you.