Robotic/Laparoscopic/open Radical prostatectomy with pelvic lymphadenectomy

Procedure– Radical prostatectomy is an operation to remove the prostate gland and tissues surrounding it. This usually includes the seminal vesicles and some nearby lymph nodes. Radical prostatectomy can cure prostate cancer in men whose cancer is limited to the prostate.

Radical prostatectomy can be done by laparoscopic, robotic or open approach. In laparoscopic approach 5-6 small 5-10 mm holes are made in the abdominal wall and ports are inserted. Prostate and in selected cases pelvic lymph nodes are removed via a small incision of 3-4 cm and sent for histopathology.

Radical prostatectomy is a major surgery from which your body needs time to recover.  Most men can start to drive 5-6 weeks after surgery. You should avoid heavy lifting for several weeks after surgery. It usually takes about six weeks for most men to feel back to normal.

Radical prostatectomy is a major operation. It may not be suitable if you have other health problems, such as heart disease, that would increase the risks involved.Following surgery, many men experience erectile dysfunction (ED), but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction.

Recovery time after the procedure and the length of your hospital stay depend on your overall health . Usually patient is kept in ICU for 1-2 days and goes home in a week. The urinary catheter remains in place for 3-4 weeks during your recovery. Catheter is removed at 3-4 weeks after doing a contrast study called Cystogram. Cystogram is a radio-logical test to confirm if the suture line is completely healed or not.

Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you’ll need to avoid strenuous activity or heavy lifting for several weeks.

For most patients, these procedures don’t affect quality of life — once you’re completely recovered, you can expect to resume your normal routine and activities.

Risks and complications –

1. Anejaculation– You no longer ejaculatesemenif you have had a radical  This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
2. Bleeding requiring blood transfusion- Radical prostatectomy is a major surgery so blood is always arranged and kept in blood bank for any intraoperative or postoperative blood transfusion need. Such transfusions are needed in 5% of patients.
3. Infection -post operative wound infection may happen in 10% of cases which may require prolonged antibiotics and dressing.
4. UrinaryIncontinence- The major possibleside effects of radical prostatectomy are urinary incontinence (being unable to control urine) and erectile dysfunction. Urinary incontinence occurs in  4% of patients. These side effects can also occur with other forms of prostate cancer treatment.
5. Impotence/ Erectile dysfunction– Problems in getting or keeping erections happen in almost 80-90 % of patients. Nerve sparing prostatectomy if feasible can help in preserving the erectile function in some patients . Post operative use of Sildenafil or vacuum erection device do help in some patients in having intercourse after radical prostatcetomy.
6. Visceral complications– Injury to the surrounding organs of prostate like rectum , blood vessels may happen which require immediate measures to repair it. Such incidence are rare and happens in lesser than 5% of patients.
7. Bladder neck contracture is 0.5-10%.
8. Anesthesia related complications like chest infection, vomiting, headache may occur for few days in some patients.
9. Recurrence- Radical prostatectomyremains the primary treatment for localized Prostate cancer (PCa) and has been performed for many years with excellent oncologic control. However, approximately 20-40% of patients with clinically localized PCa will present biochemicalrecurrence (BCR) after RP. Such patients may require adjuvant treatment in the form of Radiotherapy/ hormonal therapy/ chemotherapy.
10. Lower limb swelling- It may sometime develop due to pelvic lymph node removal. However, it gradually subside in the due course of time.
11. Deep venous thrombosis (DVT) and thromboembolism- This means formation of blood clots in large veins of limb which may migrate to distant veins/ lungs and heart. This is a rare phenomenon and reported in <1% of patients .