Radical Open Prostatectomy

What is Radical Open Prostatectomy?

Open radical prostatectomy is a surgical procedure to treat prostate cancer and involves the removal of the whole prostate gland, seminal vesicles, and the surrounding tissues typically through a single long incision in the lower abdomen. The prostate gland and surrounding abnormal tissues may also be removed through the perineum, the region between the scrotum and the anus, although this method is uncommon. Surgery may increase life expectancy by at least 10 years.

Anatomy of the Prostate

The prostate gland is a small, walnut-sized gland situated between the bladder and the penis, just in front of the rectum. It forms part of the male reproductive system and releases a fluid that protects and nourishes sperm.  This fluid is secreted into the urethra and is discharged along with sperm as semen during ejaculation. The prostate is divided into 4 anatomical zones: the peripheral zone, the central zone, the transition zone, and the anterior fibromuscular stroma. Prostate cancer typically occurs in the peripheral zone.

Indications for Radical Open Prostatectomy

Your surgeon may recommend radical open prostatectomy for the following patients:

• Those who are physically fit for major surgery
• Diagnosed with fast-growing tumor
• Diagnosed with localized cancer of the prostate gland 
• Those who can follow the available treatment protocols
• Men younger than 75 years of age with a life expectancy of at least 10 more years

Preparation for Radical Open Prostatectomy

Pre-procedure preparation for radical open prostatectomy will involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements that you are taking or any medical conditions you have such as lung or heart disease.
• You may need to refrain from certain medications such as blood thinners or anti-inflammatories for a week or two prior to the surgery.
• You may be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Radical Open Prostatectomy

The goal of radical open prostatectomy is to get rid of all the cancer cells. The surgery usually involves the following steps.

• You will lie down on the procedure table in a supine position on your back.
• General or spinal anesthesia is administered to keep you asleep throughout the procedure.
• You will also be given antibiotics prior to the procedure to prevent any risk of infection.
• The surgical area is marked and thoroughly cleaned with an antiseptic solution. 
• Your surgeon will typically make a vertical incision of about 3.5 inches in the lower abdomen starting from your navel to your pubic region. This approach is known as the retropubic (suprapubic) approach and is the most common surgical approach used by urologists.
• Surgical instruments are inserted through the incision and the whole of the prostate gland and tissues surrounding it are removed totally.
• After adequate treatment is confirmed, the incision is closed with absorbable sutures and sterile dressings are applied.
• Open radical prostatectomy may take 2 to 4 hours to complete and you will stay in the hospital for about 4 days after the surgery.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after radical open prostatectomy will involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You will wake up with a urinary catheter tube placed in the bladder through the urethra. There will also be a drain tube from the abdomen to allow drainage of gas and fluid from the operation site.
• You may experience pain, inflammation, and discomfort around the operated area. Pain and anti-inflammatory medications are provided as needed.
• You should be able to eat and drink normally and get up and walk the next day. The drain tube is also removed the day after surgery.
• You are encouraged to walk around post surgery to prevent the risk of blood clot formation and help with the healing process.
• You will likely be discharged 2 to 4 days after the operation depending on how comfortable you are. You will return home with the catheter in place. Most men need a urinary catheter for 10 days after surgery. The catheter is usually removed after a couple of weeks during your follow-up visit.
• You will need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks with certain activity restrictions.
• It is important to keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from driving until you receive your doctor’s consent. Most patients can resume driving after a couple of weeks following surgery.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Radical open prostatectomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Infection
• Bleeding
• Blood clots
• Infertility
• Erectile dysfunction
• Adverse reactions to anesthesia
• Damage to surrounding tissue/organs
• Tightening of the urinary opening
• Difficulty controlling urine and bowel movements