What happens in the surgery?
Diagnostic Tests:
The doctor might suggest the following tests before prostatectomy surgery:
Digital rectal exam (DRE)
In this test, the surgeon inserts a gloved and lubricated finger in the rectum to look for any abnormal growths and the prostate gland’s shape, size, and texture. This helps the surgeon assess the extent of the condition.
Prostate-specific antigen (PSA) test
This is one of the most accurate and reliable tests for prostate pathology. When the prostate is enlarged, the amount of PSA (a protein made by the prostate gland) increases. Its concentration depends upon the severity of the condition.
Cystoscopy
In this test, the doctor inserts a visual scope into the urethra and bladder to determine the prostate gland’s size. This is generally performed before the surgery.
Ultrasound
An ultrasound for prostatectomy involves inserting a small probe into the rectum. It produces images of the gland that help doctors determine the exact shape and size of the prostate gland.
Magnetic Resonance Imaging (MRI)
MRI scans give a more detailed picture of the prostate gland. It is generally suggested if the doctor suspects aggressive prostate cancer.
Prostate Biopsy
This is the most accurate test for confirming the presence of prostate cancer. In this test, the doctor collects cells from the prostate cells and studies them under a microscope to determine their cellular structure and confirm or rule out prostate cancer.
Preparation
Being prepared before prostatectomy surgery helps in having a seamless surgery, and even lowers the risk of complications during and after the surgery. Here are a few things that you should take care of before a prostatectomy:
- Keep your bowel clean and empty before the surgery.
- Take care of your dietary habits and make modifications in what you eat as directed by the doctor.
- The doctor might ask you to do a bowel prep. This includes using laxatives and enemas to clear out the bowel.
- If you smoke, it’s better to stop it about 2 weeks before the surgery. Smoking delays the healing and recovery process. The doctor might also suggest ways to quit smoking.
- Talk to your doctor about the medicines you’re taking, as some medicines can affect the effectiveness of the surgery. The doctor might ask you to discontinue certain medicines for a few days before the surgery.
The prostatectomy procedure varies based on the type of technique being used, such as:
Laser Prostatectomy: Laser prostatectomy has several advantages over other techniques, such as it has a lower risk of bleeding, requires short hospital stay, ensures quicker recovery, and so on. In this technique, the doctor inserts a scope through the urethra. A laser is passed through the scope, which delivers energy that shrinks or removes the excess tissue from the enlarged prostate and relieves the symptoms.
Robot-assisted Radical Prostatectomy: This is the most advanced prostatectomy technique, which is performed widely now. In this procedure, the surgeon sits on a remote-control console placed at a distance from the operating table. The motion of the equipment is controlled with two hand-and-finger control devices. The doctor gets a magnified, 3D view of the area to be operated on, which allows them to perform the procedure with greater precision. The surgeon can make smaller and much more accurate incisions, which allows quicker recovery than other methods. This technique involves nerve-sparing methods that help preserve sexual potency and continence in the patient.
Open Radical Prostatectomy: In this technique, the surgeon makes incisions in your lower abdomen, right above your pelvic bone. Upon accessing the prostate gland, the surgeon carefully dissects it from the surrounding nerves and blood vessels. Finally, the gland is removed along with the nearby tissue, and the incision is sealed with sutures.
Open Simple Prostatectomy: The first step of this procedure involves inserting a long and flexible cystoscope (a viewing scope) through the urethra to the bladder and prostate area. Then, the doctor inserts a tube called a Foley Catheter through the tip of the penis, which reaches your bladder to drain it all the urine.
Next, the surgeon will make a large incision below the belly button, right below the navel, and above the pelvic bone to extract the problematic parts of the prostate gland. The final step involves placing some temporary drain tubes through punctures in the skin near the surgery site. These tubes are removed before discharge.
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