RADICAL PROSTATECTOMY PAGE
Member Jim Jauchem produced this page which normal resides on his site. Due to
an "upgrade" foisted on him by his ISP, his website has been wiped out. He has
kindly agreed to allow me to put this on the Yana site until he gets his site
This page was designed for men who have decided
to undergo radical prostatectomy as a treatment for prostate cancer. This page
should not be of interest to anyone else (and will not be very "pleasant"
early radical prostatectomy to treat prostate cancer was performed at Johns
in 1904. So this is nothing new and lots of men have been through this.
web site from the University of Pittsburgh Cancer Institute covers the
retropubic, perineal, and laparoscopic
procedures. A group in China
actually performs a "combined retropubo-perineal
prostatectomy" to achieve a better connection between the bladder and
urethra (I've never heard of this in the U.S.). Although I've tried to
answer the questions below specifically for the retropubic approach, some of the
information is pertinent to the other surgeries.
and Answers on Radical RetropubicProstatectomy:
Do I need to give blood and have it blood-banked before surgery?
A: It used
to be common practice to have a patient donate several units of blood prior to
surgery. Many centers are now abandoning this practice. I did not donate any blood
before surgery. Even though I was told that I lost a lot of blood during surgery,
it wasn't quite to the point of requiring any transfusions.
Will I have to drink some nasty stuff the day before surgery to clear out my bowels?
A: Since the risk of rectal puncture during surgery is really low, some surgeons
have eliminated that requirement. But I believe most would still want it.
I had to drink "GoLYTELY" the day before.
Will I be completely "out" (anesthetized) during the surgery?
A surgeon at Weiss Memorial Hospital
at the University
of Chicago has stated, "Pain
is more effectively controlled by epidural rather than general anesthesia. We
believe that if the patient is conscious he can effectively help us to monitor
pain." They also add methadone, and claim that this procedure results
in less blood loss, a more rapid return of normal bowel function, and minimizes
blood clots and respiratory suppression. Their patients do appear to be
released from the hospital faster (see interview on "drive-through" radical prostatectomy). But would YOU want to be awake
during the surgery (mine took three-and-a-half hours)? I think not...
Will my lymph nodes be sampled and analyzed before the rest of the surgery proceeds?
A: Some surgeons believe that lymph-node sectioning just extends the time of surgery
and increases the chance of complications while waiting for the analysis of the
frozen sections. Depending on your PSA, Gleason grade, and clinical stage,
lymph node dissection may be omitted, and the surgeon may simply do a gross
inspection of the lymph nodes before proceeding.
How big will my incision be?
A: The incision, in the lower abdomen, generally
runs from the pubic bone up close to the navel. Here's a photo of my incision a few weeks afterwards
(the dark "bruise-like" area on my far right is where the drain [see
next Q&A] was).
Will I have a bunch of tubes coming out of me when I wake up?
A: The surgical
area must be drained of excess fluids, such as blood and urine. While this
used to mean several drains from the abdomen (known as "Jackson Pratt"
or "penrose" drains), most surgeons now use
just ONE drain. It will be left in place for about three days, or until
minimal fluid flows through it.
Some doctors now question the need for pelvic drains
after the retropubic procedure, if the bladder neck was preserved. In my
case, however, it seemed like there was still a lot of drainage.
Will I wake up with tight stockings or something on my legs to keep blood clots
A: One surgical group claims there's no evidence suggesting
that "compression devices" lower the risk of clots, so "we decided
to eliminate their use." But it still seems like a good idea; I had
a pneumatic-pump device that went to cuffs on both legs (the commonly-used technical
term is "intermittent pneumatic compression stockings"). The cuff
of the system that I had looks like this:
What if I'm in pain when I wake up?
A: They should let you have morphine.
The easiest way to get this is via "patient-controlled anesthesia".
You can push a button when you want more, and a machine like the one pictured
here will give you another dose. Since morphine can cause nausea and vomiting,
they will also periodically give you something like phenergan
to decrease that likelihood.
How long will I be in the hospital?
A: They usually say about two to three
days (I was in for three). But "every patient is different" (and
see interview on "drive-through" radical prostatectomy, above).
What determines when I can go home?
A: At the bare minimum (according to most
medical professionals), you must: be walking, have pain under control, have a
normal temperature, and eat some solid food. I actually had a bowel movement
while still in the hospital (amazing what makes one proud at these times...)
How long do I have to have the Foley catheter in?
A: While two to three weeks
used to be standard, some centers are dropping down to ten days (like I had).
Since the urethra will have been re-attached to the bladder at the end of
surgery, they want the catheter to stay in place for awhile to allow the new connection
to heal. One of the most recent studies suggests that only seven days
is enough. The fear in "early" catheter removal is that, without it in place as a
kind of rigid "stent", a stricture could form (or there could be immediate
post-decatheterization urinary retention). During
surgery, they may be able to determine that the anastomosis procedure went well (meaning less of a need for
Will the Foley "bother" me?
A. "Every patient is different..."
I used loads of tape around my thigh to hold it in place. That way, the
one time I forgot that I had temporarily hooked the "bag" somewhere
and wasn't holding it with me, when I walked away it didn't hurt. About
20% of patients have bladder contractions due to the catheter (mine were very
painful). (The bladder's essentially trying to get rid of the catheter.)
These can be minimized by oxybutynin chloride
(Ditropan) or belladonna & opium suppositories (wish I'd had some at the time...).
How do I keep the catheter and penis clean?
A: They used to be pretty strict
about this, requiring the site at the opening of the penis to be regularly cleaned
with 50% peroxide or an antibiotic ointment. Apparently, someone has studied
this and surprisingly found that it doesn't really matter much whatever one does.
I don't have a reference from the medical literature that addresses this
specifically, but one did find that the same degree of infection occurred with
chlorhexidine cleaning prior to catheter insertion.
Does it hurt when they take out the catheter?
A: "Every patient is different..."
(get the picture?). Some say, "I didn't even
know they had taken it out." Then there are those of us that do NOT
enjoy it (but it's over with quickly).
Do you think you did the right thing by agreeing to have a prostatectomy?
A: Bottom line: Yes; at this point, I feel that it was right for me.
Should I go with a surgeon in private practice or with one at a medical school?
What if I don't want residents "practicing" on me?
have shown that the "whole team" in the hospital is as important as
who has their hands on you the most during surgery. When I went with a highly-regarded
med. school urology department, I was willing to accept the fact that a resident
could do a lot of the "hands-on" cutting. Actually, you could
be better off in a teaching hospital with surgery being overseen by a well-experienced
surgeon, regardless of the participation of the residents.
Should every patient count on having at least some incontinence for awhile after
A: I never had any incontinence. Although I talk to more and
more patients with the same experience, the norm would seem to be at least some
incontinence, with gradual improvement.
I've heard that some patients end up with "strictures" when the new
connection between the urethra and the bladder essentially closes up. How
common are these?
A: In the past, at some centers about 10 to 20% of RP patients
developed bladder neck contractures or strictures. Some centers nowadays,
on the other hand, have lower rates of stricture development (and see next Q&A).
Most of those happen within 3 or 4 months of surgery; some within a year
of surgery; and a smaller percentage even later (source: British J. of Urology
What difference does it make if the bladder neck is "spared" during
A: There are data to support the theory that preserving the bladder
neck (in addition to helping with continence) helps prevent strictures (e.g.,
the article listed above, another showing 3% incidence [vs 8% WITHOUT
sparing], and one with only 0.5% [in patients without prior transurethral
prostate resection]). I don't think my surgeon has ever had any patients
with this condition after sparing the bladder neck. The article listed above
also suggested that tension on the anastomosis from
the catheter balloon should be avoided after surgery since it could decrease blood
supply (and make tissue healing less than optimal, resulting in more chance of
Will I be impotent after surgery?
A: Every patient is REALLY different here.
In a 2000 paper, "Among men who were potent before
surgery, the proportion of men reporting impotence at 18 or more months after
surgery varied according to whether the procedure was nerve sparing (66% of non-nerve-sparing,
59% of unilateral, and 56% of bilateral nerve-sparing)." Thus, although
nerve-sparing is often touted as a really big deal, that particular study showed
it didn't make a "huge" difference. The data seem pretty surprising
to me. I've heard most guys (including me) say that after several months
they start to see some action, with gradual improvement over time.
Are there are new improvements to radical prostatectomy that I should ask for?
A: The University of Texas Health Science Center at San Antonio is looking at
the possiblity of urethral-sparing radical prostatectomy. This could improve continence
(and maybe make stricture less likely, I'm guessing). So far, it looks like
prostate cancer isn't likely to be right alongside the urethra, but there is residual
prostate adenoma (benign prostatic hyperplasia) in the
length of urethra running through the prostate. This could release enough
PSA to still be detected (and could make follow-up PSA readings difficult to interpret).
But if they can learn more about how to deal with this, sparing the urethra
could be a good thing. (Guess it's a little too early to ask your urologist
about this yet; but maybe some day.)
What if I think I'm too fat to haveradical prostaectomy?
A: My surgeon was
recently involved with a retropubic procedure on a guy over 300 lbs. A perineal approach couldn't
be used, but new techiques for the anastomosis allowed for the retropubic.