Introduction:
Prostate cancer is the most common type of cancer diagnosed in men, apart from skin cancer, according to the American Cancer Society. A common treatment option is prostatectomy (a prostate cancer surgery used for the treatment of localized cancer). Prostatectomy involves the removal of the prostate gland partly or completely. The prostate gland is located below the urinary bladder in the male pelvis. This gland is surrounded by the urethra carrying urine from the bladder to the penis. Prostatectomy is the procedure used for treating various conditions that affect the prostate. Mostly it is used for treating prostate cancer.
What Are the Types of Prostatectomy?
Prostatectomy can be done in various ways, based on the condition. Options usually include minimally invasive surgery that requires robotic assistance and traditional open surgery.
The three types of prostatectomy are:
1. Simple or Open Prostatectomy (Subtotal Prostatectomy): It is a procedure that involves the excision of a specific portion of the prostate gland. This type of prostatectomy is used for treating benign conditions. A simple prostatectomy helps to relieve urinary symptoms. It causes a higher risk of complications with a prolonged recovery time than other enlarged prostate surgery procedures like:
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Laser surgery.
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Transurethral resection of the prostate (TURP).
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Holmium laser prostate surgery (HoLEP).
2. Radical Prostatectomy: A radical prostatectomy involves the excision of the entire prostate gland, the seminal vesicles, and the vas deferens. This procedure is performed for malignant conditions only.
3. Salvage Prostatectomy: It is a more technically complex procedure compared to radical prostatectomy. Patients who have undergone radiation therapy in the past often experience scarring in and around the prostate. This leads to difficulty in separating the tissue during the surgery. Salvage prostatectomy is potentially curative in patients where cancer has recurred or remained in the prostate without spreading.
What Are the Complications Involved in Prostatectomy?
The complications involved in prostatectomy are as follows:
Simple Prostatectomy:
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Bleeding.
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Urinary tract infection.
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Dry orgasm.
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Urinary incontinence.
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Narrowing or stricture of the urethra or bladder neck.
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Impotence or erectile dysfunction.
Radical Prostatectomy:
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Urinary incontinence.
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Bleeding.
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Urinary tract infection.
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Narrowing of the urethra or bladder neck.
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Impotence or erectile dysfunction.
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Lymphocele (formation of cysts containing lymph).
What Happens After the Surgical Removal of the Prostate Gland?
If a patient has had his prostate gland removed, he can have children only through suitable environments created in laboratories. After the prostate gland or seminal vesicles are removed, the patient is usually unable to ejaculate even after having an orgasm, as it does not cause loss of sensation or inability to have an orgasm in the penis. However, a complete erection is usually not possible. A short-term change is seen in erectile ability if cancer has not reached the nerves and caused injury to the nerves during the surgery.
What Are the Potential Risks Associated With Prostatectomy?
It is essential for the patient to be aware of potential risks associated with prostatectomy.
The risks seen immediately after the surgery may include the following:
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Bleeding.
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Reaction to the anesthesia.
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Damage to organs near the prostate.
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Infections at the surgery site.
What Are the Main Complications After Prostate Surgery?
The main complications after prostate surgery are:
1. Bleeding After Prostate Surgery: The most common problem after prostate surgery is bleeding. A drain system is placed in the surgical area to prevent this problem. In addition to this system, some treatments are also performed to prevent bleeding. However, bleeding after prostate surgery is not a sign of an important issue; the physician must be contacted immediately if it becomes chronic.
2. Urinary Incontinence After Prostate Surgery: The inability to urinate is a common side effect after prostate surgery. This side effect subsides in a short time. Transient urinary incontinence is seen as a consequence of discomfort in the sphincter muscles, which control the release of urine. Prostate surgery usually aims to recover quickly, have full control over the bladder, and be sexually active. This type of incontinence is generally similar to the stress incontinence that women often experience after vaginal delivery.
What Precautions Must Be Taken After a Prostate Surgery to Avoid Complications?
The following precautions must be taken after prostate surgery to avoid complications:
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The patient must avoid constipation.
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Avoid sitting on hard surfaces like the floor.
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Do not consume hot and spicy foods.
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Sitting for a long duration must be avoided.
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Avoid lifting heavy articles.
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The patient must avoid wearing tight clothes.
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Avoid long and strenuous activities.
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At least three liters of water must be consumed daily.
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The medicines prescribed by the doctor must be taken regularly.
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The patient is advised not to drive for the first week after surgery and also avoid activities like exercising, cycling, and horseback riding for at least six months as it might cause strain in the groin area.
What Increases the Risk of Complications After Prostate Surgery?
The risk of complication is increased if surgery for any other reasons has been performed in the past. However, complication rates are increased when surgery is performed on patients with unsuccessful other prostate cancer treatments, like radiation therapy. Radiation therapy is a good and effective treatment option for patients with prostate cancer. However, it is not beneficial for all the patients. The patients undergoing salvage prostatectomy possess a higher risk of urinary incontinence, with a higher rate of scar tissue development.
Conclusion:
A prostatectomy (removal of the prostate gland) is usually considered the best treatment option for most men suffering from high-risk prostate cancer. Various treatment options are available for prostate cancer patients. The treatment depends on the stage and grade of cancer and the patient’s health. After a successful surgery and discharge, the patient must take all the necessary precautions. Bleeding is considered one of the most common complications for the first several months after surgery. The duration of the recovery period after prostate cancer surgery might vary depending on various factors like the type of surgery, the disease stage, and the patient's health status. The overall recovery usually takes a short period.
