March 30, 2023

Prostatectomy – Things to know about prostate surgery

In the case of prostate cancer, surgery on the prostate is sometimes unavoidable. Here, the most basic goal is to fully remove the cancer from the healthy tissue.

The appropriate therapy concept is first determined with regard to the patient’s PSA value, the emptying of the patient’s bladder and, in particular, in accordance with the patient’s general physical constitution.

In this context, of course, it is also important to take into account any pre-existing conditions. Often, after weighing all the risks, a prostatectomy is recommended.

A difficult step – but often necessary

If the tumor growth is not yet too advanced, it may be sufficient to carry out so-called active surveillance and successively observe the cancer cells in the prostate.

Nevertheless, it is often seen that the patients are exposed to an often considerable psychological burden, because they become more and more aware of the fact that there is a tumor – a malignant foreign body – in their body. Especially in the case of seniors, one proceeds in this way in order to spare their body.

The fact is that during radical prostatectomy the prostate gland, including the capsule, the seminal vesicles and the local lymph nodes are completely removed. Usually the procedure is performed by means of an episiotomy.

In this regard, doctors speak of perineal radical prostatectomy. Retropubic radical prostatectomy is also recommended. the lower abdominal incision between the navel and the pubic bone, is common in many hospitals.

The latter variant offers the advantage that at the same time possible pelvic lymph nodes are eliminated and can be explicitly examined afterwards. The prostatectomy procedure is very complex, but is carried out routinely and professionally in renowned hospitals.

If, incidentally, the perineal radical prostatectomy shows that the cancer cell growth has progressed further, there is the option after the prostatectomy to remove the lymph nodes during a subsequent laparoscopy – an abdominal endoscopy –.

This is how the prostatectomy proceeds

If a retropubic radical prostatectomy is performed, the first step is to locate and remove the lymph nodes in the immediate vicinity of the prostate gland. In the case of a more extensive lymph node involvement, it often proves to be more sensible to carry out hormone deprivation treatment.

In general, however, it has been shown that affected lymph nodes are the only existing metastases, so that a removal of the affected lymph nodes in combination with the prostatectomy is associated with excellent chances of cure.

Provided that the lymph nodes are not affected by cancer cells, removal of the prostate including its capsule as well as the seminal vesicle located behind the urinary bladder is sufficient. At the same time, the vas deferens are cut off, with the focus on nerve preservation in order to protect potency.

To ensure this, the vascular nerve bundles connected to the prostate capsule are removed. Subsequently, an artificial connection between the urethra and the bladder is designed. Usually the implementation of a so-called transurethral catheter is necessary.

In the aftermath of prostatectomy

If the operation is successful, a leakage test must be carried out afterwards. Accordingly, the connection between the bladder and the urethra must be carefully examined once again.

Only when the tightness of this „bridge“ is established can the catheter be removed, so that natural urination by the patient is possible again.

Conclusion

Certainly, the operation of the prostate – like any other operation – is associated with certain risks. However, considering the very good healing prospects, it is definitely worthwhile to have a prostatectomy performed in order to be able to lead a tumor-free and thus symptom-free life.