Overview

What is an open radical prostatectomy?

Open radical prostatectomy, or the complete removal of the prostate gland, is a surgery used to treat prostate cancer. In an open surgery, the surgeon makes a short incision that allows them to insert surgical tools and to see the surgical site clearly.

The prostate gland is part of a man’s reproductive system. The urethra, the tube that carries both urine and semen out of the body, goes through the middle of the prostate. The prostate is located right below the bladder.

During a prostate removal, the surgeon may also remove surrounding tissue like lymph nodes and fat around the prostate gland. Your urethra will be reattached to your bladder, and the tubes that transport semen will be cut.

Procedure Details

Where will the incision be made in an open radical prostatectomy?

The surgeon will make a vertical 3.5-inch incision, starting at the top of the pubic bone.

Risks / Benefits

What are some of the risks of an open radical prostatectomy?

Risks of an open radical prostatectomy may include:

Bleeding.
Infections.
Blood clots in the lungs or legs.
Anesthesia reactions.
Damage to surrounding tissue and organs.
Lymphocele (fluid that has leaked from the lymph nodes).

Additional risks may include:

Increased risk of an inguinal hernia in the future.
Temporary urinary incontinence (being unable to control urine).
Temporary erectile dysfunction (the inability to have or keep an erection).

Will I have incontinence after an open radical prostatectomy?

Most men leak at least some urine after the prostate is removed. Many have excellent control as soon as the catheter is removed, while some will leak a lot for a few weeks. Most men have good urinary control by six to 12 weeks after the surgery.

Will I have problems with impotence after an open radical prostatectomy?

Men experience erectile dysfunction after all forms of radical prostatectomy because the nerves that allow for erections are bruised or otherwise damaged during removal of the prostate. Sometimes all or part of a nerve needs to be removed to get all the cancer out.

Most men won’t experience erections for several months after surgery, even if both neurovascular bundles are preserved. This should improve gradually starting at around six months after surgery. It may take two full years after surgery to recover erections of a quality equal to those present before surgery.

Even without an erection after surgery, men can still experience an orgasm though no semen will be present. It’s important to begin sexual activity as soon as urinary control has returned in order to maintain good blood flow to the penis. This helps prevent fibrosis (scarring or thickening) that can make it more difficult to return to good erections.

There are therapies that are used to help restore erections, including:

Drugs called PDE5 inhibitors (Viagra®, Cialis®, and Levitra®).
Injection therapy.
Vacuum erection devices.

What can I expect after the open radical prostatectomy?

One night in the hospital.
A catheter (thin, flexible tube) to drain urine.
A drain to allow healing, Generally, drains are removed when you are discharged.

Recovery and Outlook

What follow-up care do I need after an open radical prostatectomy?

Two post op-visits are usually required. One is scheduled about a week after hospital discharge to remove the catheter (and staples from the incision if they were used) and another about five weeks later to check on overall recovery. You’ll need PSA blood tests, usually performed at six weeks after surgery and then again every six months, to check for cancer recurrence

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Open Radical Prostatectomy