is the prostate?
a small gland that lies just beneath the bladder in the male
and surrounds the urethra through which urine is passed.
does the operation involve?
diagram to explain the steps of radical prostatectomy
removes the entire prostate glan, the water tube (urethra)
is rejoined to the bladder. Please ask your Mr Puri if you
want further details.
is this operation necessary for me?
has performed investigations on your prostate gland, which
have shown the presence of prostate cancer. The operation,
which is described below, will remove all of the prostate
there any alternatives?
kind of cancer, the alternatives to removal of the prostate
gland are treatment of the prostate cancer with radiotherapy
(a beam of special, focused x-rays) or brachytherapy (radioactive
seed implantation into the prostate)
possible to do nothing for the time being Ė i.e. to watch
and wait to see if problems develop. However for men like
you, this is not recommended, as there is a significant chance
of the cancer progressing if no treatment is given.
are the advantages of surgery
true extent (stage) and aggressiveness (grade) of prostate
cancer can be determined.
the cancer is confined to the prostate and completely removed
the operation should be curative
value should decrease to <0.1 six weeks after the operation
operation also relieves the obstruction caused by enlargement
of the prostate gland and relieves symptoms as poor flow
and getting up at night to pass water.
cancer recurs PSA rise will detect this 4-5 years before
symptoms so the radiotherapy can be given.
discomfort- The wounds heal within 10 days and most
patients are able to resume normal activity like driving
within 2-3 weeks. The discomfort is easily controlled by
painkillers. Wound complications are rare
complications are unusual but are rapidly recognised and dealt
dysfunction (problems getting an erection)
(problems controlling your flow of urine)
problems. It is possible for your rectum to become damaged
during surgery, although this is not common.
is a very small (less than 1 percent) chance that you may
die from your surgery. As operation involves a general anaesthetic
and this can lead to complications such as heart problems
and breathing problems.
your surgeon's attempt to remove the entire tumour, you may
not be cancer-free. Even if your test results indicate your
cancer is only in your prostate, it's still possible
that it has spread to other parts of your body but can not
be detected. It is essential that you have regular follow
up for 5 years after operation
happens before the operation?
be requested to attend the ward before your admission date
to have blood tests and examinations performed to ensure you
are fit for the operation. On admission to the ward, you will
be welcomed and shown to your bed. You should plan to be in
hospital for 3-4 days. The nursing staff will discuss your
discharge with you.
be seen by the Surgeon who will explain the operation to you
and ask you to sign the consent for surgery. If you are unsure
about any aspect of the operation, please ask for more details
from the medical or nursing staff. You will be advised of
the approximate time of your operation
be seen by an anaesthetist who will discuss the type of anaesthetic
you will be given. They will be interested in chest troubles,
dental treatment and any previous anaesthetics you have had.
The anaesthetist will discuss with you the different types
of pain relief.
occasionally you may be nursed on the High Dependency Unit
(HDU) after the operation. There are more nurses available
so more attention can be given to you. If this is planned,
you will be introduced to the nurses from HDU and shown around
the unit the night before theatre.
have your usual diet until approximately 6 hours before surgery.
This will let your stomach empty to prevent vomiting during
operation. You will be advised at what time to stop drinking
be asked to wear stockings to prevent blood clots and aid
circulation. You will be asked to wear a cotton gown and remove
be given a sedative about one hour before the operation to
help relax you; if so you will be taken to theatre on a trolley.
If no sedation has been prescribed, you may choose to walk
to theatre, accompanied by a ward nurse. Your details will
be checked again before your anaesthetic begins.
happens after the operation?
you will be conscious a minute or two after the operation
ends, you are unlikely to remember anything until you are
back in your bed. You will have a tube (catheter) coming from
your penis. This tube drains the urine from your bladder and
is connected to a collecting bag. It is quite normal for your
urine to be quite bloodstained initially. Some men experience
slight discomfort around the catheter. Please inform the nursing
staff who will be able to give you pain killers.
first day after your operation, you may begin to sip fluids.
You will have in intravenous drip containing saline and this
will make up for any fluids you are unable to drink. By the
second day, you will probably be drinking quite freely again,
and may be able to tolerate a light diet. Your bowels may
stop working for 1-2 days after surgery. If you have not opened
your bowels after 2 days, or are feeling comfortable, please
ask the nursing staff for advice.
be encouraged to get out of bed and start walking right from
the first day. You will not do your wound any harm and it
is important to start moving to avoid complications.
need to remain in hospital until you can walk freely without
pain, and can manage by yourself. We will also ensure that
you are eating normally before you are discharged home. Usually
patients are discharged home 2
to 3 days
after their operation
will be sent home with your catheter in place. This catheter
should remain in place for 5 to 12 days and must not be removed
for any reason except on your surgeonís instructions.
any problems occur with the catheter please contact Ward 14
or Yorkshire Clinic Ward 1 immediately for advice.
complications are unusual but are rapidly recognised and dealt
with. If you think that all is not well, please ask the nursing
or medical staff.
infections can occur after anaesthetics, particularly in people
who smoke. Exercises are taught to clear the air passages,
and can prevent this condition. You should try not to smoke
before surgery, and make every effort to give up smoking after
is a risk that blood clots may form in the veins of the calf
during surgery (known as "deep vein thrombosis")
This may lead to a swollen, tender calf. Although this is
easily treated, it can lead to further problems if the clots
break away and float up into the lungs ("Pulmonary Embolus").
You will be given stockings to wear prior to surgery and you
should keep these on during your stay on the ward. You will
also be given a fresh pair to take home and you should wear
these at home for a further 6 weeks. Your surgeon may also
prescribe daily injections during your hospital stay to thin
the blood slightly and reduce the risk of forming these clots.
eat and drink whatever you wish. You may drink alcohol but
it is not wise to overindulge. Try to avoid constipation by
keeping to a diet that contains plenty of fruit and fibre.
If you do become constipated, then ask your doctor for advice
you go home, you should avoid heavy lifting and vigorous exercise
for 6 weeks, to let the scar tissue and wound heal. If you
engage in strenuous activity before this time, you might cause
damage to the join between the bladder and urethra (water
pipe) and in the long term this could cause problems with
first four weeks at home, do not sit upright in a firm chair
for more than an hour at a time. Instead sit in a semi-reclining
chair, on a sofa, or on a comfortable chair with a stool.
raises your legs and improves the drainage from your leg
veins reducing the risk of clots forming
avoids placing weight on the area of your surgery
take light exercise regularly. You can take off the elastic
support stockings after 6 weeks at home and you can drive
your car when you can operate the pedals without any discomfort
of the catheter
go home after the operation, you will have the original catheter
draining urine from the bladder. Although it will be taped
to your thigh immediately after your surgery (to prevent any
pulling on the catheter), this tape will be removed when you
go home. Avoid any situation where the catheter may be caught,
or pulled on.
catheter must remain in place for five to twelve days and
should not be removed for ANY reason except on your
be given an appointment to come back into hospital five to
twelve days after your operation for removal of catheter.
The catheter will be removed on the ward. This is a painless
procedure and is performed at the bedside. You will then be
able to pass urine normally, we will observe you for a few
hours but will usually allow you to go home on the same evening.
catheter is removed, you may find to begin with that you get
little warning before needing to pass urine, and may leak
a few drops of urine on movement. This is quite common and
usually settles quickly. If it does not, please let the nursing
you may need a special x-ray to determine whether the internal
stitches around the join between the urethra and the bladder
have healed. This may mean that you have to stay overnight
in the hospital.
Problems which may occur
common for there to be a slight discharge of blood around
the catheter when you open your bowels. This will settle down
by itself and is not a cause for concern. You may also see
some blood in the catheter bag, particularly after exercise.
If this happens, you should increase your fluid intake to
help flush out the blood. This kind of bleeding usually settles
by itself and does not require treatment in most cases.
around the catheter
this is also common and does not require treatment. If the
leakage is very severe, then it can be managed by absorbent
pads that the community or hospital nursing staff will provide
for you. The catheter should not be removed. Very rarely,
the catheter may stop draining altogether. If this happens,
lie down flat and drink plenty of fluids for an hour. If this
does not result in drainage from the catheter, then come
straight to Ward 14 / Yorkshire Clinic ward 1 for
advice. Do not let anybody remove your catheter without
discussion with your Consultant.
have a approximately 3 to 3.5 inch wound below the belly button
are closed with self dissolving internal stitches and skin
glue and so do not require removal. These stitches are not
visible on the skin. Occasionally we use skin clips, these
should be removed ten days after you option. If you have already
gone home at this stage, we will arrange for the District
Nurse to remove the clips for you. You can shower or bathe
may develop a wound infection after they go home which shows
as redness or swelling around the wound. If this happens,
seek advice from your GP.
in the leg (Deep Vein Thrombosis)
first six weeks after surgery, one of the most serious potential
complications is the development of clots in the back of the
calf. If you develop any of the symptoms described earlier,
e.g. chest pain, shortness of breath, pain or swelling in
your leg, then call your GP or contact your nearest Accident
and Emergency Department if you are away from home. You should
tell the doctor who sees you that you have had a radical prostatectomy,
and are concerned about a possible blood clot.
in the urine
tract infections are quite common in anyone who has a catheter
in place. Unless you have symptoms, the infection may not
require any treatment.
of a urinary tract infection include
or cloudy urine
there may be cloudiness in the urine, which does not necessarily
signify an infection, but may represent sediment in the urine
that is a normal occurrence.
discussion you had with your Consultant prior to surgery,
the problem of urinary incontinence following surgery was
discussed with you. The majority of men find that they experience
a small amount of urinary leakage. However for a few men,
the problem is more severe.
to normal control occurs in three phases, and you should try
to be patient with the speed of your recovery. The first phase
is that you will be dry when you are lying down at night.
In phase two you will be dry when walking around, and finally
in phase three you will be dry when you get up from a sitting
position. The return to normal occurs at different speeds
in different men and is impossible to predict accurately.
Until you gain full control, you may find it useful to limit
the amount of caffeine drinks (tea and coffee) and alcohol
that you drink as these drinks act as a stimulant on the bladder.
recovery of urinary control occurs in up to 95% of men who
undergo this procedure although this can take up to 1 year.
of sexual function
surgery, you may find it difficult to get or maintain an erection
that is firm enough for intercourse.
dysfunction happens because the nerves and blood vessels that
control erections lie close to the prostate and can become
damaged during surgery. A technique called nerve-sparing
surgery can protect the nerves from injury and where possible
this will be done. However, nerve-sparing surgery is not possible
for all men. Even when nerves are spared, it may not prevent
erectile dysfunction. However, your erections may continue
to improve over time. The nerves that are involved seem
to be able to recover after surgery, but the older you are,
the less likely you are to regain the ability to have an erection.
you may not be able to have penetrative sex, you may still
experience the sensation of an orgasm, which may be achieved
from either foreplay or masturbation. After your prostate
is removed, you will no longer be able to ejaculate (release
fluid from your penis when you orgasm). This is because you
no longer have a prostate to produce this fluid. As you will
be sterile you do not need to use any form of contraception.
are treatments available for erectile dysfunction, so
it's worth talking to your Consultant or Specialist Nurse
about which one may be right for you at your regular follow
up appointments. Current research suggests that early treatment
is associated with greater success.
(erection) rates differ amongst surgeons. Good potency rates
would be 50% of patients, at 12 months after surgery.
not be afraid to attempt intercourse, but it is better to
wait for at least 6 weeks after surgery, to make sure everything
has healed. Do not be tempted to wait for a perfect erection
before attempting intercourse
up after surgery
after the operation you will be seen by the Consultant in
the outpatient clinic. You will have a card for a PSA test
to be carried out at your GP surgery , BRI, SLH or the Yorkshire
Clinic a week before your clinic appointment. This so is the
results of the surgery can be discussed with you, and any
other treatments planned.
follow up appointments will be given at regular intervals,
although the time between visits may lengthen if there are
no particular problems.
do not hesitate to contact us with any questions or concerns
that you may have about your condition. We are here to help
have any questions please contact
David Tyson 01274 382079 Mrs Lyn Taylor 01274 550600
14 Ward 1
Royal Infirmary Yorkshire Clinic
(01274) 364383 Tel (01274) 560311
to Mr R. Puri
Royal Infirmary Yorkshire Clinic
Lane Bradford Road
BD9 6RJ Bingley BD16 1TW
(01274) 382655 Tel (01274) 564521