The Prostate Gland
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and entire Genito-Urinary System.
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Tests involved with prostate cancer treatment:
Cancer Discussion on:Factors Determining Treatment
Radical Retropubic Prostatectomy
Rectal Ultrasound (TRUS) Guided biopsies
Urethral Resection of the Prostate (TURP)
RETROPUBIC PROSTATECTOMY INFORMATION
The bladder is the organ that stores urine
and the urethra is the tube that drains urine out
through the penis. The prostate lies immediately beneath the
bladder and completely
surrounds the urethra. Attached to the prostate are accessory
organs that assist in fertility known as the ejaculatory ducts and
the seminal vesicles.
Prostate Cancer is the second commonest cause of cancer related deaths
in men in
Australia and each year this amounts to approximately 2500 men an
number to women dying of breast cancer each year.If treated sufficiently
survival at 15 years has been shown to match those of men without
Preparation For Surgery
Follow the instructions on your hospital admission papers.If you have
been instructed to
donate your own blood, you will need to contact the Red Cross on the
forms that you will
be provided with. If no such instructions have been made, it can be
assumed that blood
will be collected at the immediate commencement of surgery by the
Most men are admitted to hospital the day prior to surgery to allow
for preparation of the
bowel.Emptying out the bowel allows for optimal operating conditions.In
situations you could be admitted to hospital on the morning of your
surgery but this
would require you to self-administer your bowel prep the day prior
The main problem with taking the bowel prep at home is dehydration
if you cannot keep
up with an adequate fluid intake. During this process you will
have marked diarrhoea,
which will ultimately become water-like, which is how bowel prep empties
Soon after your arrival into hospital, staff are under instructions
to put up an intravenous
line for the administration of additional fluids into your veins.
Usually a number of routine tests are arranged through a Pathology
Laboratory prior to
your admission to hospital. If this is to be the case, you should
have these carried out approximately a week prior to your admission
to hospital you will be given a referral
to have blood tests and an electrocardiograph (ECG). The results
will automatically be
sent to both the hospital and to your doctor.
Nature of the Surgery
A cut is made in the lower abdomen in the midline. Through this opening,
prostate and the immediate surrounding tissues are surgically removed.
The bladder is
then rejoined to the urethra with stitches. A catheter, which
is a plastic tube that drains
urine from the bladder, is left in place and exits from the body through
A tube known as a drain is also left in place and attached to a special
bottle to allow
excess fluids to drain out after the surgery this tube exits from
the lower abdomen.
The anaesthetist will discuss with you the type of anaesthetic to
be administered and as
a general rule you would have a general anaesthetic. Your pain relief
also be discussed with your anaesthetist this may take the form of
an epidural (needle
in the back through which pain relieving medications can be administered)
or a PCA
(patient controlled analgesia) pump where you press a button to automatically
pain relief to yourself.
In Hospital Post Operative Course
Following this type of surgery, the bowels usually fail to function
normally for a day or so.
An early sign of resumption of normal bowel activity is the sounds
of bowel activity by
listening to your abdomen with a stethoscope.Another early sign is
the passage of flatus
from your back passage. Once this occurs, fluids will be introduced
and as they are
tolerated, you will generally be back onto a fairly normal diet by
about the fourth or
fifth day after the operation.
The drain coming from the abdomen is usually removed on the second
or third day.
The plastic cannula or drip in your veins is usually in place until
the third or fourth day.
The catheter is generally in place throughout the entire in-hospital
In selected cases, it may be possible to remove the catheter prior
to going home. Many
men will go home with the catheter in place. Usually by the
fourth day, the catheter is
switched over to drainage into a bag that attaches to the leg rather
than a large drainage
bag that hangs from the side the bed.
After its removal, a pathologist assesses the prostate gland under
the microscope the
results will then be able to give an indication as to whether the
cancer was fully contained
within the prostate. This result is usually but not always available
prior to your discharge
After Going Home
Obviously you will need to take things easy after going home. You
free to walk around but avoid going up and down stairs unnecessarily
in the first few weeks. Have plenty of fibre in your diet to
minimise any difficulty with opening your bowels.
If you go home with a catheter in place, arrangements may be made
for you to have a
special X-ray called a cystogram to check on the healing internally.
This is usually
performed about a week or two following discharge from hospital.
as well as your follow up appointments are arranged and detailed to
you prior to your
discharge from hospital.
Risks of Surgery
The risks of surgery are mentioned to allow you to be fully informed.
It is worth bearing
in mind that the great majority of men will have a fairly uneventful
recovery. Like any
form of surgery anywhere on the body, there are general risks such
as bleeding and
infection. It is relatively uncommon to require a blood transfusion
in addition to any blood
that is collected from you either prior to your admission to hospital
or immediately prior to
your surgery. Administering antibiotics at the time of the procedure
reduces the risk of
Urinary incontinence or in other words
the loss of your control of the urine, is a significant complication
that occurs in only a small minority of patients. You can expect
control to be shaky immediately after the removal of the catheter,
but this rapidly improves
over the following few weeks. By about 3 months the majority
of men will not find it
necessary to wear any pads. Further improvement in urinary control
can occur over a
period as long as 12 months.
The loss of penile erections (Erectile Dysfunction) is commonly
radical prostatectomy. The nerves that are important in generating
an erection run closely
behind the prostate. Whilst it is possible to carry out the
surgery with preservation of these nerves, this needs to be balanced
against obtaining clearance of the cancer. Furthermore,
nerve sparing radical prostatectomy does not guarantee continued erections
success rates are quite good. Whether or not you are a candidate for
nerve sparing radical prostatectomy will be discussed on an individual
basis. In the event of erection problems following surgery,
there are a number of treatment options available.
Scar tissue can sometimes form following surgery. Internal scarring
can lead to an
obstruction where the urethra is joined to the bladder and is known
as a bladder neck
contracture or a bladder neck stricture.This is usually rectified
by a simple telescopic
procedure through the eye of the penis.This complication is uncommon.
Injury to adjacent organs to the prostate such as the bladder, ureters
(back passage) is theoretically possible. Fortunately, these
risks are particularly
rare but are mentioned for completeness.
There are also general risks associated with any major operation but
as is the case with
all surgery, the risks are carefully balanced against the risks of
continuing with the cancer untreated.
If there are any issues that you are unsure about, you should discuss
them with your
Doctor prior to your surgery.