Before the procedure
Before surgery, your doctor will give you a general anesthetic, which means you'll be unconscious during the procedure. Or you may receive a spinal anesthetic, which means you'll be conscious during surgery but won't feel any pain, although spinal anesthetic is rarely used anymore. In some instances, intrathecal injections are also provided in addition to general anesthetic.
Your doctor may also give you an antibiotic right before surgery to help prevent infection.
During the procedure
Robot-assisted radical prostatectomy. Your surgeon sits at a remote control console a short distance from you and the operating table and precisely controls the motion of the surgical instruments using two hand-and-finger control devices. The console displays a magnified, 3-D view of the surgical area that enables the surgeon to visualize the procedure in much greater detail than in traditional laparoscopic surgery. The robotic system allows smaller and more-precise incisions, which for some men promotes faster recovery than traditional open surgery does. Just as with open retropubic surgery, the robotic approach enables nerve-sparing techniques that may preserve both sexual potency and continence in the appropriately selected person.
You usually can return to normal activity, with minor restrictions, two to four weeks after surgery.
Standard retropubic radical prostatectomy. Your surgeon makes an incision in your lower abdomen, from below your navel to just above your pubic bone. After carefully dissecting the prostate gland from surrounding nerves and blood vessels, the surgeon removes the prostate along with nearby tissue. The incision is then closed with sutures. Compared with other types of prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage, which can lead to problems with bladder control and erections.
Simple prostatectomy. Once the anesthetic is working, your doctor may perform a cystoscopy. A long, flexible viewing scope (cystoscope) is inserted through the tip of your penis to see inside the urethra, bladder and prostate area.
Your doctor will then insert a tube (Foley catheter) into the tip of your penis that extends into your bladder. The tube drains urine during the procedure. Your doctor will make a cut (incision) below your navel. Depending on what technique your doctor uses, he or she may need to make an incision through the bladder to reach the prostate.
If you also have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it.
Once your doctor has removed the part of your prostate causing symptoms, one to two temporary drain tubes may be inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder (suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After the procedure
After surgery you should expect that:
- You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the IV is removed.
- Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.
- You'll likely go home the day after surgery. When your doctor thinks it's safe for you to go home, the pelvic drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.
- You'll return home with a catheter in place. Most men need a urinary catheter for five to 10 days after surgery.
Make sure you understand the post-surgery steps you need to take, and any restrictions.
- You'll need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks.
- You won't be able to drive for at least a few days after going home. Don't drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it's OK.
- You'll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about six weeks and then again after a few months. If you have problems, you may need to see your doctor sooner or more often, although it's unlikely.
- You'll probably be able to resume sexual activity after recuperating from surgery. After simple prostatectomy, you can still have an orgasm during sex, but you'll ejaculate very little or no semen.