Surgery: Radical prostatectomy
By Mayo Clinic staffDuring a radical prostatectomy, your surgeon removes the entire prostate and if necessary, the nearby lymph nodes, while trying to spare the muscles and nerves that control urination and sexual function (nerve-sparing techniques).
The procedure is usually done under general or spinal anesthesia. Surgical approaches for a radical prostatectomy include:
- Open radical retropubic prostatectomy. With this approach an incision is made below the navel down to the pubic bone. Through this incision the prostate is removed by making an incision in the urethra and the part of the bladder surrounded by the prostate gland (bladder neck). The doctor can then lift out the prostate gland. Nerve-sparing techniques may be used to help preserve urinary control and sexual function. Your doctor may also remove lymph nodes, if necessary. You will need to stay in the hospital two to three days and have a urinary tube (catheter) in place one to two weeks.
- Radical perineal prostatectomy. With the perineal approach, which is less commonly used, your doctor removes the entire prostate through a half-moon incision between the anus and scrotum. Perineal surgery generally results in less bleeding, but has a higher risk of rectal injury. Also, your surgeon isn't generally able to remove nearby lymph nodes unless a second incision is made. Although nerve sparing can be performed, it is more difficult and less successful with this approach. The hospital stay is one to two days, and the catheter will need to stay in place one to two weeks.
- Robot-assisted radical prostatectomy. With the robotic approach, the operation is performed utilizing laparoscopic techniques through five or six "keyhole" incisions. Nerve sparing and lymph node removal can be done as well. The prostate is removed through a small incision in the navel area. The main advantage is a shortened hospital stay, shortened recovery time and less blood loss, compared with open prostatectomy. Most men stay in the hospital overnight and have a urinary catheter in place for five to seven days.
