What is Perineal Prostatectomy?
Perineal prostatectomy is a surgical technique used to remove the prostate to treat advanced forms of prostate cancer. It is most often used on localized cancer than has not spread outside the prostate.
In addition to being an effective treatment method, the surgeons at Affiliated Urologists use this approach because of reduced blood loss; a smaller, less noticeable incision scar; and a shorter time in the hospital. The procedure has a high success rate and since it is a minimally invasive technique, the risk of complication is low.
Before going into the hospital or surgery center, the patient may need to fast and only consume only liquid beverages. It may be advised to stop taking certain medications, particularly any that thin the blood and do not allow blood to clot. It’s important to give the physician a complete list of any medications and dietary supplements that are being taken to see if it is safe to take them before surgery.
Once the physician is ready, an anesthesiologist will put the patient under general anesthesia. After the patient is prepped and sterilized, the physician can begin to make a small, 2-inch incision between the anus and the scrotum. The surgeon then maneuvers through muscle and tissue and uses nerve-sparing techniques to get to the prostate. The prostate and seminal vesicles are separated from the bladder and urethra and removed. The surgeon reattaches the bladder to the urethra and a catheter is put in place to drain the urine. If necessary, the surgeon can remove lymph nodes for testing if they are believed to be affected by cancer as well. Finally, when the physician is confident all of the cancerous cells are removed, he or she will stitch the incision and bandage the patient to conclude the procedure.
Following the procedure, patients will be taken to a recovery room where they will be monitored as they begin to wake up. The hospital stay can last up 5 days and the patient must have a caregiver to drive them home. Oral antibiotics, pain medication, and a stool softener may be prescribed and should be taken precisely as directed. The antibiotics are used to prevent post-operative infection, but if patients notice any signs of infection, they should call Affiliated Urologists as soon as possible. Patients should only change bandages with clean hands and avoid soaking the wound in a bath. If patients are sent home with a catheter, it should be handled with care, following physician instructions in order to avoid bleeding and limit the risk of infection. The physician may recommend doing pelvic floor exercises to strengthen the muscles and avoid accidental leakage after the procedure.
Patients may be asked to return for a series of follow-up appointments in order to monitor the cancer and ensure that it does not come back. Some side effects of the procedure, such as impotence or problems with sexual intercourse, may not be apparent right away, and the patient may want to talk about additional treatment options during the follow-up.