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Prostate Cancer: Radical Prostatectomy

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Open Radical Prostatectomy vs. Minimally Invasive Radical Prostatectomy

In 2003, only 9.2% of radical prostatectomies were done using a minimally invasive procedure. By 2007, that number had jumped to 43.2%. In 2009, researchers in Boston reported on a study that compared outcomes, benefits, and complications of open surgery vs. minimally invasive surgery:

  • No difference was found in deaths or in the need for additional cancer therapy between the two approaches.
  • The median hospital stay was two days for minimally invasive surgery and three days for open surgery.
  • 2.7% of men having laparoscopic surgery required a blood transfusion compared with 20.8% of men having open surgery.
  • There was more anastomotic stricture -- narrowing of the suture where internal body parts are rejoined -- for open surgery (14%) than for minimally invasive surgery (5.8%).
  • There were fewer respiratory complications with minimally invasive surgery (4.3%) than with open surgery (6.6%).
  • There were lower rates of incontinence and erectile dysfunction with open surgery. The overall rate was 4.7% for laparoscopic surgery and 2.1% for open surgery.

 

Risks of Radical Prostatectomy

Radical prostatectomy has a low risk of serious complications. Death or serious disability caused by radical prostatectomy is extremely rare.

Important nerves travel through the prostate on the way to the penis. Skilled surgeons can usually protect most of these nerves during radical prostatectomy. Still, complications from inadvertent nerve damage do occur after radical prostatectomy. They include:

  • Urinary incontinence: More than 95% of men younger than age 50 are continent after radical prostatectomy. Around 85% of men aged 70 or older maintain continence after the operation.
  • Erectile dysfunction (ED): Problems with erections are common after prostatectomy. Still, most men are able to have sex after prostatectomy while using medicines for ED (such as Viagra or Cialis), an external pump, or injectable medications. The younger the man, the higher the chance of maintaining potency after prostatectomy. A period of penile rehabilitation is often necessary.

Much of the skill involved in radical prostatectomy centers on sparing these nerves during the operation. A man undergoing radical prostatectomy by a surgeon at an advanced prostate cancer center has a better chance of maintaining sexual and urinary function.

Other complications of radical prostatectomy include:

  • Bleeding after the operation
  • Urinary leaks
  • Blood clots
  • Infection
  • Poor wound healing
  • Groin hernia
  • Narrowing of the urethra, blocking urine flow

Less than 10% of men experience complications after prostatectomy, and these are usually treatable or short-term.

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