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Wellington Urology Associates Wakefield Hospital, the largest private hospital in the Wellington region
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Radical Prostatectomy

Radical prostatectomy is the surgical removal of the entire prostate, with simultaneous reconnection of the bladder neck to the urethra. The operation is performed under general anaesthetic through a low-midline abdominal incision. It is generally well-tolerated, patients being up and about on the second post-operative day, with a hospital stay of 3-4 days and catheter to stay 7-10 days. Continence improves rapidly following removal of catheter in the majority of patients, and continues to improve for 12 months. The histology results will be discussed at the first follow up visit.

Pre-operatively:

  • discontinue aspirin 1 week prior
  • some other medications may also need to be stopped
  • enema evening prior to surgery
  • nil by mouth from midnight

Post-operatively - early:

  • 1st post-operative day: diet, reinstate usual medications
  • mobilisation on day 1 and home on day 3-4
  • return day 7-10 for removal of catheter, start pelvic floor exercises
  • resume full normal activity by 6 weeks
  • medication for erection from 6 weeks

Post-operatively - late:

  • regular PSA check and clinical follow up indefinitely

At follow up, 90% of patients feel positive about their surgery and would choose the same procedure again. However, all patients must accept the possibility of long-term impotence and of troublesome incontinence (<10%). Spontaneous erections are more likely in younger men and where nerve-preservation is possible. Some patients will respond to medications such as Viagra, but the results from penile injection therapy are significantly better. Ejaculation may be painful initially, but settles over time. Most patients who are unable to achieve erection still resume non-penetrative sexual activity. It is possible to have orgasm without erection.

Almost all patients report incontinence immediately after catheter removal; this improves rapidly over the succeeding days and weeks. Again, younger patients in general do better, pelvic floor exercises help, and only 1% require more than pad protection. Placement of a synthetic urethral sling or an artificial sphincter is available for the uncommon severe and persisting incontinence.

Other surgical complications occur overall in 5% of patients. Those recognised as common or serious are listed below but this does not include the rare and extraordinary. We try at all costs to avoid any adverse outcome.

Early complications --Bleeding occurs in all patients, transfusion in 10%
Infection
Rectal injury <1%, occasionally requiring temporary colostomy
Temporary altered bowel sensation and more frequent bowel movement
Temporary perineal discomfort
Temporary numbness, tingling
DVT, PE
Late complications --Urethral stricture / bladder neck stenosis 5%
Inguinal hernia - unclear whether true increased risk
Penile shortening of < 1cm, altered penile sensation
PSA relapse and cancer recurrence
Fistula (<1%) which would require further surgery for closure

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.