Information
about your radical prostatectomy
Radical Prostatectomy - booklet coverContents
What
is a radical prostatectomy?
A radical prostatectomy is removal of the entire prostate
gland and surrounding tissue including the seminal vesicles
(see diagrams below).
Who
has a radical prostatectomy?
The investigations you have had so far suggest that you have an early
stage prostate cancer. Surgery is an appropriate option for curative
treatment of your condition
What
are the risks and benefits?
The doctor at the Christie has explained to you that this is a commonly
performed major procedure. The aim of the operation is to cure you of your
prostate cancer.
Diagram 1:
A cut in the abdomen is made
Diagram 2:
The entire prostate and seminal
vesicles are removed (shaded area)
Diagram 3:
The urethra is rejoined to the bladder and a catheter inserted for a period of
3 week.
Possible early complications of a major operation:
Early complications in hospital are similar to those for any
major operation. These could be:
- chest infection
- blood clots in the lower leg which could pass to the lung
- wound infection
- bruising in the wound
- poor wound healing or weakness in the wound site
- bleeding and the need for blood transfusion
- injury to nearby nerves or tissues.
Specific side effects following a radical prostatectomy
are as the doctor explained
- Swelling of penis and scrotum - This swelling is a short-term effect of the surgery and
usually subsides by the end of your hospital stay.
- Incontinence - By incontinence we mean a small leak of urine that can
occur if you cough, sneeze or laugh, when pressure in
the pelvis is raised and urine can then be forced out
of the bladder. This occurs in about 10% (1 in 10)
of men after the operation. We will teach you some
exercises before the operation which you can do after
the operation to strengthen your pelvic floor muscles. These exercises, when correctly done, are known to help
with continence. For some men this small leak of urine
lasts for a short time after the operation, other men may need to continue their exercises in the long-term. See
pelvic floor exercise information at end of booklet. The long-term risk of significant leak of urine is less than
1% (1 in 100).
- Impotence (inability to get an erection for sexual
intercourse) -
Impotence can be a permanent consequence of surgery
in about 50% (5 in 10 ) to 100% (10 out of 10) of men.
The risk is variable due to certain factors. You should
discuss your individual risk with your urologist.
For some men who have become impotent as a result
of surgery there may be treatment to restore erections.
This is usually given in the form of tablets. You can
discuss this at your follow up appointment after the
operation.
What
happens when I am admitted for my operation?
Day of admission
You will be admitted to hospital the day before your proposed surgery
for a stay of approximately 5-7 days. On your admission day you will be
allocated to a ward where you will meet the nursing and medical staff
who will be looking after you. There will also be the opportunity to meet
the anaesthetist and physiotherapist who will take part in your care.
The following day
Before you go to theatre you will have nothing to eat
or drink for 4 to 6 hours before your operation (apart
from any tablet medication) as preparation for your
anaesthetic.
After
your operation
When you come out of theatre, we will nurse you in the
recovery room for a short while and then transfer you to
the ward.
- To reduce the soreness and pain in your abdomen
after the operation, we will give you painkillers. The
anaesthetist will discuss the options with you: either a
painkiller device that you control, that releases painkillers
into your blood system or an epidural by which pain
killers are given directly into the spinal nerve system.
After about two days you will be able to have either
of these two systems removed. You will then take
painkilling tablets instead.
- Your blood pressure, heart rate and fluid levels will be
measured for 24 to 48 hours. This will usually be done
in the Critical Care Unit.
- You will have a drip running into a vein in your arm to
give you fluids until you are allowed to drink normally.
This is usually the next day.
- As well as a dressing on your wound, you will also have
a drain (a small plastic tube) from your abdomen which
drains away fluid from inside your wound. This will
normally stay in place for a couple of days.
- You will have a catheter inserted into your penis to
drain urine from your bladder. This stays in place for
approximately 2 weeks while your urethra (urine tube
from the bladder) heals.
When
will I be allowed home?
Usually you will be ready for discharge home within 5 days of your
operation.
Your
catheter
The ward nurses will teach you how to look after your
catheter, which will remain in place for about two weeks
after your discharge home.
Your
arrangements for going home
On discharge home you should have a letter for your GP,
a letter for your district nurse and a week’s supply of any
medication that you have been prescribed.
Removal
of the catheter
You will be readmitted to hospital for a short stay of up
to 24 hours, 2 weeks after your operation. During this
admission we will remove your catheter, and assess your
ability to pass urine.
Sometimes it is difficult to control the flow of urine after
the catheter has been removed, and you may feel the need
to pass urine urgently. These symptoms will gradually settle
down. When you are passing urine satisfactorily you will be
discharged home. In the early stages after the operation
some men feel more confident wearing a continence pad,
such as TENA for Men, in their underclothes. These are
available from your local chemist. Incontinence problems
usually settle down within three months of the operation.
Follow
up after a prostatectomy
We will make an outpatient’s appointment for you three
months after your operation when you will have a blood
test to check your PSA level. We will see you every three
months for the first year after your operation, and then
every six months thereafter.
Getting
back to normal
Recuperation after abdominal surgery takes a variable
amount of time but generally about 6 to 18 weeks.
During the first 4 to 6 weeks you should not attempt to drive as
you may find that your car insurance is invalid for that period.
During this time you should not attempt to lift or move
heavy objects or start digging the garden.
Getting back to work will depend on the type of job you
do, please ask your surgeon for further advice.
The ward clerk can provide you with a sick note for the
time that you are in hospital, your GP will then supply you
with any further sick notes.
Contacting
the hospital
For health queries about your operation phone:
- Macmillan Urology Clinical Nurse Specialists: Jane Booker
and Cath Gwatkin - 0161 446 8018
- or contact Ward 10 - where the staff on duty will be able
to contact the doctors who were looking after you.
- For queries out of hours: ring the Christie switchboard
and ask to speak to the Nurse Practitioner - 0161 446 3000.
Improving
your continence with pelvic floor exercises
Pelvic floor exercises can help many men regain control
of their bladders. The exercises work by strengthening
the muscles that control peeing. This can mean re strengthening
weakened muscles or training surviving
muscles to deal with what was once dealt with by two
muscles. Pelvic floor exercises are also called Kegal
exercises, after their inventor.
Pelvic floor exercises can be
done by healthy men to help
prevent future incontinence,
or by men who have
undergone surgery on the
prostate.
Finding the correct muscles
Sit or lie down. Relax your
thighs, buttocks and stomach. Tense your muscles as if you
are trying to stop peeing or passing wind. You should feel
a lifting sensation inside and a tightening of the muscles
around your anus. You should not be tensing your thighs,
buttocks or stomach. You can also learn what tensing the
correct muscles feels like by stopping and starting your
stream whilst peeing. Don’t do this regularly though, only
to find the muscles.
The exercises
Once you have found the correct muscles, and know
what it feels like when you tense them, you should do the
following exercises.
- Tense the muscles so you feel a lifting sensation. Hold
this lift for as long as you can up to 10 seconds. Don’t
hold your breath whilst doing this. Relax. You should
have a definite feeling of letting go.
- Wait 10 to 20 seconds then repeat the ‘lift’. You should
aim to lift then relax 12 times.
- Do 5 to 10 short fast lifts.
You should try to spend 5 to 10 minutes each day on this
exercise routine.
As you get better at the exercises, you should try to
increase the time you hold the contractions. Try to see how many you can do before your muscles start to feel tired.
Also, increase the number of short, fast lifts you do.
Regular training of these muscles for 4 to 6 months will
improve the control you have over peeing.
If you suffer from stress incontinence, remember to contract
the muscles before you sneeze, cough or try to lift anything.
Dealing with the problem
The above exercises and treatments for incontinence may
take some time to take effect. Anyone who experiences
incontinence needs to know how to take action to deal
with the problems they experience in the meantime. Some
men may also find that their incontinence is not treatable.
They too need to know how to deal with leaks and spills.
© Exercises reproduced by kind permission of the Prostate
cancer charity
For the visually impaired: Large print
versions of the booklets are available, please
contact Patient Information on 0161 446 3576
Benefits and finance
You may be entitled to Disability Living Allowance (for
under 65s) or Attendance Allowance (65+)
Find out more today
- Freephone 0800 882200
- pick up a leaflet
- or ask to see a social worker
Macmillan Cancer Relief has an advice line: Help with the
cost of cancer on 0800 500800 or www.macmillan.org.uk
Student training
The Christie is a training hospital for postgraduate
and undergraduate trainees so you may meet male and
female students in all areas of the hospital. We train
doctors, nurses, radiographers and other therapists in the
treatment and care of cancer patients.
Placements at The Christie are an important part
of student training, so by allowing them to assist in your
care, you will be making a valuable contribution to student
education.
Students are always supervised by fully qualified staff.
However, you have the right to decide if students can take
part in your care. If you prefer them not to, please tell the
doctor, nurse, radiographer or other therapist in charge
as soon as possible. You have a right to do this and your
treatment will not be affected in any way.
We also try to respect the concerns of patients in relation to
the gender of their doctor and other health professionals.
CHR/SUR/222-03/14.03.04
July 2008 - Review July 2011