Prostatectomy
Radical prostatectomy is the surgical removal of the entire prostate gland along with the seminal vesicles, for the treatment of localised prostate cancer. It can be performed as open surgery, laparoscopically, or with robotic assistance. The goal is complete cancer removal while preserving the urinary sphincter (continence) and, when possible, the nerve bundles responsible for erectile function (nerve-sparing prostatectomy). Iswarya Hospital's urology team performs laparoscopic radical prostatectomy with nerve-sparing technique where oncologically safe.
🔬 How the Procedure Is Performed
- 1
General anaesthesia is administered; the patient is positioned on their back.
- 2
Laparoscopic approach: 5–6 small incisions; robotic or standard laparoscopic instruments are used.
- 3
The prostate is carefully dissected free from the bladder, urethra, and rectum.
- 4
Nerve-sparing technique: the neurovascular bundles on one or both sides are preserved.
- 5
The prostate is removed; the urethra is reconnected to the bladder (vesico-urethral anastomosis).
- 6
A urinary catheter is left in place for 10–14 days to allow healing.
✅ Benefits of Prostatectomy
- ✓Curative intent for localised prostate cancer
- ✓Complete pathological staging of the removed specimen
- ✓Nerve-sparing technique preserves erectile function in appropriately selected patients
- ✓PSA becomes undetectable after successful surgery (monitoring marker)
- ✓Removes the need for radiotherapy in most cases
📋 How to Prepare
- PSA, Gleason grade, number of positive biopsy cores to confirm candidacy.
- MRI prostate to assess local staging and nerve involvement.
- Pre-operative pelvic floor physiotherapy — learn Kegel exercises before surgery.
- Stop blood thinners as directed.
- Bowel preparation on the day before surgery.
⚠️ Possible Risks & Side Effects
- Urinary incontinence — common initially; improves over 6–12 months with pelvic floor exercises
- Erectile dysfunction — risk depends on nerve sparing; often improves over 1–2 years
- Anastomotic leak — the reconnection between urethra and bladder
- Lymphoedema of the legs if lymph nodes are removed
- Rectal injury — rare
Your surgeon will discuss all risks with you before the procedure and take appropriate precautions to minimise them.
💊 Post-Procedure Care
- Catheter in place for 10–14 days — guided removal after a cystogram confirms healing.
- Pelvic floor exercises (Kegels) begin the day the catheter is removed.
- Return to light activity in 2–3 weeks; full activity in 6–8 weeks.
- PSA checked at 6 weeks, 3 months, and then every 6 months.
- Erectile rehabilitation: early use of PDE5 inhibitors aids nerve recovery.
❓ Frequently Asked Questions
Will I be incontinent after prostatectomy?
Most men have some degree of urinary leakage initially, but 85–90% regain complete continence within 6–12 months with pelvic floor exercises. Severe permanent incontinence is rare.
Can prostate cancer come back after prostatectomy?
In some cases, PSA levels rise after surgery (biochemical recurrence) indicating residual cancer. Salvage radiotherapy to the prostate bed is very effective in this situation.
🏥 Prostatectomy at Iswarya Hospital
Advanced diagnostic and surgical care for adult and pediatric urological conditions, led by Dr. Prabhu.
ℹ️ This information is for educational purposes only and does not constitute medical advice. Individual treatment plans may vary. Always consult a qualified healthcare professional before making any medical decisions.