What is radical retropubic prostatectomy?

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Radical retropubic prostatectomy: Overview

A radical retropubic prostatectomy is surgery to remove the prostate gland. It is usually done to treat prostate cancer that hasn't spread out of the prostate. The doctor will make a 3- to 4-inch cut (incision) in your lower belly. The cut is between the navel and the pubic bone.

You will probably stay in the hospital for 1 to 3 days after surgery. Most people can go back to work or their usual activities 3 to 5 weeks after surgery. But it can take 6 to 8 weeks to fully recover.

After surgery, your body will need time to heal. It may take several weeks or more for you to regain control of your urine. And it may take 6 months or more for you to be able to have erections again. But with time, most people regain urine control and much of their previous sexual function. If not, medicines or other treatments may help.

After your surgery, you won't be able to ejaculate sperm. If you want to be able to have biological children after your surgery, talk to your doctor about your options. You may be able to save your sperm before the surgery.

How can you care for yourself after a radical retropubic prostatectomy?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. At first, avoid hills, and try to stay on flat ground. You can climb stairs, but try to limit how often you do this. When you do climb them, do it slowly, and pause every few steps.
  • Avoid strenuous activities for 6 to 8 weeks, or until your doctor says it is okay. This includes bicycle riding, jogging, weight lifting, or aerobic exercise.
  • For 6 to 8 weeks or until your doctor says it is okay, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
  • You may shower if your doctor says it is okay. Empty the catheter bag before you start. When you shower, keep the catheter taped to your leg. Do not take a bath until your doctor or nurse has removed the catheter.
  • Ask your doctor when you can drive again.
  • Avoid riding in a car for more than 1 hour at a time for the first 3 weeks after surgery. If you must ride in a car for a longer distance, stop often to walk and stretch your legs.
  • You will probably need to take 3 to 5 weeks off from work. It depends on the type of work you do and how you feel.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
  • If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • Your doctor may prescribe antibiotics when your urinary catheter is removed. Take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
  • If you had stitches, your doctor will tell you when to come back to have them removed.
  • Wash the area daily with warm water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
  • Keep the area clean and dry.

Ice and elevation

  • To help with pain and swelling, put ice or a cold pack on your groin for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.

Other instructions

  • You will have a urinary catheter for 1 to 2 weeks. Your doctor or nurse will tell you how to care for it.
  • Be sure the catheter is securely taped to your thigh and attached to the large drainage bag when you are at home. Use the smaller leg bag only when you go out.
  • A little urine leakage around the catheter is normal. You can place an incontinence pad in your underwear to absorb urine leaks.
  • Do not have an enema or use a rectal thermometer for 3 months, or until your doctor says it is okay.

How do you prepare for a radical retropubic prostatectomy?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

After radical retropubic prostatectomy: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have chest pain, are short of breath, or cough up blood.

Call your doctor now or seek immediate medical care if:

  • You have pain that does not get better after you take pain medicine.
  • You have loose stitches, or your incision comes open.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the area.
    • Pus draining from the area.
    • A fever.
  • You are unable to urinate.
  • You are bleeding from your incision.
  • You are sick to your stomach or cannot drink fluids.
  • You have symptoms of a urinary tract infection. This may include:
    • Pain or burning when you urinate.
    • A frequent need to urinate without being able to pass much urine.
    • Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
    • Blood in your urine.
    • A fever.
  • You have signs of a blood clot in your leg (called a deep vein thrombosis), such as:
    • Pain in your calf, back of the knee, thigh, or groin.
    • Redness or swelling in your leg.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

After a radical retropubic prostatectomy: Overview

A radical retropubic prostatectomy is surgery to remove the prostate gland. It is usually done to treat prostate cancer that hasn't spread beyond the prostate. The doctor did the surgery through a 3- to 4-inch cut, called an incision, in your lower belly between the navel and the pubic bone.

You may see some bruising and swelling right after your surgery. In the week after surgery, your penis and scrotum may swell. This usually gets better after 1 to 2 weeks. The incision may be sore for 1 to 2 weeks. Your doctor will give you medicine for pain.

You will have a tube (urinary catheter) to drain urine from your bladder for the first 1 to 2 weeks after surgery. You may have bladder cramps, or spasms, while the catheter is in your bladder. Your doctor can give you medicine to help prevent bladder spasms.

After your catheter is removed, it may take several weeks or more for you to control your urine. And it may take 6 months or more for you to be able to have erections again. But with time, most people regain urine control and much of their previous sexual function. If not, medicines or other treatments may help.

You will probably be able to go back to work or your usual activities 3 to 5 weeks after surgery. But it can take longer to fully recover.

You will need to see your doctor regularly. This includes having blood tests to measure your PSA level. PSA is a substance that can suggest whether your cancer has returned. PSA tests are usually done more often for the first several years after your surgery, but less often after that.

What happens on the day of a radical retropubic prostatectomy?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

  • Bring a picture ID.
  • The area for surgery is often marked to make sure there are no errors.
  • You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
  • The surgery will take 2 to 4 hours.
  • You will have a tube that drains urine from your bladder. This is called a urinary catheter. It is usually left in place for 1 to 2 weeks.
  • You will have a tube coming out of your lower belly. This drains fluids that can build up after surgery. It is usually removed in the days after surgery.

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