Urology Casablanca

Total prostatectomy for prostate cancer

The operation proposed to you is intended to remove the prostate which is affected by a malignant tumour. Anatomical reminder The prostate is a gland that participates in the formation of sperm. It is located under the bladder and is crossed by the canal of the urethra. It is close to the sphincter system which ensures urinary continence and erection nerves. The seminal vesicles are the reservoir of sperm and open directly into the prostate. Legend: pr: prostate; r: rectum; u: ureter; ur: urethra; ve: bladder; vs: seminal vesicles.

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Why this action? Prostate biopsies revealed a malignant tumor. The purpose of this intervention is to remove the tumor and the prostate gland as a whole with the seminal vesicles. The absence of treatment exposes to the risks of tumor development, locally and remotely in the form of metastases. Are there other possibilities? There are other treatments for prostate cancer, the advantages and disadvantages of which have been explained to you by your urologist. The choice of surgery took into account your age, your general condition and the characteristics of your tumour. Surgical technique The operation takes place under general anesthesia. Several types of incision are possible. The choice depends on the habits of your urologist. The prostate is completely removed, as well as the seminal vesicles. The continuity between the bladder and the urethra is restored by sutures using threads. At the end of the operation, a urinary catheter is placed in the bladder through the urethral canal to promote healing. The surgical site is drained for a few days. In some cases, a sample of lymph nodes from the small pelvis is taken at the start of the operation, to look for microscopic spread of the cancer which could lead to a stoppage of the operation.

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Usual suites The pain associated with the intervention is due to painkillers which will be administered to you regularly. Anticoagulant treatment by daily subcutaneous injection is performed to prevent the risk of phlebitis and pulmonary embolism. Getting up is usually authorized from the first days as well as the resumption of food. The moment of removal of the drain(s) is variable and will be defined by the surgeon. The urinary catheter is usually well tolerated, but it can sometimes cause discomfort. The duration of maintenance of the urinary catheter and the duration of hospitalization will be specified by your surgeon. After removal of the bladder catheter, urinary incontinence, sometimes significant, is usual. This incontinence is most often temporary and regresses within a few weeks to a few months in about 9 out of 10 men. Simple muscle rehabilitation of the perineum and sphincter is recommended. Rehabilitation sessions by a physiotherapist are sometimes useful. The length of recovery and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the date you return to work or normal physical activity depend on the approach and your age. One to two months are sometimes necessary to find your form before the operation. You will discuss with your surgeon the date of resuming your activities and the follow-up after the operation. The prostate is analyzed under a microscope by the pathologist, who specifies whether the tumor is limited to the prostate or whether it has spread beyond it. In this case, there is a risk of recurrence and additional treatment after the intervention with radiation or medication may then be necessary. The follow-up after the intervention meets two objectives: to monitor the absence of tumor recurrence mainly by measuring the PSA and to evaluate the way you urinate as well as the sexual function.

Late complications Urinary incontinence Permanent and definitive urinary incontinence is exceptional (about 3% of cases). Incontinence is most often limited to leakage of a few drops of urine during major efforts (10 to 15% of cases). As continence improves over time, it is advisable to wait at least 3 to 6 months before considering, in the event of permanent urinary incontinence, an additional intervention. Sexual disorders The risk of loss of erection is high and increases with age and tumor size. Its frequency is estimated between 30 and 100% of cases. Despite all the surgical technical progress made, it is impossible to guarantee the maintenance of a complete or partial erection after the intervention. It may take up to a year for sexual function to return. In the event that erectile difficulty persists, various treatments to restore the erection may be offered. On the other hand this intervention permanently suppresses ejaculation but does not remove the feeling of pleasure at the time of sexual intercourse. Urethral stricture The suture between the bladder and the urethra can heal, leading to a fibrotic reaction and stricture (less than 5% of cases). It then requires an intervention of widening by the natural ways. Eventration of the abdominal wall The eventration of the abdominal wall sometimes requires surgical repair. Your urologist is at your disposal for any information.

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