Retro-Pubic Radical Prostatectomy
This is an operation used to remove the prostate gland from the body in order to treat men with prostate cancer. It involves making an incision in the skin between the umbilicus (belly button) and the pubic bone. The surgeon enters the space behind the pubic bone (hence the name retro-pubic). The surgery is known as an extra-peritoneal operation because the surgeon operates outside of the peritoneal reflection which is a membrane that holds the abdominal contents. The prostate is cut away from the bladder. The bladder neck (end of the bladder) is dissected away from the prostate. The prostate is also cut away from its attachment to the urethra, just above the uro-gentital diaphragm (pelvic floor muscles or external sphincter). The bladder neck is then re-anastomosed (re-attached) to the urethra and the prostate is removed from the body along with the attached seminal vesicles. A small margin of normal surrounding tissue is removed as well. The main limitation of this operation from a cancer stand point is that, due to the prostate close proximity to the bladder , rectum and external sphincter, adequate normal tissue margins are often difficult to obtain. In other words, if inadequate amount of surrounding normal tissue is removed along with the prostate, it is possible that microscopic cancer cells can be left behind. Indications that cancer cells have been left behind can be found by examining the pathology report from the surgery. Pathologic findings of positive surgical margins, seminal vesicle invasion, extra-capsular tumor invasion are all signs that cancerous cells may have been left behind in the surgical bed. The major side effects of such an operation are urinary incontinence, of varying degrees, sexual dysfunction (penile erectile problems), bladder neck contractures and penile shortening. In addition, there is a small risk of death secondary to the procedure since it is still a major surgical operation.