#radicalprostatectomy

A 62-year-old male presented with poor urine flow and was diagnosed with clinically localized adenocarcinoma of the prostate. He underwent an open radical prostatectomy with bilateral pelvic lymph node dissection. Postoperatively, he had transient hypotension and lower limb weakness but recovered well and was discharged in a stable condition.

Chief Complaints

A 62-year-old male patient presented to the Urology Department of PACE Hospitals, Hyderabad, with complaints of progressive decline in urine flow over time, which became increasingly noticeable and concerning.

Medical History

The patient was a known case of hypertension, which was being effectively managed with appropriate antihypertensive medications. There were no other significant comorbidities reported, and the patient did not mention any history of cardiovascular, metabolic, or renal disorders that could contribute to the current urological symptoms.

Clinical Investigations

Clinical investigations revealed a Gleason score of 5+5 on a TRUS-guided biopsy, indicating a high-grade and aggressive prostate malignancy. The prostate-specific antigen (PSA) index was significantly elevated at 25 ng/ml. MRI findings showed a right-sided lesion extending to the apex of the prostate gland from its base, suggestive of locally advanced disease. Moreover, a swollen right external iliac lymph node was found.

Diagnosis

Based on the clinical evaluation, imaging studies, and histopathological findings, the patient was diagnosed with adenocarcinoma of the prostate. The disease was clinically localized and classified as cT2, indicating confinement to the prostate without evidence of extracapsular extension.

PSMA PET-CT findings were negative for distant metastases, which confirms that the malignancy remained localized without systemic spread. These findings guided the formulation of an appropriate treatment plan tailored to the patient's disease stage and overall health status.

Medical Decision Making (MDM)

Based on the diagnosis, Consultant Laparoscopic Urologist, Endourologist, Andrologist & Kidney Transplant Surgeon, Dr. Abhik Debnath decided to perform an open radical prostatectomy with bilateral pelvic lymph node dissection under general anesthesia.

Surgical Procedure

An open radical prostatectomy was performed using a lower midline incision with an extraperitoneal approach. Bilateral external iliac lymph nodes were enlarged, necessitating thorough dissection, along with bilateral pelvic lymph node dissection for optimal cancer clearance. 

Early control of the dorsal venous complex minimized intraoperative bleeding. A good membranous urethral length was preserved for continence, with wide clearance on the right and probable neurovascular bundle (NVB) preservation on the left. Vesicourethral anastomosis was secured with eight watertight sutures. 

A pelvic drain was placed, and the incision was closed in layers. The patient was then transferred to the recovery unit for close monitoring.

On average, the surgery lasts just one hour, and patients experience a quick recovery with a 5-night hospital stay. Post-surgery, continuous support from the surgical team ensures peace of mind at every stage.

After prostate cancer surgery (Radical Prostatectomy), the majority of patients are able to return to work within just 2 weeks. While a diaper may be necessary for added comfort during recovery, it’s a small step on the path to getting back to your daily routine. Recovery is quick, and resilience is key!

012 – Barriers to Sexual Health after a Radical Prostatectomy

Barriers to Sexual Health after a Radical Prostatectomy

In this podcast, I discuss a research article that looked at the potential sexual barriers couples have prior to surgery or other treatment and their response to the diagnosis of prostate cancer.