From the Guidelines
Radical prostatectomy is an appropriate therapy for patients with clinically localized prostate cancer, a life expectancy of 10 years, and no serious comorbid conditions, as it can provide better outcomes in high-volume centers with experienced surgeons 1.
Key Considerations
- The procedure involves the removal of the entire prostate gland, and potential adverse effects include urinary incontinence, erectile dysfunction, and anastomotic strictures.
- High-volume surgeons in high-volume centers generally provide better outcomes, and laparoscopic and robot-assisted radical prostatectomy are used commonly, with results comparable to those of open surgical approaches 1.
- Blood loss can be substantial, but can be reduced by careful control of the dorsal vein complex and periprostatic vessels, and urinary incontinence can be reduced by preservation of urethral length and avoiding damage to the distal sphincter mechanism 1.
Post-Operative Care
- Patients should expect to use a catheter for 1-2 weeks after surgery and should avoid heavy lifting (over 10 pounds) for at least 4 weeks.
- Pain management usually involves oral medications like acetaminophen or NSAIDs for 1-2 weeks post-surgery.
- Follow-up appointments are crucial to monitor recovery and address any complications, such as anastomotic strictures, which can increase the risk of long-term incontinence 1.
Outcomes
- Recovery of erectile function is directly related to age at radical prostatectomy, preoperative erectile function, and the degree of preservation of the cavernous nerves 1.
- Early restoration of erections may improve late recovery, and salvage radical prostatectomy is an option for highly selected patients with local recurrence after external beam radiation therapy (EBRT), brachytherapy, or cryotherapy, but the morbidity is high 1.
From the Research
Prostectomy Overview
- Prostectomy, particularly penile prosthesis surgery, has been a subject of interest in terms of infection prevention and management 2, 3.
- The introduction of antibiotic-coated penile implants has significantly reduced infection rates, with some series reporting rates lower than 0.5% 2.
- However, the change in microbiology and the persistent occurrence of penile implant infections require the development of novel strategies to target these organisms 2.
Infection Prevention and Management
- Preoperative, intraoperative, and postoperative strategies are crucial in preventing infections in penile prosthesis surgery 2, 3.
- The use of antibiotic-impregnated or antibiotic-coated penile implants has been shown to reduce infection rates 4.
- Postoperative antibiotics may not be necessary in average-risk patients undergoing inflatable penile prosthesis (IPP) insertion, as they do not demonstrate a benefit and may lead to antibiotic-associated adverse events and drug resistance 4.
- A comprehensive review of preoperative and perioperative factors can help identify patient risk factors for infection and optimize the use of oral and intravenous antibiotics 3.
Robotic Prostatectomy
- Robotic prostatectomy is a commonly performed procedure, and characterization of robot malfunctions and associated patient injuries is necessary 5.
- A review of the Manufacturer and User Facility Device Experience (MAUDE) database found that instrument failures comprise the majority of malfunctions, and malfunctions rarely lead to patient injury 5.
- However, this information is not directly relevant to prostectomy, specifically penile prosthesis surgery 5.