What Is Open Retropubic Prostatectomy?

Medically Reviewed on 5/11/2022
What is open retropubic prostatectomy?
During open retropubic prostatectomy, the prostate and surrounding tissues are removed.

Retropubic prostatectomy is a surgical treatment for patients with localized to advanced prostate cancer who have a chance of living for at least 10 years following the surgery.

To destroy cancer cells, the prostate and surrounding tissues are removed during the treatment. The technique is often carried out under general anesthesia and is classified as major surgery.

Open retropubic prostatectomy procedure

  • The retropubic technique involves making an incision on the top of the prostate and removing the enlarged central section of the prostate without accessing the bladder.
  • This treatment frequently only necessitates the use of a single catheter and may not necessitate the use of a continuous irrigation system.
  • The procedure is typically carried out through a 6 to 8 cm incision in the lower abdomen. Thus, it is possible to remove the lymph glands on both sides of the pelvis.
  • The prostate gland is then removed and submitted to pathology for examination.
  • The bladder is then reconnected to the urethra, and a catheter is inserted through the penis into the bladder to drain the urine. This will often remain in your bladder for 12 to 14 days. After this, your doctor will reassess the wound site and decide if they can remove the catheter.
  • Sometimes an extra tube (drain) will be introduced from the right side and will be withdrawn before you leave the hospital.
  • The treatment normally takes about three hours, but you might be in the operating room for up to four to five hours.

8 risks of the open retropubic prostatectomy procedure

  1. Infection at the surgical site or a urinary infection
  2. Lung collapse
  3. Chest infection
  4. Obese persons are at a higher risk of wound infection, chest infection, heart and lung problems, and thrombosis
  5. Heart attack
  6. Deep vein thrombosis
  7. Bleeding
  8. Death

Outcome of the open retropubic prostatectomy procedure

Most patients are satisfied with the results of surgery.

The following are common benefits that are noticed immediately following surgery:

  • Better urine output stream force
  • Relieved from symptoms of urine incontinence
  • Complete bladder emptying

Though open retropubic radical prostatectomy remains the “gold standard” treatment for clinically localized prostate cancer, advanced surgical techniques, such as laparoscopic and robotic radical prostatectomy, are now available.

Cancer management, urine control preservation, and sexual function preservation are the three main goals of the open retropubic prostatectomy procedure. In patients with clinically localized prostate cancer, preserving puboprostatic ligaments during an open-ended posterior prostatectomy is linked to quicker and more frequent urine continent regeneration.

Retropubic prostatectomy is thought to be a successful operation with a good patient outcome. This open surgical procedure is preferred because it has a better chance of protecting the nerves around the prostate while removing the necessary tissue to ensure that all cancer is removed.


Screening Tests Every Man Should Have See Slideshow

What is prostate cancer?

Prostate cancer is a kind of cancer that develops in the prostate (a small walnut-shaped gland). It is the most frequent cancer among males. Prostate cancer arises when the DNA in a prostate gland cell is damaged or altered. This dangerous cell proceeds to grow and develop into a tumor, and if left untreated, prostate cancer may eventually metastasize to other organs.

9 common signs and symptoms of prostate cancer

  1. Urine flow is weak or intermittent
  2. Urinating often (especially at night)
  3. Having trouble urinating or holding back urine
  4. Urinary incontinence
  5. When urinating, you may experience pain or a burning sensation
  6. Urine or sperm may contain blood
  7. Back, hip, or pelvic discomfort that persists
  8. Unable to get an erection
  9. Unusually weight loss

Risk factors of prostate cancer

All men are at risk of getting prostate cancer, but some men are more vulnerable than others.

Besides being a male, other risk factors for prostate cancer may include:

  • Age: Prostate cancer risk increases with age. Cancer is practically never observed in people younger than 40 to 50 years, and over 60 percent of prostate cancers are detected in males older than 65 years.
  • Ethnicity: African American men.
  • Family history: Men who have a family history of prostate, breast, ovarian, colon, or pancreatic cancer may be at a higher risk.
  • Genetic mutations: In some families, inherited mutations in the BRCA1 or BRCA2 genes increase the risk of breast, ovarian, and prostate cancer.
  • Diet and lifestyle:
    • According to research, there might be a relationship between nutrition and the causation or prevention of prostate cancer.
    • Prostate cancer has been linked to lifestyle variables, such as smoking and alcohol intake.
    • Obesity has been connected to the onset of the disease.
    • Workplace exposure to some hazardous compounds may increase the risk of prostate cancer.
  • Chemical exposure:
    • Exposure to certain chemicals, such as pesticides and herbicides, may result in higher than usual prostate cancer rates.
    • Veterans who were exposed to the defoliant Agent Orange are 49 percent more likely to be diagnosed with prostate cancer than nonexposed veterans.
  • Firefighters: According to recent research, firefighters have a 28 percent higher chance of developing prostate cancer than the overall population.
  • High testosterone levels: A rise in testosterone levels encourages prostate gland development, rendering certain men more susceptible to prostate cancer.
  • Others:
    • According to research, males who had vitamin D deficiency or excess vitamin D had an elevated risk of prostate cancer.
    • According to certain research, prostate gland damage, swelling, and infection may start and raise the risk of prostate cancer.
    • Several studies have found that males who have had a vasectomy (sterilization) have a modest of prostate cancer.

Having one or more risk factors does not guarantee that you will develop prostate cancer. However, having frequent prostate cancer tests is a good idea, especially if risk factors are present. Prostate screening is currently advised for males of moderate risk between the ages of 40 and 45 years.

What are the different stages of prostate cancer?

According to the American Joint Committee on Cancer (AJCC), prostate cancer is commonly split into four stages. However, some clinicians may divide the fourth stage into IVA, IVB, or V.

  1. Stage I
    • Localized cancer
    • Cancer may be detected in only one part of the prostate
    • Cannot be felt during a digital rectal exam or seen with imaging tests
    • If the prostate-specific antigen (PSA) is less than 10 ng/mL, it is most likely slow-growing
  2. Stage II
    • Localized but more advanced than stage I
    • Cells are less normal than in stage I and may grow more rapidly
    • Stage IIA means that the cancer is found only on one side of the prostate, whereas Stage IIB means that the cancer is found on both sides of the prostate
  3. Stage III
    • Locally advanced prostate cancer
    • Cancer has spread outside the prostate into local tissue, such as the seminal vesicles
  4. Stage IV
    • A tumor may have spread to nearby lymph nodes, but it has not spread to other parts of the body.
  5. Stage V or IVB cancer
    • A tumor may have spread to other parts of the body, such as distant lymph nodes, bones, or other organs.

Treatment for prostate cancer

  • Treatment for stage I
    • Watchful waiting (tracking symptoms)
    • Active surveillance (monitoring PSA levels)
    • Radiation therapy (external beam or brachytherapy)
    • Prostatectomy (removal of the prostate)
  • Treatment for stage II
  • Treatment for stage III
    • Radiation or hormone therapy or both
    • Radical prostatectomy
  • Treatment for IV and V prostate cancer
    • Hormone or chemotherapy or both
    • Radiation therapy and hormone therapy
    • Prostatectomy
    • Transurethral resection of the prostate (TURP)
    • Treatments aimed at the site of metastasis, such as the bone
    •  Active surveillance
    • Treatments to improve symptoms, such as pain or urinary difficulties (palliative care)

When choosing therapy, your symptoms, age, life expectancy, and personal preferences could be considered. The prognosis is better when detected early, and the proper safeguards are implemented.

Following a nutritious diet and leading a stress-free lifestyle with routine screening may aid in preventing any cancer. Many men live with prostate cancer for their whole lives with no signs of the spread of the malignancy.

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Medically Reviewed on 5/11/2022
Image Source: iStock Image

Pereira R, Joshi A, Roberts M, Yaxley J, Vela I. Open retropubic radical prostatectomy. Transl Androl Urol. 2020;9(6):3025-3035. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807367/

American Cancer Society. Surgery for Prostate Cancer. https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html

American Cancer Society. Prostate Cancer Stages and Other Ways to Assess Risk. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html

Cancer Council Victoria. Prostate cancer. https://www.cancervic.org.au/cancer-information/types-of-cancer/prostate_cancer/diagnosing_prostate_cancer.html