Open radical prostatectomy

A Radical Prostatectomy is one of the treatment options for localised Prostate Cancer. This surgery involves removing the entire prostate gland and seminal vesicles. In some instances, a lymph node dissection is also required and can be done at the same time.

A Radical Prostatectomy can be done either through an open approach (an incision made through the abdomen) or laparoscopically (small incisions are made in the abdomen to allow passage of instruments and telescopes). At North Eastern Urology our surgeons perform both open and laparoscopic radical prostatectomies.

Generally, I week prior to surgery you will meet with the nurse. The nurse will discuss with you the objectives of surgery, your pre surgery and post-surgery care. Your hospital paperwork and tests required will also be given to you.

If time permits at your initial appointment with the surgeon, you will be given information on pelvic floor exercises and advised to see a Continence Physiotherapist at your earliest convenience. You are required to start your pelvic floor exercises immediately and continue until the day before surgery.

Before surgery

  • Ensure your hospital paperwork is completed and sent to the hospital at least 7 days before surgery.
  • Ensure you have all your tests completed 4-7 days before surgery. These include bloods, ECG and urine test.
  • Ensure your bowels are regular and that you have your bowels opened on the morning of surgery.
  • Arrange to see a Continence Physiotherapist – details will be provided by the Practice Nurse.
  • Fasting time: If your surgery is scheduled in the morning, you are required to fast (nothing to eat or drink) from midnight. If your surgery is scheduled in the afternoon, you are required to fast (nothing to eat or drink) from 8am. These are approximate times. Sometimes the hospital staff may vary fasting time if surgery is delayed.
  • You will be admitted on day of surgery. Time will be determined by hospital staff. You will receive a call the day before your surgery is scheduled and a time will be given to you.
  • Once admitted, you will be issued with anti-embolic stockings (compression stockings). You are required to wear these throughout your admission and at home up until the day you return to have your catheter removed.
  • If you are a Diabetic, please speak to the Practice Nurse at your earliest convenience.
  • If you are on any blood thinning medications, then please alert the nurse at your earliest convenience.
  • Please inform staff if you have any allergies.

Following discharge

  • It is normal to feel tired following surgery. It is important you get plenty of rest, eat a well-balanced diet and do gentle exercises such a walking. Avoid stairs if possible for the first few weeks.
  • You are advised to avoid heavy lifting for 4 weeks (2 kilos is too heavy) and any strenuous exercise or activities for 4 weeks. Strenuous exercise includes bike riding, running, horse ring and golf.
  • Ensure your bowels are regular. A high fibre diet with adequate fluids is essential. Avoid constipation as this may cause discomfort whilst the catheter is in. Sometimes mild laxatives are required. Speak to the Practice Nurse for further advice.
  • Take regular pain relief as required. Avoid codeine as this may cause constipation.
  • Your wound dressing will be removed before discharge. Your sutures are dissolvable and therefore will dissolve within 1-2 weeks. Please call the rooms if you notice redness, swelling and or discharge from the wound.
  • It is important you drink adequate fluids and to ensure your urine is pale yellow during the day.
  • You will have a catheter in place for 14 days. You will be provided with verbal and written instructions on how to care for your catheter, how to empty your leg bag, how to attach the overnight bag each night and disconnect each morning and how to ensure correct anchoring to avoid unnecessary discomfort and pain. It is important to contact the rooms during office hours or your surgeon’s after hours pager number if your catheter has fallen out or if your catheter is blocked. If difficulties contacting the surgeon after hours, please call the ward you were discharged from. Do not present to any emergency department or allow a non-urology doctor to manipulate or change your catheter.
  • You will return to the hospital to have your catheter removed (Trial of void) approximately 14 days following surgery. The date for this will be given to you by the nursing staff on the day you are discharged.
  • You will return to the rooms approximately 4 weeks following removal of your catheter for your first appointment. Please call the rooms if this appointment has not been made for you.
  • Incontinence: At your education/counselling meeting before surgery you were advised to purchase incontinence pads. Following removal of catheter there may be some incontinence. Please use the pads as required and contact the Practice Nurse if you feel the pads recommended are not effective.
  • Pelvic floor exercises should not recommence until after the catheter is removed. Performing your pelvic floor exercises with a catheter in place will only create more pain and discomfort for you. Once the catheter is removed, please commence your pelvic floor exercises as recommended by the Continence Physiotherapist.
  • Erectile dysfunction: Most men experience erectile dysfunction following surgery. Return of function is dependent on the degree of nerve sparing surgery, age, other medical conditions and medications. It is important you discuss your concerns at your first appointment following surgery. As discussed before surgery, there are treatment options available to you and can be discussed in detail with the Practice Nurse.
  • Return to work is dependent on the type of work you do. Generally being off work for 4-6 weeks is recommended. If you wish to return earlier you will need to discuss this with your surgeon.
  • No driving is allowed for 6 weeks.
  • It is important you contact the Practice Nurse if your urine flow slows down, it is taking you longer to empty your bladder and you’re going to the toilet more frequently.

You must contact the rooms if you experience any of the following:

  • Redness, swelling and presence of purulent discharge from the wound
  • Fever, chills, sweats
  • Swelling and redness in your legs
  • Shortness of breath/back pain
  • Cloudy, offensive urine