Laparoscopic radical prostatectomy at Bristol Hospital

What is prostate cancer?

Prostate cancer is a malignant (cancerous) growth that starts in your prostate gland. Your prostate gland surrounds your urethra (tube that carries urine and semen to the tip of your penis) and lies under your bladder.

Most prostate cancers are small, slow-growing and don't spread outside your prostate gland (early or localised prostate cancer). Localised prostate cancer doesn't usually cause any symptoms. However, as the cancer grows, it can tighten around your urethra and interrupt the flow of urine from your bladder.

The cancer can spread just outside your prostate gland (locally-advanced cancer) or further, usually into your bones or lymph glands (metastatic disease).

What are the symptoms of prostate cancer?

Most patients with this condition present to their GP with either with no symptoms or lower urinary tract symptoms. These may include:

• passing urine frequently
• poor or weak flow of urine
• needing to rush to the toilet (urgency)
• incomplete bladder emptying.

Less common symptoms include:

• passing blood in the urine/semen
• urinary infection
• erectile dysfunction.

What is laparoscopic radical prostatectomy?

Using a laparoscope (tiny telescope), the surgeon is able to view magnified images of the prostate and surrounding organs.

This allows for very precise removal of the affected tissue and helps to preserve erectile function and urinary continence.

What are the benefits of laparoscopic radical prostatectomy?

Laparoscopic radical prostatectomy gives the best chance of you being free of prostate cancer and is the most effective treatment in younger men.

The procedure is almost painless, resulting in minimal blood loss with an excellent cancer cure rate and swift recovery. 

Is laparoscopic radical prostatectomy right for me?

Surgery is usually only recommended if there are signs the cancer is likely to spread. Your GP will be able to tell you if you need this procedure.

What happens during laparoscopic radical prostatectomy?

This surgery usually takes 2–3 hours. It's carried out using general anaesthetic so you'll be asleep.

Laparoscopic (keyhole) surgery is associated with less pain and scarring than open surgery, as well as a faster return to normal activities.

Before the procedure

• Let your doctor know about any medication you take and follow their instructions
• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Do the exercises your physiotherapist or continence advisor gives you to strengthen your sphincter muscles, as this will help you to control the flow of urine from your bladder
• Exercise regularly
• In the week before the operation, don't shave or wax the area where a cut is likely to be made
• Try to have a bath or shower either the day before or on the day of the operation
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

During the procedure

1. Your surgeon will make a cut on or near your belly button and insert an instrument to inflate your abdominal cavity with carbon dioxide
2. They'll then make two small cuts on your abdomen, so they can insert surgical instruments as well as laparoscope via thin tubes
3. Your surgeon will remove your prostate gland and a section of urethra that runs through it before connecting your urethra to your bladder
4. They may also remove the lymph nodes in your pelvis for examination, to help decide on any further treatment
5. Finally, they'll remove the instruments and close the cuts with stitches.

After the procedure

After the operation, you'll be transferred to the recovery area where you'll wake up. A nurse will be there to check your wounds, blood pressure and pulse.

You'll have a catheter in your bladder to allow you to pass urine easily. For 1–2 days, this will also be used to wash out your bladder with fluid to prevent blood clots.

You may also have a drain in your abdomen to drain any extra fluids. 

When you're ready, a nurse will take you to your room.

Recovery from laparoscopic radical prostatectomy

You should be able to go back to normal activities after 3–5 weeks.

You'll have some small scars that will heal after 4–6 weeks.

Short-term recovery

You'll need to stay in hospital for 2–3 days. You'll usually stay in bed until the morning following your surgery. Then you'll be encouraged to get up and move around, as well as wear compression stockings, to prevent blood clots.

You may feel some discomfort, which you'll be given pain relief for. 

You won't be able to drive, so please arrange for someone to take you home. You'll be discharged with the catheter and collection bag. The healthcare team will show you how to care for your catheter.

Managing your recovery at home

Make sure you continue to follow the healthcare team's instructions to reduce the risk of blood clots.

For up to 4 weeks it's normal to notice blood and small clots in your urine. Don't worry as a little blood can look like a lot, especially when mixed with urine. It's also normal to feel tired for at least 4 weeks.

Here are a few things you can do to make sure you recover well:

• Drink plenty of water to help you pass urine more easily and reduce the risk of blood clots
• If the catheter becomes blocked or falls out, contact the healthcare team straightaway
  
• Don't do strenuous activity for the first 4 weeks
• Gradually increase your activity after 2 weeks
• Avoid heavy lifting for 6 weeks.

When to call us 

If you notice any of the following symptoms, let the healthcare team know straightaway as it can be a sign you have a serious complication.

• Pain that gets worse over time or is severe when you move, breathe or cough
• A high temperature or fever
• Dizziness, feeling faint or shortness of breath
• Feeling sick or not having an appetite, which gets worse after the first 1–2 days
• Not opening your bowels and not passing wind
• Swelling in your abdomen.

Time off work

Most patients return to work within 6–8 weeks, depending on your type of work and how you feel.

Follow up appointments

Once your urine is clear, you'll need to come back to hospital to have the catheter removed. This is usually after 1–2 weeks.

Your surgeon will also tell you the results of the biopsy and let you know whether you need any further treatment. You may need radiotherapy, and you'll need regular tests to check the levels of prostate-specific antigen (PSA) in your blood.

Complications of laparoscopic radical prostatectomy

As with any surgery there is a small risk of complications, such as:

• infection
• bleeding
• pain
• blood clots.
  

Specific complications of laparoscopic radical prostatectomy include:

• difficulty passing urine
• urinary incontinence
• erectile function
• damage to other organs.

The healthcare team will do their best to minimise any risks. Make sure you discuss any concerns you have about these complications with your consultant.

Alternative treatment options

• Radiotherapy: this can be internal or external. External radiotherapy treatment is given over several small doses and is used if the cancer has spread locally. Internal radiotherapy, or brachytherapy, can be used if the cancer hasn’t spread. It involves surgically inserting radioactive pellets into the prostate.
• High-intensity focused ultrasound (HIFU): This involves surgery to remove the centre of your prostate gland and then an ultrasound probe is placed into your rectum to kill off cancer cells using heat energy.