Perineal prostatectomy is a surgical procedure that is carried out as a treatment for prostate cancer. During this surgery, which is carried out under general anesthetic, the prostate is removed entirely. Perineal prostatectomy is the preferred method of surgical removal for many surgeons because it does not require cutting through major muscles, causes less pain, reduces recovery time and has fewer risks involved for the patient.
Prior to undergoing a perineal prostatectomy, a patient should ensure that his doctor is aware of any medications he is taking. This is important because medications such as aspirin, non-steroidal anti-inflammatories and blood thinners can increase the risk of dangerous bleeding during or after surgery. The doctor also should be told of any previous instances of unusual bleeding, because these can be an indicator of an increased risk of uncontrolled bleeding during or after the surgery.
During the perineal prostatectomy procedure, the patient lies on his back. His feet are placed in stirrups that hold the legs apart above the body such that the surgeon can easily access the perineal area. The incision is a horizontal cut made across the perineum, between the scrotum and the anus. Next, the surgeon locates the prostate gland and begins the painstaking work of separating the gland from the bladder, urethra, vas deferens and rectum. After this has been completed, the prostate gland is removed, and the vas deferens is tied off.
The last stage of the procedure involves reconnecting the urethra and bladder. A catheter is inserted into the urethra via the penis and remains in place for two to three weeks, until the reconnected urethra and bladder have healed. This is necessary to keep scar tissue from blocking the urethra. Finally, drains are inserted into the perineal area, and the surgical incision is stitched.
In most cases, a patient will spend two to three days in the hospital after undergoing a perineal prostatectomy. During this time, he is encouraged to perform regular, gentle exercise, such as walking, to reduce the risk of blood clots. Patients also are given laxatives or stool softeners, which must be taken for several days after the procedure. This is necessary because the rectum is at risk of injury after the procedure, and the medication helps reduce the risk that straining during a bowel movement will injure the rectum.
For the first year following the procedure, the patient will undergo a prostate-specific antigen blood test every three months. This is to monitor signs that the cancer might have returned. After the first year, if all of the tests have been negative, the blood tests are then carried out on an annual basis.
