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What Happens During a Radical Prostatectomy

On the day of your radical prostatectomy, you will be given a drug called an anesthesia. This makes you fall asleep and keeps you from feeling pain during the operation. You'll get this from an anesthesiologist or a nurse anesthetist. Before surgery, you'll meet the anesthesiologist. Then you can ask questions about the anesthesia and how it will affect you. What happens from that point depends on the kind of surgery you are having.

What Happens During a Radical Retropubic Prostatectomy

For this surgery, the doctor makes the cut in your lower abdomen. If you're having lymph nodes removed for a biopsy, your doctor can use the same cut.

The location of this cut may allow your doctor to do a nerve-sparing prostatectomy. That means there is less damage to the nerves and muscles that are involved in erections. There are a couple of ways to do this. One way is to remove the bundle of nerves on only one side of your prostate and leave the ones on the other side alone. You may hear this called a unilateral nerve-sparing operation. Another way is to leave the nerve bundles on both sides alone. This is called a bilateral nerve-sparing operation. Neither of these types of surgery guarantees that you'll be able to get an erection after surgery. Whether or not your surgeon can try to spare the nerves mostly depends on what he or she finds in the operating room. You can discuss the pros and cons of this surgery with your doctor.

What Happens During a Radical Perineal Prostatectomy

For this surgery, the doctor makes the cut in the skin between your scrotum and anus. Your doctor may suggest this method if you aren't worried about nerve damage. It's also sometimes used if you have another serious health problem, such as being very overweight, which could make it hard to do retropubic radical prostatectomy.

This surgery takes more time than a retropubic one. It may also take a little longer if you're having a lymph node dissection first. Plus you'll need a separate cut to remove the lymph nodes.

It's harder to spare the nerves involved with erections with this cut than it is with a retropubic one. But it takes less time to recover from this surgery than a retropubic one.

What Happens During a Laparoscopic Radical Prostatectomy

For this surgery, your doctor makes a few small cuts in your lower abdomen. The surgeon uses a laparoscope -- a long, thin tool with a video camera on the end -- in one of the cuts to see inside the abdomen. Other long, thin instruments are inserted in the other cuts to remove the prostate and sometimes nearby lymph nodes as well.

A newer, and increasingly popular, version of this surgery is known as a robotic-assisted laparoscopic radical prostatectomy. For this operation, the surgeon sits at a control panel near the operating table and controls robotic arms to remove the prostate through several small incisions in the abdomen. 

There are some benefits of these fairly new methods. It takes less time to recover because the cuts are so small. And there's less blood loss during the operation and less scarring afterward. A disadvantage is that you must have a skilled laparoscopy surgeon, and not every urologist is trained in this type of surgery. Laparoscopic surgery also takes longer on average than the other types.