H Radical prostatectomy

Open prostatectomy refers to removal of the prostate with or without the prostatic capsule. Several surgical approaches may be used, including suprapubic, transvesical, retropubic, perineal, and transcoccygeal. In suprapubic or transvesical procedures, the prostate is removed through the cavity of the bladder. Retropubic prostatectomy is performed through a low abdominal incision without opening the bladder. The transcoccygeal approach allows maximal surgical access to the posterior lobes of the prostate. Perineal prostatectomy is most often performed for cancer of the prostate when it is confined to the capsule. This procedure may also be done with the assistance of a robot.

2. Preoperative assessment and patient preparation

a)  History and physical examination: These are individualized based on the patient’s condition; assess for symptoms of metastatic disease.

b)  Diagnostic tests

(1) Plasma concentration of prostate-specific antigen is increased in prostate cancer.

(2) Blood urea nitrogen, creatinine, electrolytes, complete blood count, coagulation profile, and type and cross-match are obtained.

(3) Ultrasonography is used.

c)  Preoperative medication and IV therapy

(1)  Bowel preparation will render the patient in a dehydrated state.

(2)  Have a minimum of two peripheral IV lines (18 and 16 gauge) with moderate fluid replacement.

(3)  Epidural catheter: Perform a test dose in the preoperative area.

(4) Administer antibiotics.

(5) Small incremental doses of benzodiazepines may be given to ease patient preparation.

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