Prostatectomy

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The term prostatectomy (a composition of prostate , from ancient Greek προστάτης prostátēs = 'head', 'front man' and ectomy ( Greek εκτομή = 'cutting out'), also called prostate enucleation or prostate removal ), describes the surgical removal.

Types of prostatectomy

Depending on the extent of the tissue removal, a distinction is made between one

  • Partial removal of the prostate (also called partial prostatectomy ), especially in the case of benign prostatic hyperplasia (benign enlargement of the prostate) and a
  • radical prostatectomy (RP or RPE for short), in which the prostate is completely removed. This is especially the case with prostate cancer . The prostate, the vesicle glands ( vesiculae seminalis ) and the prostate capsule ( capsula prostatica or capsula prostatae ) are surgically removed.

Depending on the access route and the type of operation, a distinction is made between the two open operations for the complete removal of the prostate

and the three minimally invasive procedures

In retropubic prostatectomy, the operation is performed from the abdomen (retropubic means "located behind the pubic bone"), while in perineal prostatectomy the operation is performed via the perineum - the area between the scrotum and anus . The radical retropubic prostatectomy is currently (as of 2011) the most widely used method worldwide for the complete removal of the prostate.

In the last few years, the robot-assisted radical prostatectomy (RARP) has become increasingly important in German-speaking countries, and in the US it has now replaced the “classic open surgery” (RRP) as the most frequently performed procedure. Currently (as of 2020) this technology is offered at over 90 clinics in Germany. [1]

Radical prostatectomy is the surgical treatment of choice for locally limited prostate cancer. It is one of the most common tumor surgical interventions in urology. In terms of the clinical result and the expected side effects, the established procedures for radical prostatectomy mentioned are almost equivalent. The access via which the prostate is removed therefore depends primarily on the wishes of the patient and the level of training of the surgeon. The skill of the surgeon has a significant influence on the outcome of the operation and the possible postoperative side effects.

In the case of partial removal of the prostate, the most important thing is the procedure

applied.

Side effects of radical prostatectomy

A radical prostatectomy, regardless of how it is performed, is a very difficult operation. This is mainly due to the anatomical conditions. The prostate lies deep in the pelvis and is surrounded by bones , which makes it extremely difficult to access. In addition, the prostate is surrounded by both branches of the cavernous nerve at a distance of just a few millimeters. These two nerve bundles contain, among other things, the nerve fibers necessary for erection . Traumatization of both cavernous nerves , for example an accidental severing or excessive stretching, usually leads to a loss of erectile function, which can no longer be treated with medication - for example with PDE-5 inhibitors . One then speaks of postoperative erectile dysfunction . In most cases, an operation that is gentle on the nerves is sought, in which at least one nerve bundle is preserved. If, however, during a prostatectomy, which is indicated by a prostate carcinoma, it is found that the tumor has also extended to the cavernous nerves , they are usually also removed.

Urinary incontinence was a very common side effect of radical prostatectomy, especially in the past. The modified version of the retropubic prostatectomy developed by the US urologist Patrick Craig Walsh has significantly reduced the frequency of urinary incontinence. In a large-scale study with 1291 patients, 8.4% of the patients complained of urinary incontinence and 59.9% of impotence.

In radical prostatectomy, the penis is shortened in many cases, as a piece of the urethra is removed along with the prostate, which is roughly the size of the prostate and can be up to 40 mm long. The two ends of the severed urethra are reattached. To compensate for the missing piece of the urethra, the penis is pulled slightly into the body so that the outer part of the penis is shortened accordingly. Due to the shortened penis, the unchanged foreskin is now a little too long. This can lead to chronic inflammation of the glans. Another cause of penile shortening can be a severing of the cavernous nerves , which can cause penile atrophy . According to a study, penis shortening can obviously be counteracted with the help of a penis pump .

In radical retropubic prostatectomy, an inguinal hernia is a common complication with an incidence of 15 to 20%.

further reading

Individual evidence

  1. ↑ JU Stolzenburg, I. Tuerk, EN Liatsikos (ed.): Laparoscopic and robot-assisted surgery in urology. Chapter 3.11: Transperitoneal Radical Prostatectomy Springer, 2011, ISBN 3-642-10378-2 , p. 292f limited preview in the Google book search
  2. ↑ In: JU Stolzenburg, I. Tuerk, EN Liatsikos (ed.): Laparoscopic and robot-assisted surgery in urology. Chapter 3.12: Endoscopic extraperitoneal radical prostatectomy (EERPE) Springer, 2011, ISBN 3-642-10378-2 , p. 292f limited preview in the Google book search
  3. ↑ J. Hugosson, J. Stranne, SV Carlsson: Radical retropubic prostatectomy: a review of outcomes and side-effects. In: Acta Oncologica . Vol. 50, June 2011, pp. 92-97, ISSN  1651-226X . doi : 10.3109 / 0284186X.2010.535848 . PMID 21604947 . (Review).
  4. ↑ Endoscopic extraperitoneal radical prostatectomy (EERPE). ( Memento of the original from November 3, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Urological Clinic and Polyclinic of the Ludwig Maximilians University in Munich, accessed on December 31, 2011 @1@ 2Template: Webachiv / IABot / www.klinikum.uni-muenchen.de
  5. ↑ TC Gasser, T. Sulser u. a. : Radical Prostatectomy: Which Approach for Which Patient? In: Dtsch Arztebl. Vol. 101, Numbers 28-29, 2004, pp. A-2055.
  6. ↑ U. Zwergel, J. Sökeland: Benign prostatic hyperplasia: Basics and therapy. Springer, 1999, ISBN 3-540-65269-8 , p. 167. Restricted preview in the Google book search
  7. ↑ U. Zwergel, J. Sökeland: Benign prostatic hyperplasia: Basics and therapy. Springer, 1999, ISBN 3-540-65269-8 , p. 137. limited preview in Google book search
  8. ↑ J. Steffens, E. Stark: TUR prostate. In: J. Steffens, D. Echtle, T. Kalem (Ed.): Endourologie. Verlag Springer, 2003, ISBN 3-7985-1432-1 , p. 22. Restricted preview in the Google book search
  9. ↑ a b Radical prostatectomy (RP). Federal Association for Prostate Cancer Self-Help, accessed on December 31, 2011
  10. ^ J. Wolff, JE Altwein: Prostate carcinoma - basics and therapy. Springer, 2004, ISBN 3-540-20393-1 , p. 12. Restricted preview in the Google book search
  11. ^ A. McCullough: Penile change following radical prostatectomy: size, smooth muscle atrophy, and curve. In: Current urology reports. Volume 9, No. 6, November 2008, pp. 492-499, ISSN  1534-6285 . PMID 18947515 . (Review).
  12. ^ LT Klein, MI Miller et al. a .: Apoptosis in the rat penis after penile denervation. In: The Journal of Urology . Vol. 158, 1997, pp. 626-630. PMID 9224381 .
  13. ↑ M. Savoie, SS Kim, MS Soloway: A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. In: The Journal of urology. Vol. 169, No. 4, April 2003, pp. 1462-1464, ISSN  0022-5347 . doi : 10.1097 / 01.ju.0000053720.93303.33 . PMID 12629384 .
  14. ↑ P. Gontero, M. Galzerano a. a .: New insights into the pathogenesis of penile shortening after radical prostatectomy and the role of postoperative sexual function. In: The Journal of urology. Vol. 178, number 2, August 2007, pp. 602-607, ISSN  0022-5347 . doi : 10.1016 / j.juro.2007.03.119 . PMID 17570431 .
  15. ↑ TS Köhler, R. Pedro u. a .: A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. In: BJU international. Vol. 100, No. 4, October 2007, pp. 858-862, ISSN  1464-4096 . doi : 10.1111 / j.1464-410X.2007.07161.x . PMID 17822466 .
  16. ↑ J. Stranne, P. Lodding: Inguinal hernia after radical retropubic prostatectomy: risk factors and prevention. In: Nature reviews. Urology. Volume 8, No. 5, May 2011, pp. 267-273, ISSN  1759-4820 . doi : 10.1038 / nrurol.2011.40 . PMID 21467967 . (Review).

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