Radical prostatectomy: removing the prostate to treat prostate cancerRadical prostatectomy: prostate cancer ke ilaaj ke liye prostate nikalna

Yeh kya hai aur kyun kiya jata hai

Radical prostatectomy mein surgeon poori prostate aur seminal vesicles (prostate ke peeche ki chhoti gilteyan) nikalta hai. Kabhi qareeb ki lymph gilteyan bhi nikali jati hain taake dekha jaye ke cancer phaila hai ya nahi. Phir bladder ko taankon se seedha peshab ki nali (urethra) se jora jata hai.

Yeh un mardon ko tajveez ki jati hai jin ka prostate cancer prostate tak mehdood, ya us se sirf thora aage, samjha jata hai, jo operation ke liye kaafi tandurust hon aur jin se umeed ho ke woh itna jiyenge ke is ka fayda uthayen. Faisla biopsy aur scans ke baad, aam tor par mahiron ki team ke saath, hota hai (dekhein prostate biopsy ki guide, prostate ke MRI ki guide aur PSA test ki guide). Doosre options mein active surveillance, radiotherapy aur hormone ilaaj shamil hain, aur aap ke urologist ko woh sab options samjhane chahiye jo aap par lagoo hon (dekhein prostate cancer ki guide).

Yeh operation teen tareeqon se ho sakta hai: open surgery jo pait ke neeche ke hisse mein cut se hoti hai, laparoscopic (keyhole) surgery jo chhote cuts se hoti hai, aur robotic-assisted keyhole surgery jis mein surgeon console se aalaat chalata hai. Teenon ka maqsad cancer ko aik hi tarah nikalna hai. Robotic surgery har jagah dastiyab nahi, aur tareeqe se zyada surgeon ka tajurba ahem hai.

Procedure se pehle

• Tests: aap ki biopsy ka nateeja, MRI aur doosre scans dekhe jate hain, aur khoon aur peshab ke tests hote hain. Peshab ke infection ka pehle ilaaj hota hai (dekhein peshab ke tests ki guide).
• Pelvic floor ki kasrat: operation se pehle yeh seekhna aur karna baad mein peshab par qaboo wapas pane mein madad karta hai. Team ya physiotherapist se dikhane ko kahein.
• Aam sehat: cigarette chhorna, chalta phirta rehna aur diabetes jaisi bimariyon ko qaboo mein rakhna recovery mein madad karta hai. Khoon patla karne wali dawaon aur allergy ke baare mein team ko batayein. Apne taur par koi dawa band na karein.
• Bay-hoshi: operation poori bay-hoshi mein hota hai. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi. Faisla karne se pehle peshab par qaboo, khaas hissay ki sakhti, manyi aur aulad ke baare mein khul kar baat karein. Agar aap bachon ki khwahish rakhte hon to pehle se poochhein.
• Qeemat, operation kahan hoga, kaun sa tareeqa istemal hoga aur kitni raatein hospital mein rehna hoga, yeh bhi poochh lein.

Procedure ke dauran

Poore operation ke dauran aap soye hote hain. Surgeon prostate aur seminal vesicles nikalta hai, aur jahan mehfooz ho woh khaas hissay ki sakhti ko control karne wali nason aur peshab rokne wali muscle ko bachane ki koshish karta hai. Jab cancer nason ke qareeb ho to unhein aik ya dono taraf se nikalna par sakta hai.

Phir catheter par bladder ko taankon se peshab ki nali se jora jata hai. Jagah ke qareeb paani nikalne ke liye drain ki nali chhodi ja sakti hai. Nikala hua tissue laboratory bheja jata hai jahan us ka baareeki se muaina hota hai.

Procedure ke baad aur recovery

Hospital mein

• Hospital mein qayam: zyadatar mard kuch raatein hospital mein rehte hain. Aap ko jaldi uth kar chalne mein madad di jati hai jis se khoon ke lothron ka imkaan kam hota hai. Lothron se bachao ke liye injection ya mozay diye ja sakte hain.
• Dard ka ilaaj kiya jata hai, aur zyadatar mardon ko dard qabil-e-bardasht lagta hai.
• Catheter takreeban aik se do haftay rehti hai, aur aap us ke saath ghar ja sakte hain. Aap ko us ki dekh-bhal dikhayi jayegi.

Ghar par

• Shuru mein peshab ka reesna aam hai. Catheter nikalne ke baad bohat se mard rees'te hain, khaas tor par khansi, wazan uthane ya khade hone par. Yeh pelvic floor ki kasrat se haftay se mahinon mein aam tor par behtar hota hai. Kuch der pads ki zaroorat par sakti hai.
• Khaas hissay ki sakhti: operation ke baad shuru mein sakhti aksar kamzor ya bilkul nahi hoti, chahe nasein bachayi gayi hon. Recovery mein kayi mahine ya zyada lag sakte hain, aur ilaaj madad kar sakta hai (dekhein erectile dysfunction ki guide).
• Manyi aur aulad: aap ko manyi ke baghair orgasm hoga (dry orgasm), aur aap aam tareeqe se aulad paida nahi kar sakenge.
• Sargarmi: roz chalein, aur kayi haftay bhaari wazan uthane aur zor wali kasrat se parhez karein, jaisa mashwara ho. Gaari, kaam, aur jinsi taluq kab shuru ho sakta hai, is ke baare mein team se poochh lein.
• Qabz se bachein. Paani peeyein aur rayedar ghiza khayein.

Mumkina khatrat

• Aam: shuru ke haftoon mein peshab ka reesna, khaas hissay ki sakhti mein mushkil, manyi ka khatam hona (dry orgasm) aur aulad na hona, aur yeh ehsaas ke khaas hissa chhota ho gaya hai.
• Kam aam: khoon jis ke liye mazeed ilaaj chahiye, zakhm ya peshab ka infection, operation ki jagah ke qareeb paani jama hona (lymphocele), aur bladder aur peshab ki nali ke jor par tangi.
• Ghair aam: peshab ka lambay arsay ke liye reesna, aur nikali gayi prostate ke kinare par cancer cells ka milna jis ka matlab ho sakta hai ke mazeed ilaaj chahiye.
• Bohat kam: aant ya qareeb ke angon ko chot, taang ya phephre mein khoon ka lothra, nishan ki jagah hernia, ya anaesthetic ke khatrat.

Peshab par qaboo aur khaas hissay ki sakhti woh asraat hain jin ki mardon ko sab se zyada fikr hoti hai. Surgeon ka tajurba in par asar karta hai, is liye us ke baare mein poochhein. Faisla karne se pehle us par baat karein jo aap ke liye sab se ahem hai.

Follow-up aur nateeje

• Laboratory ki report cancer ki qism aur phailao dikhati hai, aur yeh bhi ke woh tissue ke kinare tak pohancha ya nahi. Poochh lein ke aap ko kab bataya jayega, aur yaqeeni banayein ke aap ko mile.
• PSA ki jaanch: prostate nikalne ke baad PSA bohat kam satah par aa jani chahiye. Us ki baqaidgi se jaanch hoti hai. Baad mein PSA barhne ka matlab ho sakta hai ke mazeed ilaaj, jaise radiotherapy ya hormone ilaaj, tajveez ho (dekhein PSA test ki guide).
• Mazeed ilaaj hamesha zaroori nahi hota. Aap ka urologist aap ki report ki bunyad par samjhayega.
• Peshab par qaboo aur khaas hissay ki sakhti ki recovery ko kayi mahine dekha jata hai. Agar dono mein behtari na aaye to madad dastiyab hai, is liye bataein.

Aam sawalaat

What it is and why it is done

In a radical prostatectomy the surgeon removes the whole prostate and the seminal vesicles (the small glands that sit behind it). Sometimes nearby lymph glands are removed too, to check whether the cancer has spread. The bladder is then joined directly to the urethra with stitches.

It is offered to men whose prostate cancer is thought to be limited to the prostate, or only just beyond it, who are fit enough for surgery and expected to live long enough to benefit. The decision is made after a biopsy and scans, usually with a team of specialists (see the prostate biopsy guide, the MRI of the prostate guide and the PSA test guide). Other options include active surveillance, radiotherapy and hormone treatment, and your urologist should explain all the options that apply to you (see the prostate cancer guide).

The operation can be done in three ways: open surgery through a cut in the lower abdomen, laparoscopic (keyhole) surgery through small cuts, and robotic-assisted keyhole surgery, where the surgeon controls the instruments from a console. All three aim to remove the cancer in the same way. Robotic surgery is not available everywhere, and the surgeon's experience matters more than the method.

Before the procedure

• Tests: your biopsy result, MRI and any other scans are reviewed, and blood and urine tests are done. A urine infection is treated first (see the urine tests guide).
• Pelvic floor exercises: learning and practising these before the operation can help you regain bladder control afterwards. Ask the team or a physiotherapist to show you.
• General health: stopping smoking, keeping active and managing conditions such as diabetes help recovery. Tell the team about blood thinners and allergies. Please do not stop any medicine on your own.
• Anaesthetic: the operation is done under general anaesthetic. Follow the instructions about eating and drinking.
• You will be asked for consent. Please talk openly about urine control, erections, ejaculation and fertility before you decide. If you may want children, ask about this beforehand.
• Ask about the cost, where it will be done, which method will be used and how many nights you will stay.

During the procedure

You are asleep for the whole operation. The surgeon removes the prostate and seminal vesicles, taking care to protect the nerves that control erections and the muscle that holds in urine, where it is safe to do so. When the cancer is close to the nerves, they may need to be removed on one or both sides.

The bladder is then joined to the urethra with stitches over a catheter. A drain tube may be left near the area to remove fluid. The removed tissue is sent to the laboratory to be examined carefully.

After the procedure and recovery

In hospital

• Hospital stay: most men stay a few nights. You will be helped to get up and walk early, which lowers the chance of blood clots. You may have injections or stockings to help prevent clots.
• Pain relief is given, and most men find the pain manageable.
• The catheter stays in for around one to two weeks, and you may go home with it. You will be shown how to look after it.

At home

• Urine leakage is common at first. Many men leak, especially on coughing, lifting or standing, after the catheter comes out. This usually improves over weeks to months with pelvic floor exercises. Pads may be needed for a time.
• Erections: after surgery, erections are often weak or absent at first, even if the nerves were protected. Recovery can take many months or longer, and treatment can help (see the erectile dysfunction guide).
• Ejaculation and fertility: you will have an orgasm without semen (a dry orgasm), and you will be unable to father a child in the usual way.
• Activity: walk daily, and avoid heavy lifting and strenuous exercise for several weeks, as advised. Ask the team about driving, work, and when sex can restart.
• Constipation should be avoided. Drink water and eat fibre.

Possible risks

• Common: urine leakage in the early weeks, difficulty with erections, loss of semen (dry orgasm) and infertility, and a feeling that the penis is shorter.
• Less common: bleeding that needs more treatment, a wound or urine infection, fluid collecting near the surgery site (a lymphocele), and a narrowing at the join between the bladder and urethra.
• Uncommon: long-term leakage of urine, and cancer cells being found at the edge of the removed prostate, which may mean further treatment is needed.
• Rare: injury to the bowel or nearby structures, a blood clot in the leg or lung, a hernia at the scar, or the risks of the anaesthetic.

Urine control and erections are the effects most men worry about. Your surgeon's experience affects them, so ask about it. Please discuss what matters most to you before you decide.

Follow-up and results

• The laboratory report shows the type and spread of the cancer and whether it reached the edge of the tissue. Ask when you will be told, and make sure you receive it.
• PSA checks: after the prostate is removed, the PSA should fall to a very low level. It is checked regularly. A rising PSA later may mean more treatment is advised, such as radiotherapy or hormone treatment (see the PSA test guide).
• Further treatment is not always needed. Your urologist will explain based on your report.
• Recovery of urine control and erections is followed over many months. Help is available if either is not improving, so please speak up.

Common questions