Progress of laparoscopic surgery
Through punctures in the lower abdomen, the surgeon isolates the prostate from the neck of the bladder to the urethra, preserving the neurovascular bundles along the posterolateral surfaces (at a favorable stage), cuts off the seminal vesicles and crosses the urethra at the apex, preserving its length as much as possible to retain urine. Then a vesicourethral anastomosis is performed using a continuous suture on a catheter, and the drug is removed in a container. At intermediate risk, limited lymph node dissection is performed. The drainage is removed after 2-3 days, the catheter - after 7-10 days after cystography.
Who is indicated for radical prostatectomy?
Surgery is the main treatment for localized and locally advanced prostate cancer in men with a life expectancy of more than 10 years. Indications: intermediate and high-risk cancer (Gleason 7 or higher, PSA greater than 10, stage T2-T3) and low-risk cancer if desired by the patient instead of active surveillance. An alternative is radiation therapy; the choice is discussed at the oncology consultation.
Laparoscopy and nerve sparing
Laparoscopic prostatectomy provides an enlarged image, minimal blood loss, precise anastomosis and quick recovery - hospital stay is 5-6 days versus 7-8 with open surgery. In low- and intermediate-risk cancers, the neurovascular bundles are preserved—erection is restored in 50–70% of men within 1–2 years with rehabilitation. Extended lymph node dissection is performed in intermediate and high-risk patients for staging.
Functional results
Urinary continence is restored in 90–95% of patients within 3–12 months with the help of pelvic floor muscle exercises; In the first weeks, pads are used. Erectile function depends on nerve sparing, age and initial potency. PSA after surgery should become undetectable (less than 0.1 ng/ml) - its monitoring every 3-6 months reveals a relapse, in which case radiation or hormonal therapy is prescribed.
