Open radical prostatectomy is usually carried out by making a retro pubic incision in the lower abdomen between the navel and the pubic bone. The entire prostate is then removed and the urologist may also remove some of the pubic lymph nodes. These are then sent to the pathologist for immediate analysis so that the urologist can confirm that the cancer has not spread. If there is any spread to the lymph nodes the urologist may decide to close the incision without removing the prostate but this would depend on the extent of mesastatis, the age of the patient and if there are any further treatments planned.
Open radical prostatectomy can also be performed by making a perineal incision between the anus and the scrotum. This method normally reduces bleeding but it can cause damage to the rectum and it prevents the urologist from accessing the lymph nodes without making another incision.
During surgery a patient will be catheterized and this will stay in place for one to two weeks. There are a number of possible side effects from the surgery and they can vary in severity. The most likely problems are urinary incontinence, stress incontinence (where urinary leakage occurs when the bladder is put under increased pressure: laughing, coughing, lifting etc), fecal incontinence (dependant of the method of surgery) and erectile dysfunction. The latter is common as the prostate is surrounded by the nerves that control erections and even with new nerve sparing techniques there is no guarantee that erectile function will not be affected. However, there are a number of treatments available that can assist with problems in this area.
Occasionally troubles with incontinence are severe and this can result in the need to undergo a second surgical procedure to correct the problem. However, in general, side effects of surgery will heal over the course of time and after the first year many patients retain complete control of their urinary function.