Access to the prostate is gained via an 8 – 10 cm long incision in the abdomen above the pubis, following which the prostate is exposed. After the removal of the anchors on the pelvic wall and the pelvic muscles, and after the ligation of the very strong venal blood vessels which run along the front of the prostate, the nerve-sparing procedure is, if tenable from an oncological perspective, carried out. This procedure is time-consuming and carried out with great care: the neurovascular layer is separated millimeter by millimeter from the prostate. During this procedure it is ensured that no heat or electrical energy is used in order to prevent damage to the sensitive nerves.
Subsequently, the urethra is initially severed directly above, and then below, the prostate at the transition to the urinary bladder. A technique which was developed by doctors of the Martini-Klinik is used which completely spares the urethral sphincter muscle in order to maintain the patient’s continence. In the following step, the prostate is separated from the rectum and removed together with the seminal vesicles. In order to ensure that the incision margins are tumor-free, a frozen section (NeuroSAFE-technique) of the entire area is carried out. If necessary, the lymph nodes are removed.
Finally, the connection of the urinary tract is reconstructed with stitches between the urethra and the bladder neck as well as with a permanent catheter for splinting. Where necessary, a surgical drain is introduced to remove lymphatic fluids and fluids from the wound. The operation is concluded with the closing of the abdominal incision.
Almost every patient's nerves are protected during operation to preserve the erectile function. This is not possible if single cells of the tumor have already spread to the nerves, which are delicately attached to the prostate gland's sides. As the only clinic in Germany, the Martini-Klinik investigates during the operationwhether the sides of the gland, touching the nerves, contain cancerous cells (Neuro-Safe-Technique).
Based on this finding it is then decided whether the nerves on both sides can be preserved or have to be removed. By this procedure, developped in the Martini-Klinik, 88 to 99 % of patients, depending on the tumor stadium (97 % in total) could undergo this nerve preserving procedure.
The Martini-Klinik offers the reliable operation techniques of the open operation (radical retropubical prostatectomy) and the da Vinci robot-assisted removal of the prostate. Together with you we decide which operation method meets your individual needs best.
The necessity of a blood transfusion after the operation is very low (3 - 5%). Therefore, patients who donate blood before theoperation do so for no reason and are weakend before the operation. For this reason, we do not advise to donate one's own blood beforehand.
Luckily, the infection rate is very low in our clinic. Consequently, the rate of infections with multi-resistant germs is rather low. The reason for this lies in the specialization of the clinic. Moreover, strict strategies of precaution concerning these infections are being met at the Martini-Klinik.
The stationary stay takes about a week.
We predict about 2 to 3 weeks for further recovery after discharge from our clinic. After this time, you are usually recovered to take up your daily procedures.
Yes, during every operation method a catheter is inserted. In general, it remains for one to two weeks after the operation.