Question

A 65-year-old man is seen in the preoperative clinic 1 week before a scheduled radical prostatectomy. He has been diagnosed with femoral deep vein thrombosis (DVT) following a complaint of calf soreness.

1. What is a radical prostatectomy?
2. What would be a reason for this procedure (i.e. diagnostic, curative, restorative, etc.)
3. What is the level of urgency, degree of risk, and extent of urgency for this procedure?
4. What possible treatment would you anticipate being ordered for the treatment of DVT? (Discuss 2)
5. What are risk factors that contribute to the development of DVT? (Name 3)

Answer 1

1. Radical prostatectomy is a procedure in which the prostrate gland and the surrounding tissues are removed by operation. It involves seminal vesicles and some lymph nodes.

2. Prostatectomy is done if cancer is spread beyond prostate. Risk of spreading is detected by biopsy and PSA level data along with CT scan,MRI, ultra sound and bone scans. If not spread before surgery radiation treatment, hormone therapy is tried. Doctors also consider how high the risk of cancer spread, pelvic lymph node dissection is done.

3. There number of veins that passes through prostate to the penis. Protection of these nerves during the surgery is important. Radical prostatectomy have lower risk of serious complications. Urinary incontinence, erectile dysfunction are common after prostatectomy. Other complications may include bleeding after operation, blood clots, infection, narrowing of urethra resulting in blocking of urine flow, poor wound healing etc.

4. For the treatment of DVT anticoagulant are given usually. They will prevent clot from growing. Future blood clots can also prevented by this. Blood thinners like apixaban, dabigatran, fondaparinux, warfarin are used. They can dissolve the clots. Heparin is given  first by injection twice daily. Warfarin is taken when patient is still on heparin. There is chance of interactions with vitamin and foods, so blood should be checked often.

Clot busting, cather directed thrombolysis and surgery is the next option in severe patients.