In simple words: The surgeon removes the prostate gland and some nearby tissue through a cut in the lower belly. They also check some lymph nodes in the area for cancer spread. The surgeon may try to protect the nerves needed for erections. This surgery is done for early prostate cancer.

This procedure involves the complete removal of the prostate gland and some surrounding tissue through an incision in the lower abdomen. It also includes a limited pelvic lymphadenectomy, where a small number of lymph nodes in the pelvis are biopsied or removed to check for cancer spread.The surgeon may or may not preserve the nerves responsible for erectile function (nerve sparing).The procedure begins with the patient in the supine position under anesthesia. A catheter is placed into the bladder. A midline incision is made from below the navel to the pubic bone. The surgeon may perform a biopsy or remove lymph nodes. The incision is deepened to expose the anterior fascia, which is then incised, and the rectus muscles are separated. The space of Retzius is entered, and dissection continues towards the urachus, freeing the bladder. A bilateral obturator pelvic lymphadenectomy is performed. The endopelvic fascia is opened, and the levator ani fibers are moved to expose the lateral prostate and the dorsal venous complex. The neurovascular bundles are preserved if possible. The prostate is separated from the bladder, and vascular pedicles are clipped and ligated. The seminal vesicles and ejaculatory ducts are incised and clipped. The bladder neck is dissected from the prostate, and the bladder is anastomosed to the urethra. In some cases, an autologous fascial sling is created from the rectus fascia and placed under the anastomosis. The incisions are then closed. Limited pelvic lymphadenectomy is often performed with this procedure in patients with elevated PSA levels, high Gleason scores, or a higher risk of metastasis to the pelvic lymph nodes.

Example 1: A 65-year-old male with newly diagnosed, localized prostate cancer and a PSA of 12 ng/mL undergoes radical retropubic prostatectomy with limited pelvic lymphadenectomy (55842) to remove the cancerous prostate and assess regional lymph node involvement., A 70-year-old male with a Gleason score of 7 and a positive prostate biopsy undergoes a radical retropubic prostatectomy with limited pelvic lymphadenectomy. Due to his age and the desire to preserve sexual function, the surgeon performs nerve-sparing surgery (55842)., A 58-year-old male with a family history of aggressive prostate cancer and a rising PSA undergoes a radical retropubic prostatectomy with limited pelvic lymphadenectomy (55842), even though his biopsy is negative, due to the high suspicion of cancer.

Documentation must include operative report detailing the procedure, including nerve sparing if performed, size and location of the prostate, number of lymph nodes biopsied or removed, and any complications. Pre-operative diagnostic reports including biopsy results, imaging studies, and PSA levels should also be included. Post-operative reports documenting recovery, complications, and pathology results are essential. Informed consent demonstrating patient understanding of risks and benefits is required.

** This information is current as of December 1, 2024, and may be subject to change. Always verify coding guidelines and reimbursement policies with current resources.