Prostatectomy is a surgical procedure that removes part (simple) or all (radical) of the prostate gland in men.
During a simple prostatectomy, the inner part of the prostate is removed via an incision in the lower abdomen. This is usually performed as treatment for an enlarged prostate (also known as benign prostatic hyperplasia or BPH).
Radical prostatectomy surgery, described below, removes the entire prostate and some of the surrounding tissues as part of a prostate cancer treatment. This procedure is often done in men who are expected to live at least another 10 years and whose prostate cancer has not spread and is localized to the gland.
Types of Simple Prostatectomy Surgeries
There are three types of simple prostatectomy, all of which aim to preserve at least part of the prostate gland:
- Transurethral resection of the prostate (TURP): Roughly 90 percent of all simple prostatectomies for BPH are done using this method. For this procedure, an instrument called a resectoscope is inserted into the urethra and guided to the prostate. The scope holds an electrically activated wire loop that removes affected tissue and seals bleeding vessels. The sloughed off tissue is removed via irrigation.
- Open prostatectomy: This procedure is often performed when TURP is not an option, because either the prostate is too large, there are bladder stones, or the bladder has been impaired. The surgery requires the use of general or spinal anesthesia, and consists of a cut made through the abdomen or the area behind the scrotum, through which only the inner portion of the prostate gland is extracted (the outer segment is left intact).
- Laser surgery: This surgical technique uses a high-energy laser to vaporize and destroy prostate tissue.
Types of Radical Prostatectomy Surgeries
There are four main types of radical prostatectomy, each of which takes between three and four hours to perform. During the procedure--which is done while the patient is under general or regional anesthesia--a surgeon will remove the prostate gland and sometimes the seminal vesicles (fluid-filled sacs alongside the prostate). Nearby lymph nodes may also be removed and examined for signs of cancer. The approach chosen depends upon the patient as well as the experience and training of the surgeon.
- Radical retropubic prostatectomy: In this open surgery, an incision is made from above the pubic bone to just below the belly button. This procedure allows the nerves near the prostate to be saved, which increases the likelihood of achieving erections after surgery. It can also be used when nearby lymph nodes need to be removed.
- Radical perineal prostatectomy: The cut in this surgery is made between the anus and the scrotum. Because the incision is smaller, there is less blood loss. It can, however, be more difficult to remove the nearby lymph nodes (part of the immune system) and save the nerves around the prostate. This procedure is faster, which also means quicker recovery. It is done when the nerves don't need to be saved (such as in older men where maintaining erections is not essential) and when the lymph nodes don't need to be removed.
- Laparoscopic radical prostatectomy: This surgery uses one or more small cuts in the belly, through which tools and a thin tube with a video camera (laparoscope) are inserted. This procedure generally results in less pain and faster healing. This approach (and the next) may be chosen if the doctor is comfortable performing this type of procedure.
- Robotic-assisted laparoscopic prostatectomy: Similar to the laparoscopic surgery, this procedure uses a robotic arm to remove the prostate and some of its surrounding tissue. The arm is controlled by a surgeon who operates the equipment from a computer monitor located close to the operating table.
Preparation for Prostatectomy Surgery
During the weeks before the surgery, patients should stop taking anything that prevents blood clotting, including aspirin, ibuprofen, warfarin, vitamin E, and fish oil. Ideally, they should also stop smoking several weeks before surgery so as to help speed recovery.
Patients may also be asked to take a laxative or use an enema on the morning of the surgery to clean out their colon. In addition, the doctor may administer an antibiotic to prevent infection.
Recovery After Prostatectomy Surgery
After prostatectomy performed via open surgery, patients typically remain in the hospital for between one and four days. If the procedure was performed laparoscopically or via robot assistance, a patient may be able to go home the same day.
Once discharged, a patient will have a catheter in place to give his urethra time to heal. Catheters can be removed one to two weeks after surgery.
Risks Associated with a Prostatectomy
The risks associated with any surgery include:
- Loss of blood
- Blood clots
- Difficulty breathing
- Heart attack or stroke during surgery
- Infection around the incision, or in the lungs, bladder or kidneys
- Allergic reaction to the medications or anesthesia.
In addition to risks associated with any surgery (such as infection near the incision, allergic reaction to anesthesia, loss of blood, blood clots), a prostatectomy has some added risks, including:
- Trouble controlling bowel movements
- Incontinence
- Erectile dysfunction
- Rectal injury
- Narrowing of the urethra from scar tissue (urinary stricture)
References
Schaeffer EM, Partin AW, Lepor H, et al. (2011). Radical retropubic and perineal prostatectomy. Campbell-Walsh Urology. 10th ed.
Su LM, & Smith JA Jr. (2011). Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. Campbell-Walsh Urology. 10th ed.
