Prostatectomy Procedure
Overview
A prostatectomy is a surgical operation that removes part or all of the prostate gland. The prostate gland, found below the bladder and wrapped around the urethra, is part of the male reproductive system. Surgeons most often perform this procedure to treat prostate cancer but may use it for other prostate issues. Several approaches exist for prostatectomy:
- Open Radical Prostatectomy: The surgeon makes a single larger incision to reach and remove the prostate.
- Laparoscopic Radical Prostatectomy: The surgeon uses smaller incisions and specialized tools to perform the surgery.
- Robotic-Assisted Laparoscopic Radical Prostatectomy: The surgeon uses robotic technology, allowing for better precision and control through small cuts.
| Technique | Surgical Approach |
|---|---|
| Open Radical Prostatectomy | Large incision |
| Laparoscopic Radical Prostatectomy | Small incisions |
| Robotic-Assisted Prostatectomy | Small incisions, robotics |
| Radical Perineal Prostatectomy | Incision near the anus |
Surgeons may offer advanced endoscopic options, which can avoid open, laparoscopic, or robotic surgery in some cases. The choice depends on the patient’s needs and the specific prostate problem.
Reasons for This Surgery
Surgeons perform a prostatectomy to treat a range of medical conditions, most commonly prostate cancer. When doctors believe the cancer is limited to the prostate gland, they may recommend a radical prostatectomy. In this procedure, the surgeon removes the entire prostate and some nearby tissue.
Sometimes, the surgeon also removes suspicious lymph nodes and checks them for signs of cancer. Depending on each case, radical prostatectomy can be used alone or combined with other methods such as radiation therapy or hormone therapy.
Techniques Used in Prostatectomy
| Type | Description |
|---|---|
| Robot-Assisted | Surgeon uses robotic tools through several small cuts in the lower abdomen. |
| Open Surgery | Surgeon removes the prostate through a single larger incision in the abdomen. |
Robot-assisted techniques allow for very precise movements, which can reduce pain after surgery and help patients recover more quickly compared to open surgery.
Prostatectomy also helps people who suffer from severe urinary problems due to a very enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). In these cases, the surgeon performs a simple prostatectomy and usually removes only the part of the prostate that’s causing a blockage.
Reasons for Treating Enlarged Prostate
People with BPH may experience symptoms such as:
- The need to urinate often and suddenly.
- Experiencing challenges when attempting to initiate urination.
- Slow or prolonged flow when urinating.
- Waking up at night to urinate more than once.
- Starting and stopping several times during urination.
- A feeling that the bladder is never completely empty.
- Problems like urinary tract infections or being unable to urinate at all.
Professionals use advanced techniques to help relieve these symptoms, often without large incisions. Many simple prostatectomies now use minimally invasive, robot-assisted methods.
Before surgery, patients meet with their surgical team to discuss the possible advantages and disadvantages of each approach. The surgeon and patient make the decision together, considering both medical needs and the patient’s wishes.
Possible Risks Related to Prostate Surgery
Complications From Total Prostate Removal
Radical removal of the prostate can lead to several possible problems. Blood loss during the procedure is common, and in some cases, patients may need a transfusion. Urinary incontinence can occur, meaning some people might have trouble controlling their bladder. This issue often improves as the body heals.
Erectile dysfunction can also develop, making it difficult to get or keep an erection. Narrowing of the urethra or the bladder neck may occur, making it harder to pass urine. Lymph fluid can collect in the pelvic area (lymphedema), causing swelling. Infections like urinary tract infections may develop after surgery.
Rarely, the surgeon may damage nearby organs such as the intestines or rectum, leading to a more complicated recovery. Loss of fertility is expected, as removing the prostate affects the ability to produce semen. Post-operative pain and some scarring can also occur, but pain usually improves over time.
| Risk | Possible Outcome |
|---|---|
| Blood loss | May need transfusion |
| Urinary incontinence | Trouble controlling urine |
| Erectile dysfunction | Difficulty with erections |
| Urethral/bladder stricture | Difficulty passing urine |
| Lymphedema | Swelling from fluid collection |
| Infection | Urinary tract infection |
| Organ injury | Rare, affects bowel or rectum |
| Fertility loss | Inability to have children |
| Post-op pain | Usually improves over time |
Complications Linked to Simple Prostate Surgery
Simple prostate surgery also carries certain risks. Bleeding is one of the most frequent problems, and some patients may require extra care to manage it. Urinary tract infections can occur during the healing process.
Both urinary incontinence and retrograde ejaculation—when semen flows into the bladder rather than leaving the body during ejaculation—can happen. Erectile dysfunction is also possible, though it occurs less often than with radical surgery.
Patients may develop scarring or narrowing in the urethra or at the bladder neck after the operation. Some may also feel pain after surgery, which usually lessens with time. Close follow-up helps manage these issues and reduce the chance of long-term effects.
Steps for Getting Ready
Diet and Medicine Instructions
Before surgery, the urologist or surgery team reviews all medicines and supplements the patient takes. Patients must report all prescriptions and over-the-counter products, including blood thinners and pain relievers like ibuprofen or naproxen.
The team may ask patients to stop some medicines ahead of time to lower the risk of bleeding. Patients with medicine allergies or past reactions should inform the team. Fasting is usually required before the procedure.
Most providers instruct the patient not to eat or drink after midnight before surgery. On the day of operation, patients should take only medicines approved by the surgeon with a small sip of water. The team might require bowel preparation, such as using an enema kit, to cleanse the digestive system.
Quick Reference Table
| Task | Timeline | Notes |
|---|---|---|
| Stop certain medicines | As directed | Example: Blood thinners or some pain relievers |
| Report allergies | Before surgery | Includes all known medication reactions |
| Begin fasting | After midnight | No food or drink unless instructed |
| Bowel preparation | 24 hours before | Use kit as directed for cleansing |
What to Wear and Bring
Patients should come to the hospital dressed simply and comfortably. The team will ask patients to leave items such as jewelry, watches, eyeglasses, contact lenses, and dentures at home or remove them before surgery. Patients should limit personal items brought to the facility, focusing only on essentials suggested by the surgical team.
Planning for the Trip Home
After treatment, patients will need help getting home, as driving is not allowed right after surgery. Patients should arrange for a family member, friend, or transport service before the hospital visit. Patients should check with the urology team for details about the length of hospital stay to ensure smooth planning.
Physical Limits After the Operation
Patients may need to limit physical and work activity for several weeks after surgery. The care team will recommend avoiding strenuous exercise and lifting heavy objects. The team will provide clear post-surgery guidelines outlining what the patient can and cannot do during the healing period. Patients should follow these instructions to reduce risks and support recovery.
What You Can Expect
What Happens Before Surgery
Before the procedure starts, most patients receive general anesthesia. This medicine helps them fall into a deep, sleep-like state so they do not feel pain during the operation. Doctors usually give an antibiotic to lower the risk of infection.
The care team prepares the patient for surgery by reviewing medical history and checking vital signs. Sometimes, the team performs additional tests to ensure the patient is healthy enough for surgery. Patients are asked not to eat or drink for a certain period before the operation.
Details About the Surgery Itself
Surgeons use several approaches for prostate removal. The common methods include robot-assisted surgery, open surgery, and simple prostatectomy.
Robot-Assisted Surgery
The surgeon controls robotic instruments from a console located near the patient. This system provides a clear, magnified 3D view of the surgical area, allowing for smaller and more accurate cuts. This can help lead to less scarring, a shorter hospital stay, and quicker recovery. With this method, surgeons often work to save the nerves around the prostate, which may help preserve sexual function.
Open Surgery
The surgeon makes a larger incision in the lower belly. The prostate and some tissue around it, including any affected pelvic lymph nodes or seminal vesicles, are carefully removed. The surgeon tries to avoid damaging nearby nerves if possible, but sometimes nerve-sparing is not an option.
Simple Prostatectomy
The surgeon may insert a special scope through the tip of the penis to see inside the body. A catheter is also placed to drain urine during the operation. Depending on the patient’s needs, the surgeon chooses the best way to reach and remove the prostate tissue.
If there are other problems like a hernia or bladder issue, the surgeon may repair them while the area is open. After the surgery, the team may leave small drain tubes to help remove extra fluids. Robotic surgery has become more common because it can reduce cutting, lead to faster healing, and often means a shorter time in the hospital.
Comparison Table: Main Surgical Methods
| Method | Incision Size | Nerve-Sparing Possible | Hospital Stay | Typical Recovery Time | Scarring Level |
|---|---|---|---|---|---|
| Robot-assisted | Small | Yes (if possible) | 1-2 days | 4-6 weeks | Less |
| Open (traditional) | Large | Sometimes | 1-2 days | 6-8 weeks | More |
| Simple prostatectomy | Varies | N/A | 1-2 days | 4-6 weeks | Varies |
What to Expect After Your Operation
After the surgery, patients typically wake up in a recovery room with hospital staff nearby. Most people receive pain medicine through an IV for the first several hours. The team gives oral pain medicine later as needed.
The care team encourages patients to start moving, such as walking or doing simple foot exercises, soon after surgery. This helps prevent blood clots and speeds up healing. Most patients can go home within one or two days if recovery is going well. At discharge, the team will likely remove the drain tubes.
For about one to two weeks, a urinary catheter usually remains in place to help urine drain from the bladder. The care team teaches patients how to care for the catheter before going home. Bruising or swelling in the penis and scrotum is common but should get better within a week.
Urinary control may take some time to return, sometimes up to a year. Doctors set follow-up visits, usually about a week or two after surgery to check incisions and remove any staples. More health checkups are often scheduled every few months in the first year and less often in the second.
Most patients need to rest and slowly build back energy over four to six weeks. Light duties and gentle walks are allowed after the first few days, but strenuous activities should be avoided.
Sexual recovery is possible, but things may change. Some people may notice less or no semen during orgasm. Nerve-sparing surgery may help protect erectile function, especially in younger adults, but this can vary.
Tips for Early Days at Home
- Take medicines as prescribed.
- Clean and care for the surgery site and catheter.
- Avoid driving, lifting heavy things, or doing exercise that feels too hard.
- Follow the surgeon’s instructions about showering and returning to daily activities.
Most people can go back to work and usual routines within one to two months, but the total recovery time may vary for each person. Keeping up with appointments, following self-care instructions, and asking questions are important parts of recovery after surgery.
Outcomes
Patients who undergo robot-assisted prostate removal often report less pain, a decrease in blood loss, and a faster return to day-to-day activities. Hospital stays tend to be shorter, and the procedure causes less overall tissue damage compared to traditional open surgery.
Effects observed after surgery can include:
- Erectile Function: Some individuals experience challenges with sexual performance.
- Change in Penis Length: Minor shortening may occur in a small number of cases.
- Urinary Control: Most patients regain urinary continence over time.
- Penile rehabilitation: Supportive strategies can help improve function.
| Outcome | Common Observation |
|---|---|
| Pain/Blood Loss | Robotic techniques lower both. |
| Hospital Stay | Patients stay for a shorter duration. |
| Urinary Continence | Most regain control. |
| Sexual Function | May decrease temporarily or long-term. |
| Penis Length | Small reduction possible. |
