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A prostatectomy is a surgery to remove an enlarged prostate gland. It is done to: - Relieve urinary symptoms from a noncancerous condition (simple prostatectomy)
- Remove a prostate gland containing cancer (radical prostatectomy)
Some of the surrounding tissue might be removed as well. Simple or radical prostatectomy can be done using open, laparoscopic, or robot-assisted surgery.
The prostate gland is part of a man's reproductive system. It makes and stores seminal fluid (a milky fluid that nourishes sperm and forms part of semen). The normal prostate is about the size of a walnut. It is below the bladder and in front of the rectum.
- Prostate gland
- Bladder
- Rectum
- Urethra
A prostatectomy treats these conditions:
Your doctor may consider a radical prostatectomy (complete removal of the prostate) in the early stages of prostate cancer, when it is confined to the prostate.
Your doctor will do the following:
- Physical exam
- Blood tests
- Urine tests
-
Chest x-rays
(for a simple prostatectomy)
- Kidney function tests
-
Electrocardiogram
(ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
- Ultrasound (usually transrectal)—a test that uses sound waves to visualize the inside of the body
- Bone scan or CT scan if there is reason to suspect spread of cancer
In the days leading up to the procedure:
- Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (such as ibuprofen) for one week before the procedure.
- The night before, have a light meal and do not eat or drink anything after midnight.
The surgeon uses a special instrument called a resectoscope. He inserts it into your urethra through your penis. It is used to remove obstructing tissue from the inside of your gland. Newer procedures, such as laser surgery, have replaced the need for this procedure in some cases. This is similar to TURP, but prostate tissue is not removed. The surgeon makes 1-2 incisions where the prostate meets your bladder. This lets the urethra expand and increase the flow of urine.
The surgeon makes an incision in the lower abdomen to access the prostate. The surgeon removes the inner part of your gland. This procedure is not as common in the United States. It is considered when you have other complicating factors, such as stones or bladder damage.
The surgeon makes an incision in the lower abdomen between the navel and pubic bone. This allows him to access the prostate and pelvic lymph nodes. The surgeon detaches the prostate from the bladder and urethra. Then the urethra is re-attached to the bladder. The surgeon will try to preserve nerve function related to bladder function and erections, if all the cancer can be removed safely. In some cases, the surgeon will remove lymph node tissue for testing before deciding to continue with surgery. There are several things the surgeon will consider when deciding whether to continue. Some factors are the number of cancerous lymph nodes and your age. The surgeon makes a half-moon incision between your anus and your scrotum. He then removes your prostate. This type of surgery is less common since it does not allow access to the lymph nodes. And it has a higher risk of nerve damage. Both of these surgeries will require you to care for your catheter at home. The surgeon makes five small “keyhole” incisions in the abdomen for robotic arms, including one with a small camera (laparoscope). This gives him a wider and more flexible range of motion. A surgeon sits at a console and guides the robotic arms through the surgery. Benefits include less scarring.
Water may be flushed through the bladder catheter that is inserted during surgery. This is done to reduce blood in the urine. The catheter will either be removed before you leave the hospital, or, in some cases, left in place for 1-3 weeks. This will let you urinate easier during the healing period. After a radical prostatectomy, many surgeons leave a JP® drain.
- TURP/TUIP—1-1½ hours
- Simple prostatectomy—2-4 hours
- Radical prostatectomy—2-4 hours
Anesthesia prevents pain during the procedure. You can expect some pain and discomfort for: - 7-10 days after open surgery
- 3-4 days after laparoscopic surgery
- Excessive bleeding
- Surgical wound infection
- Blood clots
-
Inability to control urinary stream (incontinence)
- Fecal incontinence
- Impotence
- Retrograde ejaculation—Sperm ejaculates into your bladder, rather than out through the penis
- This may cause the urine to appear milky white after ejaculation.
- This would occur after TURP/TUIP. After open prostatectomy, patients are not able to ejaculate.
- Sterility
- Urethral stricture
-
Low blood sodium after large amounts of fluid are used to irrigate the bladder during TURP/TUIP
- Urine leak requiring prolonged drainage (with a catheter or drain) or reoperation
- Injury to the rectum or other adjacent structures
- This is a complication after radical prostatectomy only.
1-5 days
-
Take medications as directed. Your doctor may give you antibiotics to prevent infection and/or stool softeners to prevent
constipation.
- Do not take prescription pain medication for more than seven days. After this point, take non-prescription pain relievers (such as Advil or ibuprofen) as needed. But avoid taking aspirin or aspirin-containing products.
- When resting in bed, keep legs elevated and moving to avoid deep vein blood clots.
- To promote healing, resume normal activities as quickly as possible.
- Drink plenty of liquids to clear your bladder of urine and blood.
- Shower as usual, but avoid baths until the surgical incision has completely healed.
- Wash the incision gently with mild soap and water.
- Do not drive for at least one month after surgery.
- Avoid vigorous exercise for six weeks after surgery.
- Resume sexual activity when able.
- Avoid coffee, tea, cola, cocoa, alcohol, spicy foods, or any other food or drink that might aggravate your stomach, intestines, bladder, or urinary tract.
Complete healing from surgery usually occurs within six weeks.
You may need to take an antispasmodic medication for several weeks to normalize your bladder tone. You can expect to regain normal urination function without dribbling.
You may be able to achieve an orgasm, but you may have no ejaculate or you may experience retrograde ejaculation.
If the cancer has spread from the prostate, other forms of treatment may be needed. These include
radiation,
chemotherapy, and
hormone therapy.
After you leave the hospital, call your doctor if any of the following occurs: - Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
- Bright red blood or blood clots in your urine
- Abdominal swelling or pain
- Headaches, muscle aches, dizziness, fever, or general ill feeling
- Constipation
- New, unexplained symptoms
- Poor urine drainage from catheter
Last reviewed May 2008 by
Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Copyright © EBSCO Publishing. All rights reserved.
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