Prostatectomy (Prostate Removal Surgery)
What is a prostatectomy?
A prostatectomy is the surgical removal of part or all of the prostate. The prostate is a walnut-sized gland in men that produces a portion of the fluid that makes up semen. It lies in front of the rectum, under the bladder, and surrounds the urethra. The urethra is the tube that carries urine from the bladder through the penis and out of the body.
Your doctor may recommend a prostatectomy for prostate cancer or enlarged prostate (benign prostatic hyperplasia, or BPH). BPH is the enlargement of the prostate with age. It is a common condition that causes problems with urination. These include incontinence and the inability to begin urinating or to fully empty the bladder.
A prostatectomy is a major surgery with serious risks and potential complications. You may have less invasive treatment options. These include procedures that use heat, such as with a laser or electrical current, to destroy prostate tissue. Consider getting a second opinion about all of your treatment choices before having a prostatectomy.
Types of prostatectomy
The major types of prostatectomy include:
Simple prostatectomy is the removal of just the inside portion of the prostate gland to treat benign prostatic hyperplasia (BPH). A simple prostatectomy involves making a cut from your belly button to your pubic bone to access and remove the inside of the prostate gland.
Radical prostatectomy is the removal of the entire prostate and some of the lymph nodes near it to help treat prostate cancer. A radical prostatectomy involves making a cut or series of smaller cuts under your testicles or above your pubic bone to access and remove the prostate and other tissues. This may include nearby lymph nodes.
Transurethral resection of the prostate (TURP) is the removal of all or part of the prostate to treat benign prostatic hyperplasia (BPH). Sometimes, a surgeon may choose TURP for treating prostate cancer in older or ill men who cannot tolerate a radical prostatectomy.
The surgeon accesses the prostate through your urethra using a tube-shaped tool called a cystoscope. The surgeon then removes part or all of your prostate in pieces using electric current.
Why is a prostatectomy performed?
Your doctor may recommend a prostatectomy to treat prostate cancer. Prostate cancer causes frequent urination, painful urination, painful ejaculation, and other symptoms. It can spread (metastasize) to other organs and body systems, such as the bones, liver and lungs.
Prostatectomy may also alleviate the symptoms of an enlarged prostate, or benign prostatic hyperplasia (BPH). BPH is a noncancerous condition in which the prostate enlarges as a man ages. When the prostrate grows, it can press against the urethra and bladder. This can cause sudden urination, incontinence, painful urination, and incomplete emptying of the bladder.
Your doctor may only consider a prostatectomy for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a prostatectomy.
Who performs a prostatectomy?
A urologist performs a prostatectomy. A urologist is a doctor and surgeon who specializes in diseases and conditions of the urinary tract and the male reproductive organs.
How is a prostatectomy performed?
Your prostatectomy will be performed in a hospital, a surgeon’s private office, or an outpatient surgery clinic. It involves making incisions in the lower abdomen or behind the genitals, or inserting a small tube (cystoscope) through the urethra.
The surgeon then cuts away part or all of the prostate from the tissues around it. The surgeon may also remove nearby lymph nodes if the surgery is for prostate cancer. The surgeon will tie off the remaining blood vessels and reattach the urethra to the bladder if the entire prostate is removed.
Surgical approaches to prostatectomy
Your doctor will perform a prostatectomy using one of the following approaches:
Minimally invasive prostatectomy involves inserting special instruments and a laparoscope through small incisions in the lower abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees your prostate on the screen while performing the surgery. Your surgeon may also use a surgical robotic system for a laparoscopic prostatectomy. Your surgeon directs a robotic device from a nearby computer to perform many steps of the surgery. Minimally invasive prostatectomy generally involves a faster recovery and less pain and risk of complications than open prostatectomy. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. Transurethral resection of the prostate (TURP) involves accessing your prostate with a thin tube inserted into your urethra called a cystoscope. Your surgeon then removes part or all or your prostate using a tool that is threaded through the cystoscope.
Open prostatectomy involves making an incision that runs from the belly button to the pubic bone for a radical retropubic prostatectomy. A radical perineal prostatectomy uses an incision that runs from the rectum to the base of the scrotum. Open prostatectomy allows your surgeon to directly view and access the surgical area. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon may decide after beginning a minimally invasive prostatectomy that you require an open prostatectomy to safely and most effectively complete your surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different prostatectomy procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your doctor will perform a prostatectomy using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your prostatectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A team member will insert a catheter inserted into your bladder to collect urine after you are asleep.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a prostatectomy?
As with all surgeries, a prostatectomy involves risks and possible complications. Most prostatectomy procedures are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of prostatectomy
The majority of prostatectomy procedures are successful. However, complications of prostatectomy can occur and may become serious. Potential complications include:
Damage to nearby organs including the urethra, bladder or rectum
Development of scar tissue on the urethra, which could tighten the urethra and cause a urethral stricture making it difficult to urinate
Impotence (problems with erections)
Opening of external incision(s)
Retrograde ejaculation in which the flow of semen is misdirected into the bladder instead of out the urethra
Transurethral resection syndrome (TUR syndrome), a complication of transurethral resection of the prostate (TURP). In TUR syndrome, a fluid mixture used during the surgery damages tissues surrounding the prostate.
Urinary or bowel incontinence
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, bloody urine, fever, increase in pain, decreased urination, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my prostatectomy?
You are an important member of your own healthcare team. The steps you take before surgery can significantly improve your comfort and outcome.
You can prepare for a prostatectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit or in an emergency situation. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a prostatectomy? Are there any other options for treating my condition?
What type of prostatectomy procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
How long should I wait to have sex after the surgery?
What assistance will I need at home?
How long will I need to have a tube in my bladder (urinary catheter) after the surgery?
What medications will I need before and after the surgery?
How should I take my regular medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my prostatectomy?
Knowing what to expect can help make your road to recovery after prostatectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will have a catheter in your penis. This tube is in place to drain urine from your bladder and give your urethra time to heal. Your catheter will stay in place from a few days to a few weeks, depending on the type of prostatectomy that you had.
You may also have a small tube in your lower abdomen that is attached to a bag into which fluid from the surgical site can drain. Your healthcare team will most likely remove this tube before you leave the hospital.
You may go home the same day of your surgery after a laparoscopic prostatectomy or TURP. Otherwise, you may stay for up to about four days. Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes a few weeks to a few months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your doctor or care team if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a prostatectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding of your incision, urine that is more bloody than expected, or bleeding from your penis
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to have a bowel movement or pass gas
Not producing enough urine
Pain that is not controlled by your pain medication, new pain, or severe abdominal or pelvic pain
Sudden and new abdominal swelling
Unexpected drainage, pus, redness or swelling of your incision
How might prostatectomy affect my everyday life?
A prostatectomy can help cure prostate cancer or greatly alleviate the symptoms of enlarged prostate so you can lead a more active, healthy life. If your prostate was enlarged by benign prostatic hyperplasia (BPH) or prostate cancer, a prostatectomy may help you gain better urination control and relieve pain with urination.
Life after a prostatectomy generally includes performing many of your former everyday activities, such as exercising, traveling, working, and having a healthy sex life.
In some cases, a prostatectomy changes sexual function. You will no longer ejaculate if your surgeon removed your entire prostate. You may also need medication or devices to help you gain and maintain erections.
Talk to your surgeon about how different prostatectomy procedures might affect sexual function and which procedure is best for your condition and lifestyle goals.