What is Prostatectomy Surgery

A surgical OPERATION to remove part or all of the PROSTATE GLAND. The prostate gland encircles the URETHRA at the base of the BLADDER. It produces the fluid that mixes with SPERM to form SEMENand produces the enzyme PROSTATE-SPECIFIC ANTIGEN (PSA), which facilitates sperm motility after EJACULATION. Prostatectomy is primarily treatment for PROSTATE CANCER and BENIGN PROSTATIC HYPERPLASIA (BPH) that constricts the urethra to the extent that it interferes with URINATION. Removal of the prostate gland ends a man’s FERTILITY though not necessarily his ability to have and ERECTION and ORGASM.

Prostatectomy Surgical Procedure

Surgeons may choose from a number of operations to remove the prostate gland. The choice depends on the reason for the operation, the size of the prostate gland, and the man’s overall health status. There are six commonly performed prostatectomy operations: transurethral retrograde prostatectomy (TURP), transurethral incision of the prostate (TUIP), three open prostatectomy operations (suprapubic, retropubic, and perineal), and radical open prostatectomy.

Transurethral retrograde prostatectomy (TURP)

TURP has long been the standard, and remains the most common, surgical operation to remove obstructive prostate gland tissue due to BPH (noncancerous prostate gland enlargement) when the prostate gland remains relatively small. The surgeon uses an endoscopic instrument called a resecting cystoscope or resectoscope, inserted through the PENIS and urethra to the prostate gland.

The surgeon passes a cutting tool through the resectoscope to make an incision through the urethra and remove part or all of the prostate gland by shaving away layers of tissue. After removing the prostate gland the surgeon sutures the urethra back to the neck of the bladder. The removed shreds of tissue collect in the bladder and pass out with the URINE over the first few days after surgery. TURP generally requires three days in the hospital and two to four weeks recovery time until full return to normal activities. A man who has had a TURP usually retains erectile function though has RETROGRADE EJACULATION (ejaculation into the bladder).

Transurethral incision of the prostate (TUIP)

TUIP is a cystoscopic procedure in which the surgeon makes a series of small incisions through the urethra into the prostate gland. The incisions relieve the pressure the enlarged prostate gland is exerting against the urethra, without removing prostate tissue, restoring the free flow of urine. TUIP is treatment only for noncancerous prostate enlargement, such as BPH, and is used only in limited circumstances that depend on the size and structure of the prostate gland. TUIP is often an AMBULATORY SURGERY procedure (a same-day surgery) with full return to normal activities in three to five days. Erectile and ejaculatory functions nearly always remain normal.

Open prostatectomy

The three operations of open prostatectomy, sometimes called simple prostatectomy, involve making an incision through the surface of the SKIN to reach the prostate gland. The incision for suprapubic or retropubic prostatectomy extends from the navel (belly button). In the suprapubic approach the surgeon reaches the prostate gland through the bladder. In the retropubic approach the surgeon reaches the prostate gland without entering the bladder. The incision for perineal prostatectomy is between the SCROTUM and the ANUS. Open prostatectomy removes the prostate gland and seminal vesicles intact. The surgeon may also remove nearby LYMPH nodes (lymphadenectomy) when the operation is to treat prostate cancer.

Open prostatectomy is major surgery that requires a stay of up to eight days in the hospital and six to eight weeks recovery (sometimes longer) before return to regular daily activities. There is moderate risk for significant complications such as bleeding, URINARY INCONTINENCE, and damage to the nerves that supply the penis resulting in ERECTILE DYSFUNCTION.

Radical prostatectomy

Radical prostatectomy is a treatment for prostate cancer in which the surgeon removes the prostate gland, seminal vesicles, and surrounding tissue (fat, MUSCLE, and connective tissue) during an operation that can take five hours or longer. Often the surgeon removes adjacent lymph nodes as well. Radical prostatectomy is major surgery that requires about 10 days in the hospital and up to four months for recovery. Radical prostatectomy is treatment for prostate cancer and has a high risk for complications such as urinary incontinence and erectile dysfunction, though these complications may improve over time.

In some circumstances the surgeon may opt to perform radical prostatectomy laparoscopically, inserting a laparoscope and surgical instruments through several small incisions in the abdomen. The laparoscopic approach significantly lessens the risk for complications and shortens recovery time, though the operation is nonetheless major surgery. Sometimes the surgeon may use laparoscopic surgery to remove pelvic lymph nodes while using the open perineal approach to remove the prostate gland.

Risks and Complications

Prostatectomy, particularly an open or radical approach, is extensive surgery with potential complications that require careful consideration. Among them are excessive bleeding during or after surgery that may necessitate BLOOD TRANSFUSION, INFECTION, retrograde ejaculation, urinary incontinence, bladder damage, rectal damage, and erectile dysfunction. Generalized risks include reaction to ANESTHESIA and blood clots. The risk for complications depends on the reason for the prostatectomy (cancer or noncancerous condition), the type of operation, age, and overall health status. Surgeons prescribe prophylactic antibiotics to help prevent infection and antiembolism therapies such as ANTICOAGULATION THERAPY and compression stockings or boots to help prevent blood clots.

Outlook and Lifestyle Modifications

For many men, prostatectomy ends the symptoms of the condition that necessitated the operation. Because the prostate gland continues to slowly enlarge as a man ages, about 20 percent of men who have TURP to treat BPH find their symptoms return in 10 to 15 years, requiring additional treatment. Many men are able to return to normal activities, including sexual activities, within a few months of their surgeries. However, prostate cancer may require adjuvant (follow-up or accompanying) treatment after surgery.

See also ANTIBIOTIC PROPHYLAXIS; CANCER TREATMENT OPTIONS AND DECISIONSSURGERY BENEFIT AND RISK ASSESSMENT.

Prostatectomy surgery / radical – risks and side effects
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