Prostatectomy
Procedure
(Prostate Gland Removal)
Definition
A prostatectomy is a surgery to remove the prostate gland. The prostate gland is part of the male reproductive system. It makes and stores the milky fluid that forms part of semen. The gland sits below the bladder and in front of the rectum. The urethra (the tube that carries urine out of the body) runs through the prostate gland.
The procedure may be:
- Simple prostatectomy—part of the prostate is removed
- Radical prostatectomy—the entire prostate and some surrounding tissue is removed
Copyright © 2002 Nucleus Communications, Inc. All rights reserved.
http://services.epnet.com/getimage.aspx?imageiid=25482548si1208.jpgAnatomy of the Prostate GlandNULLjpgAnatomy of the Prostate GlandNULL\\filer01\Intellect\images\si1208.jpgCopyright © 2002 Nucleus Communications, Inc. All rights reserved.22NULL2002-10-012553912548_14854Copyright © Nucleus Medical Media, Inc.Reasons for Procedure
A simple prostatectomy may be done to remove an enlarged prostate that is not cancerous. A common cause of this type of growth is called benign prostatic hyperplasia (BPH). It can interfere with the flow of urine out of the body. The surgery is done to remove extra tissue that is blocking the flow.
A radical prostatectomy may be done to remove a prostate gland and lymph nodes that have cancer.
Possible Complications
Problems are rare, but all procedures have some risk. Your doctor will go over some problems that could happen, such as:
- Bleeding
- Infection
- Problems controlling urine—incontinence
- Erectile dysfunction and other sexual side effects
- Blood clots in the legs or lungs
- Infertility
- Injury to the rectum or other nearby structures
- Narrowing of the urethra or bladder neck
Things that may increase the risk of problems include:
What to Expect
Prior to Procedure
Before surgery your doctor may do:
- A physical exam
- Blood and urine tests
- Chest x-ray
- ECG
- Ultrasound
- Bone scan or CT scan
The surgical team may meet with you to talk about:
- Any allergies you may have
- Whether you need a ride to and from surgery
- Current medicines, herbs, and supplements that you take and if you need to stop taking them before surgery
- Fasting before surgery, such as avoiding food or drink after midnight the night before
Anesthesia
The doctor may give:- General anesthesia—you will be asleep
- Spinal anesthesia—you will be numb from the belly down
Description of Procedure
The procedure can be done as:
- Open surgery—An incision is made in the skin to let the doctor see the prostate.
- Laparoscopic surgery—Very small incisions are needed. The surgery is done with special tools and a tiny camera that is passed through the incisions.
- Robot-assisted surgery—Similar to laparoscopic with use of small incisions, but the surgery is done with robotic tools that the surgeon controls.
Simple Prostatectomy
An incision is made in the lower belly. The doctor will see the prostate through this incision. The inner part of your prostate gland will then be removed. This procedure is not as common in the United States. It may be done if the prostate has grown but there is no cancer.
Radical Retropubic Prostatectomy
An incision will be made in the lower belly between the belly button and pubic bone. The prostate gland and pelvic lymph nodes can be seen through this incision. The prostate will be detached from the bladder and urethra. The urethra is then reattached to the bladder.
A main goal of treatment is to try to keep the nerves that help with the bladder and sexual functions working. Lymph node tissue may also be removed for testing. Your doctor may use these test results to decide if more tissue should be removed.
Perineal Radical Prostatectomy
An incision is made in the skin between the anus and scrotum. The prostate can be detached and removed through this incision. This is a less common surgical option due to:
- Lack of access to the lymph nodes
- Higher risk of nerve damage
Robot-assisted Laparoscopic Radical Prostatectomy (RALRP)
Five small incisions are made in the belly. Robotic arms and a small camera will be passed through these incisions. The robotic tools allow wider and more flexible range of motion. The robotic arms will be controlled by a doctor at a console. The prostate and other tissue will be cut out with these robotic arms. This type of procedure may cause less scarring than other methods.
After the Procedure
A catheter tube will be inserted to drain your bladder. Water may be flushed through the catheter to reduce blood in the urine.
The catheter may be left in place for up to 3 weeks. This will let you urinate more easily during the healing period. After a radical prostatectomy, a drain may also be placed to help fluid drain from the surgery site.
How Long Will It Take?
2 to 4 hours
Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medicines.
Average Hospital Stay
The usual length of stay is 2 to 3 days. You may need to stay longer if there are any problems.
Post-procedure Care
At the Hospital
After surgery the staff may:
- Give you IV pain medicines. Your doctor may give you pain pills to take after the IV is removed.
- Ask you to walk the day of or the day after surgery. You will also be asked to do exercises to move your feet while you are in bed.
During your stay, hospital staff will take steps to lower your risk of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
- Washing your hands often and reminding visitors and staff to do the same
- Reminding staff to wear gloves or masks
- Not letting others touch your incisions
At Home
You will go home with a catheter in place. A urinary catheter is usually needed for 5 to 10 days after surgery. Complete recovery may take up to 6 weeks. During this time you may have to change or restrict activities until your doctor says it is okay. Try to get help at home for a couple of days. You may need to see the doctor in 1 or 2 weeks to have staples taken out.
Problems to Look Out For
Call your doctor if you have:
- Signs of infection, such as fever or chills
- Redness, swelling, more pain, a lot of bleeding, or any discharge from the incision site
- Nausea or vomiting that does not go away
- Pain that you cannot control with the medicines given
- Poor drainage from the catheter
- Belly swelling or pain
- Cough, shortness of breath, or chest pain
- Headaches, muscle aches, light-headedness, or general ill feeling
- Constipation
- Problems urinating (peeing):
- Pain or burning
- Having to urinate suddenly or often
- Blood in the urine that does not go away
If you think you have an emergency, call for medical help right away.
National Cancer Institute
Urology Care Foundation
CANADIAN RESOURCES:
Canadian Cancer Society
Health Canada
National Cancer Institute
Urology Care Foundation
CANADIAN RESOURCES:
Canadian Cancer Society
Health Canada
References
- Basiri, A., de la Rosette, J.J., et al. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World Journal of Urology, 2018; 36: 609-621.
- Benign prostatic hypertrophy (BPH). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/benign-prostatic-hyperplasia-bph.
- Prostate cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/prostate-cancer.
- Prostate cancer treatments—health professional. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq.
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