This article has been reviewed and approved by Dr Deepak Bolbandi for authenticity and medical correctness on 01 Aug 2020

All about Prostatectomy

Prostatectomy or prostate removal surgery is to remove a part or whole of the prostate gland. The surgeon will also remove some tissues close to it and nearby lymph nodes.

In a radical prostatectomy, the surgeon will remove the prostate and the seminal vesicles. You will have this mainly for prostate cancers.

In a partial prostatectomy, the surgeon will remove only a part of the prostate gland. You will have this surgery for benign enlargements of the prostate.

You will have open, laparoscopic or robotic surgery to remove the prostate. Open surgery will need a large incision, while laparoscopic surgery will need only two or three small incisions. You will recover faster with laparoscopic surgery than open surgery. Robotic surgery is the latest and most advanced method.

Removing the prostate can create some sexual side effects. The doctors will take the age of the patient as a factor before considering the surgery.

When to do a prostatectomy?

You will have a prostatectomy if the prostate enlarges in size and causes problems. 

Prostate glands are small walnut-shaped glands that lie close to the urinary bladder only in men. Its primary function is to produce a component of the semen. The urethra, the tube that removes urine from the bladder, passes through the prostate. 

Any enlargement of the prostate can put pressure on the urethra. It will cause problems during urination. It will block the flow of urine or make it very weak.

Most enlargements of the prostate are not cancers. Benign prostatic hyperplasia(BHP), where the prostate increases in size, is the most common cause. 

Prostate cancers are one of the other common reasons for prostate enlargement. In this, the cells of the prostate start multiplying without control. 

An enlarged prostate, whatever be the cause, will give you many problems. By having a prostatectomy, you will get relief from the symptoms.

In cases of prostate cancers, it helps to prevent the spread of the disease to other parts of the body.

If you have benign enlargement of the prostate, your doctors will give you medicines. The medicines will help to relieve pressure in the urethra to control your symptoms. If it does not work, you will have procedures like TURP, TUIP, etc., to trim the gland. It also helps to relieve the pressure on the urethra. 

You will have a prostatectomy if these procedures also do not give the desired results. It may be partial or a radical one.

Another reason is if you have prostate cancer that has not spread outside. It helps to prevent the disease from growing and spreading to other parts of the body. For cancers that have spread outside, the treatments will be different.

Types of prostatectomy

  • Radical prostatectomy- It involves the removal of the prostate gland along with the seminal vesicles. The surgeon will also remove the nearby lymph nodes in cases of prostate cancers.
  • Partial prostatectomy- You will have this for benign enlargements of the prostate. The surgeon will remove only the part of the gland that presses on the urethra. It helps to avoid most of the sexual problems that happen after the complete removal of the prostate.

There are different techniques for doing a prostatectomy. 

  • Open surgery- In this, the surgeon will remove the gland through a single large incision. The incision will be in the lower part of the abdomen or just below the scrotum.
  • Laparoscopic surgery- You will have two or three small incisions in the lower part of your abdomen to remove the prostate. The surgeon will insert a camera through one of the incisions. The other two incisions are to insert small surgical instruments to remove the gland.
  • Robotic radical prostatectomy is the latest and most advanced method. It is a high precision surgery with less complications, short hospital stay,quick recovery, and very high success rates

Preparation for prostatectomy

You will have some tests to know the size of the prostate and the problems with the flow of urine. It helps the doctor decide on the extent of tissue to remove if you have a partial prostatectomy.

If the biopsy confirms cancer, you will have tests like MRI, CT, PET scans, etc. to ensure it has not spread outside. The treatment will vary if cancer has spread.

The doctor will also check whether you are healthy enough to have surgery. 

You will have to stop medicines like blood thinners a few days before surgery. It is to avoid any unnecessary bleeding. Some herbal supplements will also cause blood to get thin, so you need to stop them.

If you smoke, you need to stop. Or else, it may delay the healing of the wound and prolong your recovery.

The doctors will also tell you about the side effects and how to take care of it. You will have to prepare yourself to accept these and to have a mind to wait for it to get better.

Prostatectomy procedure

Before surgery- You will be in the hospital the night before surgery. The doctors will do a final check to ensure that your fit for the surgery the next day. You will not eat or drink anything 6-8 hours before the operation. In the night, you will have a mild sedative to help you relax and sleep better. The next day morning, you will go to the operating room at a fixed time.

During the surgery- You will have either spinal or general anesthesia before surgery. Having general anesthesia means you will sleep through the operation. With spinal anesthesia, you will feel numb from the waist downwards, but you will be awake.

The doctors will start the procedure by making incisions in the lower part of the abdomen. In open surgery, you will have one long incision and laparoscopic you will have to or three small incisions. 

Then the doctors will go on to remove the gland. Once this is complete, the doctors will close the incisions with the help of sutures or staples. They will leave a drain to remove any fluids that form at the site of operation. It completes the surgery.

 After the surgery- the doctors will move you to an observation room to watch you closely. You will be there for two or three hours. Once you come out of the effects of anesthesia, you will go back to your room.

Recovery- Once in your room, you will feel drowsy and tired. You may also have a little pain that goes away with painkillers. You will be able to sit up in bed after a few hours. 

The doctors will ask you to walk a few steps in the room now and then. It helps improve your blood circulation and prevent any clots from forming in the large veins of your legs. You will be able to go home the next day if everything is fine.

Risks and complications of prostatecomy

A prostatectomy is a safe surgery with fewer risks. The common risks are

  • Bleeding during surgery
  • Blood clots in the veins of the legs
  • Breathing problems
  • Infection of the wound 
  • Reactions to anesthesia

 

You will be able to prevent these by taking proper precautions.

Side effects of prostatecomy

You may have both urinary and sexual problems after a prostatectomy. In most cases, these will be temporary. These include

  • Pain while passing urine
  • Total urinary obstruction
  • Urinary incontinence. 
  • Having to strain to pass urine 
  • Having a very weak flow of urine
  • Erectile dysfunction- A condition where a person feels to achieve an erection. The problem may resolve after a few weeks in most. But in some, it may last for a long time.
  • Retrograde ejaculation- During an orgasm, the semen instead of going out through the penis goes back to the urinary bladder. There will not be any change in the pleasure you will have, but your orgasm will be 'dry.'
  • Change in penis length- This happens in a few and will not affect any sexual relations. But some may feel emotionally disturbed

Prostatectomy In India
Prostatectomy In India

References / Additional Reading
This article has been reviewed by Dr Deepak Bolbandi for authenticity and medical correctness on 01 Aug 2020
Dr Deepak Bolbandi
Dr Deepak Bolbandi
MBBS, MS, DNB, MCh (Urology)
Dr.Deepak Bolbandi is a Senior Consultant Urologist and Transplant Surgeon working with Apollo Hospitals Group. He is rated among the best in the country. He is the First Urologist to Enter Guinness Book of World Records when he removed maximum number of stones from a Single Kidney. Dr. Bolbandi has performed more than 5000 kidney stone surgeries and more than 2000 prostrate surgeries. He is an expert at Laparoscopic Nephrectomy, Laparoscopic Pyeloplasty, and Surgery for Retrocaval Ureter. He also does Laparoscopic procedures for stone Disease and complex Adrenal surgeries.
Read more...