Learn about surgical options and advances in prostatectomy, including robotic surgery, as well as the risks involved with each approach.
Prostatectomy is surgery to remove part or all of the prostate gland. The prostate gland is situated in the male pelvis, below the urinary bladder. It surrounds the urethra, which carries urine from the bladder to the penis.
The procedure is used to treat a number of conditions affecting the prostate. It's most commonly used as a treatment for prostate cancer.
Prostatectomy can be performed in several ways, depending on the condition involved. Options include minimally invasive surgery performed with robotic assistance and traditional open surgery.
Most often, prostatectomy is done to treat localized prostate cancer. It may be used alone, or in conjunction with radiation, chemotherapy and hormone therapy.
Radical prostatectomy is surgery to remove the entire prostate gland and surrounding lymph nodes to treat men with localized prostate cancer. A surgeon can perform a radical prostatectomy using different techniques, including:
Less often, simple prostatectomy may be recommended for men with severe urinary symptoms and very enlarged prostate glands. Enlarged prostate glands are known as benign prostatic hyperplasia, or BPH.
Simple prostatectomy is usually performed as a minimally invasive procedure with robotic assistance. It's not often done as an open procedure anymore.
Simple prostatectomy to treat BPH doesn't always involve removing the entire prostate, as in a radical prostatectomy. Instead, this procedure removes just the part of the prostate that's blocking the flow of urine. The surgery eases urinary symptoms and complications resulting from blocked urine flow, including:
Your surgical team will discuss the advantages and disadvantages of each technique, as well as your preferences, to determine which approach is best for you.
In addition to the risks associated with any surgery, risks with radical prostatectomy include:
Although simple prostatectomy works well at relieving urinary symptoms, it has a higher risk of complications and a longer recovery time than other enlarged prostate procedures such as transurethral resection of the prostate (TURP), laser PVP surgery or holmium laser prostate surgery (HoLEP).
Risks of open simple prostatectomy include:
Before surgery, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). Cystoscopy lets your doctor check the size of your prostate and examine your urinary system. Your doctor may also want to perform other tests, such as blood tests or tests to specifically measure your prostate and to measure urine flow.
Follow your doctor's instructions on what to do before your treatment. Here are some issues to discuss with your doctor:
Plan ahead to avoid wearing these items into surgery:
Ask your doctor how long you'll be in the hospital. You'll want to arrange in advance for a ride home, because you won't be able to drive immediately following surgery.
You may not be able to work or do strenuous activities for several weeks after surgery. Ask your doctor how much recovery time you may need.
Prostatectomy is usually done using general anesthesia, which means you're not awake during the procedure. Your doctor may also give you an antibiotic right before surgery to help prevent infection.
Robot-assisted radical prostatectomy. Your surgeon sits at a remote-control console a short distance from you and the operating table and precisely controls the motion of the surgical instruments using two hand-and-finger control devices. The console displays a magnified, 3D view of the surgical area that enables the surgeon to visualize the procedure in much greater detail than in traditional laparoscopic surgery.
The robotic system allows smaller and more-precise incisions, which for some men promotes faster recovery than traditional open surgery does. Just as with open retropubic surgery, the robotic approach enables nerve-sparing techniques that may preserve both sexual potency and continence in the appropriately selected person.
Simple prostatectomy. At the start of the procedure, your doctor may insert a long, flexible viewing scope (cystoscope) through the tip of your penis to see inside the urethra, bladder and prostate area. Your doctor will then insert a tube (Foley catheter) into the tip of your penis that extends into your bladder to drain urine during the procedure. The location of incisions will depend on what technique your doctor uses. If you also have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it.
Once your doctor has removed the part of your prostate causing symptoms, one to two temporary drain tubes may be inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder (suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After surgery you should expect that:
Make sure you understand the post-surgery steps you need to take, and any restrictions such as driving or lifting heavy things:
During an open prostatectomy, one large incision is made in your abdomen (left). During a robotic prostatectomy, several smaller incisions are made in the abdomen (right).
Robot-assisted prostatectomy can result in reduced pain and blood loss, reduced tissue trauma, a shorter hospital stay, and a quicker recovery period than a traditional prostatectomy. You usually can return to normal activity, with minor restrictions, around four weeks after surgery.
Simple prostatectomy provides long-term relief of urinary symptoms due to an enlarged prostate. Although it's the most invasive procedure to treat an enlarged prostate, serious complications are rare. Most men who have the procedure generally don't need any follow-up treatment for their BPH.