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Simple prostatectomy

Definition

Simple prostate removal is a surgery to remove all or part of the prostate gland through a surgical cut in your lower belly, to treat an enlarged prostate.

See also:

• Benign prostatic hypertrophy
• Prostate resection - minimally invasive
• Transurethral resection of the prostate

Alternative Names

Prostatectomy - simple; Suprapubic prostatectomy; Retropubic simple prostatectomy; Open prostatectomy

Description

You will be given general anesthesia (asleep, pain-free) or spinal anesthesia (sedated, awake, pain-free). The procedure takes about 2 to 4 hours.

Your surgeon will make an incision (cut) in your lower belly, from below the belly button to just above the penis. The prostate gland is removed through this cut.

Often, the surgeon removes only the inner part of the prostate gland. The outer portion is left behind (similar to scooping out the inside of an orange). After removing part of your prostate, the surgeon will close the outer shell of the prostate with stitches A drain may be left in your belly to help remove extra fluids after surgery.

Why the Procedure Is Performed

An enlarged prostate can cause problems with urinating and urinary tract infections. Removing part of the prostate gland can often make these symptoms better. Before you have surgery, your doctor will suggest you make changes in how you eat or drink. You may also be asked to try taking medicine.

Prostate removal can be performed many different ways, depending on the size of the prostate and what caused your prostate to grow.

Prostate removal may be recommended if you have:

• Difficulty emptying your bladder (urinary retention)
• Frequent urinary tract infections
• Frequent bleeding from the prostate
• Bladder stones with prostate enlargement
• Extremely slow urination
• Damage to the kidneys

Your prostate may also need to be removed if taking medicine and changing your diet do not help your symptoms.

You may have open prostatectomy, if your prostate is very large or your doctor thinks or confirms that you have cancer. You may also have this procedure if you have other problems, such as stones or bladder damage.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Additional risks are:

• Problems with urine control (incontinence)
• Problems with fecal control (bowel incontinence)
• Loss of sperm fertility (infertility)
• Erection problems (impotence)
• Passing semen back up into the bladder instead of out through the urethra (retrograde ejaculation)
• Urethral stricture (tightening of the urinary outlet from scar tissue)
• Damage to internal organs and structures

Before the Procedure

You will have many visits with your doctor and tests before your surgery:

• Complete physical exam
• Visits with your doctor to make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems, are being treated well

If you are a smoker, you should stop several weeks before the surgery. Your nurse or doctor can help.

Always tell your doctor or nurse what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the weeks before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• Sometimes, you may take a special laxative the day before your surgery. This will clean the contents out of your colon.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for about 3 to 4 days.

You will need to stay in bed until the next morning. Afterwards, you will be asked to move around as much as possible. Your nurse will help you change positions in bed, show you exercises to keep blood flowing, and recommend coughing/deep breathing techniques. You should do these every 3 to 4 hours. You may need to wear special compression stockings and use a breathing device to keep your lungs clear.

You will return from surgery with a Foley catheter in your bladder. Some men have a suprapubic catheter in their belly wall to help drain the bladder.

Outlook (Prognosis)

Many men recover fully in about 6 weeks. You can expect to regain normal urination function, without leakage.

References

Han M, Partin AW. Retropubic and suprapubic open prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 89.