Prostatectomy

A prostatectomy is a surgical procedure to remove all or part of the prostate gland, a small gland in men that produces fluid for semen. It is most commonly performed to treat prostate cancer, but it can also be done for severe non-cancerous enlargement of the prostate (benign prostatic hyperplasia or BPH) when other treatments haven't worked.

What is Prostatectomy?

A prostatectomy is a surgical operation that removes all or part of the prostate gland, a small gland located below the bladder in men. This procedure is primarily used to treat prostate cancer, but it can also address severe non-cancerous enlargement of the prostate (benign prostatic hyperplasia or BPH) that causes significant urinary problems.

The prostate gland is about the size of a walnut and surrounds the urethra, the tube that carries urine and semen out of the body. Its main job is to produce fluid that nourishes and transports sperm. There are two main types of prostatectomy. A radical prostatectomy removes the entire prostate gland, along with the seminal vesicles (glands that produce semen) and sometimes nearby lymph nodes. This type is typically performed to treat prostate cancer. A simple prostatectomy, on the other hand, removes only the enlarged part of the prostate gland. This procedure is usually done to relieve severe urinary symptoms caused by benign prostatic hyperplasia (BPH), a non-cancerous condition where the prostate grows too large.

Why it's done

Prostatectomy is most often performed to treat prostate cancer that is confined to the prostate gland or has spread only slightly. It is also an option for men with severe symptoms from an enlarged prostate (benign prostatic hyperplasia or BPH) when medications or less invasive procedures have not been effective in relieving urinary difficulties.

For prostate cancer, a radical prostatectomy aims to remove all cancerous tissue. This is a common treatment choice for localized prostate cancer, meaning the cancer has not spread beyond the prostate. Your doctor will consider the cancer's aggressiveness, your overall health, and your preferences when recommending this surgery. In cases of benign prostatic hyperplasia (BPH), the enlarged prostate can press on the urethra, making it hard to urinate. Symptoms can include a weak urine stream, frequent urination, and difficulty emptying the bladder. A simple prostatectomy can relieve these symptoms by removing the obstructive tissue. While prostatectomy is effective, it is usually considered after other treatments have been explored. For BPH, medications are often tried first. For prostate cancer, other options like radiation therapy, active surveillance, or hormone therapy might be discussed depending on the specific situation.

How to prepare

Preparing for a prostatectomy involves several important steps to ensure your safety and the best possible outcome. You will need to discuss all your medications with your doctor, stop taking certain drugs like blood thinners, and follow specific instructions regarding eating and drinking before surgery.

Before your surgery, your medical team will provide detailed instructions. It is crucial to tell your doctor about all medications, supplements, and herbal remedies you are taking. You will likely need to stop taking blood-thinning medications, such as aspirin, ibuprofen, or warfarin, several days or weeks before the procedure to reduce the risk of bleeding. You will also be asked to stop eating and drinking for a certain period, usually starting the night before surgery. This is important to prevent complications related to anesthesia. Your doctor may also recommend a bowel preparation, which involves taking laxatives or enemas to clear your bowels before the operation. It's a good idea to arrange for someone to drive you home after your hospital stay and to help you during the initial recovery period. Discuss any concerns or questions you have with your surgical team beforehand to feel more prepared and reduce anxiety.

What happens during

During a prostatectomy, you will receive general anesthesia to ensure you are asleep and pain-free. The surgeon will make an incision, remove the prostate gland (or part of it), and then reconnect the urethra to the bladder. A catheter will be placed to drain urine, and a surgical drain may be used to remove excess fluid.

Once you are under general anesthesia, the surgeon will begin the procedure. There are several approaches: Open surgery: The surgeon makes a single incision in your lower abdomen (retropubic approach) or between your anus and scrotum (perineal approach). Laparoscopic surgery: Several small incisions are made in your abdomen. The surgeon uses special long-handled instruments and a camera to view and remove the prostate. Robotic-assisted laparoscopic surgery: This is a type of laparoscopic surgery where the surgeon controls robotic arms from a console to perform the operation with enhanced precision and visualization. For a radical prostatectomy, the entire prostate gland, seminal vesicles, and sometimes nearby lymph nodes are removed. For a simple prostatectomy, only the enlarged inner part of the prostate is removed. After the prostate is removed, the surgeon will carefully reattach the urethra to the bladder. At the end of the surgery, a thin, flexible tube called a urinary catheter is inserted into your bladder through your urethra to drain urine. This catheter usually stays in place for one to three weeks to allow the area to heal. A temporary surgical drain might also be placed near the incision to remove any fluid buildup.

Recovery & timeline

Recovery from a prostatectomy typically involves a hospital stay of one to four days, followed by several weeks or months of healing at home. You will have a urinary catheter for one to three weeks, and activity restrictions, especially regarding heavy lifting, will be necessary during the initial recovery period.

After surgery, you will spend some time in a recovery room before moving to a hospital room. Pain medication will be provided to manage any discomfort. Nurses will monitor your vital signs and help you get out of bed and walk short distances, which is important for preventing complications like blood clots. The urinary catheter is a key part of recovery and will remain in place for about one to three weeks. Your doctor will give you instructions on how to care for it at home. Once the catheter is removed, you may experience some temporary urinary incontinence (leakage), which often improves over time with pelvic floor exercises (Kegel exercises). You should avoid strenuous activities, heavy lifting, and vigorous exercise for several weeks or months, as advised by your surgeon. Most people can return to light activities and work that doesn't involve physical strain within a few weeks. Full recovery, including the return of urinary control and erectile function, can take several months to a year or even longer.

Risks & side effects

Like any major surgery, prostatectomy carries potential risks and side effects. Common side effects include temporary or permanent urinary incontinence (leakage) and erectile dysfunction (difficulty getting or keeping an erection). Other risks include bleeding, infection, damage to nearby organs, and complications related to anesthesia.

Urinary Incontinence: This is a very common side effect, especially immediately after catheter removal. Many men experience some degree of leakage, ranging from a few drops to a complete loss of bladder control. While it often improves significantly over several months, some men may experience long-term incontinence. About 1 in 5 to 1 in 3 men (20-33%) may still have some incontinence at one year, depending on the definition and surgical technique. Erectile Dysfunction (ED): Difficulty achieving or maintaining an erection is also very common after prostatectomy because the nerves responsible for erections run very close to the prostate. While nerve-sparing techniques can help, they do not guarantee full erectile function will return. Recovery of erectile function can take up to two years, and many men may require medication or other treatments to help. Other potential risks include bleeding during or after surgery, which may require a blood transfusion, and infection at the surgical site or in the urinary tract. Rarely, there can be damage to nearby organs like the rectum or bladder. Anesthesia itself carries risks, such as allergic reactions or breathing problems. A less common side effect is bladder neck contracture, where scar tissue narrows the opening of the bladder, making urination difficult. This may require an additional procedure to correct. Your surgical team will discuss all potential risks with you before the procedure.

Success rate

For localized prostate cancer, prostatectomy has a high success rate in removing the cancer and achieving long-term survival. For benign prostatic hyperplasia (BPH), it is highly effective at relieving severe urinary symptoms. While successful in treating the underlying condition, common side effects like urinary incontinence and erectile dysfunction are important considerations.

When performed for localized prostate cancer, radical prostatectomy is considered a highly effective treatment. Studies show excellent long-term survival rates for men whose cancer is confined to the prostate and successfully removed. The specific success rate depends on factors like the cancer's stage, grade, and the patient's overall health. For men undergoing a simple prostatectomy for severe benign prostatic hyperplasia (BPH), the procedure is very successful in relieving urinary obstruction and improving symptoms. Most men experience a significant improvement in their urine flow and a reduction in bothersome urinary symptoms. It is important to understand that "success" in prostatectomy often refers to the primary goal of treating the disease. While effective in this regard, the common side effects of urinary incontinence and erectile dysfunction can significantly impact quality of life. Many men find these side effects improve over time, but some may experience them long-term. Your doctor will help you weigh the benefits of treatment against these potential side effects.

Frequently asked questions

How long will I have a catheter after prostatectomy?

You will typically have a urinary catheter in place for one to three weeks after your prostatectomy. This allows the area where your urethra was reconnected to your bladder to heal properly. Your doctor will provide specific instructions on how to care for the catheter at home before it is removed.

Will I be able to have sex after prostatectomy?

Many men experience erectile dysfunction (difficulty getting or keeping an erection) after prostatectomy because the nerves controlling erections are close to the prostate and can be affected. While nerve-sparing techniques can help, it can take months or even up to two years for erectile function to recover, and some men may need medication or other treatments to assist with erections.

How soon can I return to work after prostatectomy?

The time it takes to return to work varies depending on the type of surgery, your recovery, and the nature of your job. Most people can return to light activities and non-strenuous work within a few weeks after the catheter is removed. If your job involves heavy lifting or strenuous activity, you may need several months before returning.

Will I leak urine after prostatectomy?

Yes, urinary incontinence (urine leakage) is a very common side effect immediately after the catheter is removed. This can range from occasional drops to more significant leakage. While it often improves significantly over several months with pelvic floor exercises, about 1 in 5 to 1 in 3 men (20-33%) may still experience some degree of incontinence at one year.

Are there alternatives to prostatectomy for prostate cancer?

Yes, for localized prostate cancer, there are several alternatives to prostatectomy. These include radiation therapy (external beam or brachytherapy), active surveillance (monitoring the cancer without immediate treatment), and hormone therapy. Your doctor will discuss these options with you based on your specific cancer characteristics and overall health.

What is the difference between radical and simple prostatectomy?

A radical prostatectomy removes the entire prostate gland, seminal vesicles, and sometimes nearby lymph nodes, primarily to treat prostate cancer. A simple prostatectomy, on the other hand, removes only the enlarged inner part of the prostate gland to relieve severe urinary symptoms caused by benign prostatic hyperplasia (BPH), a non-cancerous condition.

Sources

• MedlinePlus — Prostatectomy
• Mayo Clinic — Prostatectomy
• Cochrane Library — Prostatectomy