Prostatectomy (Prostate Removal Surgery)

What is a prostatectomy?

A prostatectomy is the surgical removal of part or all of the prostate. The prostate is a walnut-sized gland in men that produces a portion of the fluid that makes up semen. It lies in front of the rectum, under the bladder, and surrounds the urethra. The urethra is the tube that carries urine from the bladder through the penis and out of the body. Your doctor may recommend a prostatectomy for prostate cancer or enlarged prostate (benign prostatic hyperplasia, or BPH).

BPH is the enlargement of the prostate with age. It is a common condition that causes problems with urination. These include incontinence and the inability to begin urinating or to fully empty the bladder.

A prostatectomy is a major surgery with serious risks and potential complications. You may have less invasive treatment options. These include procedures that use heat, such as with a laser or electrical current, to destroy prostate tissue. You should consider getting a second opinion about all of your treatment choices before having a prostatectomy.

Types of prostatectomy

The major types of prostatectomy include:

• Simple prostatectomy is the surgical removal of just the inside portion of the prostate gland to treat benign prostatic hyperplasia (BPH). A simple prostatectomy involves making a cut from your belly button to your pubic bone to access and remove the inside of the prostate gland.
• Radical prostatectomy is the surgical removal of the entire prostate and some of the lymph nodes near it to help treat prostate cancer. A radical prostatectomy involves making a cut or series of smaller cuts under your testicles or above your pubic bone to access and remove the prostate and other tissues. This may include nearby lymph nodes.
• Transurethral resection of the prostate (TURP) is the surgical removal of all or part of the prostate to treat benign prostatic hyperplasia (BPH). Sometimes, a surgeon may choose TURP for treating prostate cancer in older or ill men who cannot tolerate a radical prostatectomy.

In TURP, your surgeon accesses your prostate through your urethra using a tube-shaped tool called a cystoscope. Your surgeon then removes part or all of your prostate in pieces using electric current.

Why is a prostatectomy performed?

Your surgeon may perform a prostatectomy to help treat prostate cancer. Prostate cancer causes frequent urination, painful urination, painful ejaculation, and other symptoms. It can spread (metastasize) to other organs and body systems, such as the bones, liver and lungs.

Prostatectomy may also alleviate the symptoms of an enlarged prostate, or benign prostatic hyperplasia (BPH). BPH is a noncancerous condition in which the prostate enlarges as a man ages. When the prostrate grows, it can press against the urethra and bladder. This can cause sudden urination, incontinence, painful urination, and incomplete emptying of the bladder.

How is a prostatectomy performed?          

A urologist will lead a surgical team to perform your prostatectomy in a hospital, the surgeon’s private office, or an outpatient surgery clinic. A urologist is a doctor who specializes in the medical and surgical treatment of the urinary tract and genitals.

To remove the prostate, your surgeon makes incisions in your lower abdomen or behind the genitals, or inserts a small tube (cystoscope) through your urethra. Your surgeon then cuts away part or all of the prostate from the tissues around it. Your surgeon may also remove nearby lymph nodes if the surgery is for prostate cancer. Your surgeon will tie off the remaining blood vessels. With removal of the entire prostate, your surgeon may need to reattach the urethra to the bladder.

Surgical approaches to prostatectomy

Your doctor will perform a prostatectomy using one of the following approaches:

• Minimally invasive prostatectomy is performed with a laparoscope. Your surgeon will perform a laparoscopic prostatectomy by inserting special instruments and a laparoscope through small incisions in the lower abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees your prostate on the screen as he or she performs the surgery. Your surgeon may also use a surgical robotic system for a laparoscopic prostatectomy. From a nearby computer, the surgeon directs a robotic device to perform many steps of the surgery. Minimally invasive prostatectomy generally involves a faster recovery and less pain and risk of complications than open prostatectomy. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a larger one used in open surgery. He or she can then thread surgical tools around many structures, such as muscle, instead of cutting through or displacing them as in open surgery. You may be able to have a transurethral resection of the prostate (TURP). The surgeon accesses your prostate with a thin tube inserted into your urethra called a cystoscope. Your surgeon then removes part or all or your prostate using a tool that is threaded through the cystoscope.
• Open prostatectomy allows your surgeon to directly view and access the surgical area. Your surgeon performs an open prostatectomy by making an incision in one of two areas. Your surgeon will make an incision running from your belly button to your pubic bone for a radical retropubic prostatectomy or an incision running from your rectum to the base of your scrotum for a radical perineal prostatectomy. An open prostatectomy generally involves a longer recovery and more pain than minimally invasive prostatectomy. This is because it causes more trauma to tissues. Open prostatectomy requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive prostatectomy. An open prostatectomy may be a safer or more effective method for certain patients. In addition, your surgeon may decide after beginning a minimally invasive prostatectomy that you require an open prostatectomy to safely and most effectively complete your surgery.