Prostatectomy

About the Procedure

A Prostatectomy is a procedure performed to remove the prostate gland, or a section of it, due to a diagnosis of cancer or benign prostatic hyperplasia (BPH). The prostate’s purpose is to secrete a milky fluid which is discharged into the urethra during ejaculation. Cancer of the prostate is the most common cancer and second highest cause of death among American men. Cancerous tumors in the prostate grow slowly, are unlikely to metastasize for many years, and may exhibit few or no symptoms. Benign prostatic hyperplasia is an enlargement of the prostate which occurs with aging as a result of hormonal changes, and is not related to prostate cancer and is not an indicator of the development of prostate cancer. There are a number of options available for prostate cancer, such as radiation, hormone therapy, cryotherapy, and laser therapy. The most common surgical procedures include: radical prostatectomy in which the entire gland is removed through an external incision, laparoscopic, and a transurethral resection of the prostate (TURP) in which a surgical tool is inserted through the urethra. Potential complications of a total prostatectomy are impotence and incontinence and treatment is available for both conditions should they occur. A radical prostatectomy is performed by a general or oncological surgeon, with general or regional anesthesia, and may take between two to four hours. The surgeon inserts a catheter through the urethra into the bladder, then makes several small cuts in the lower abdomen or perineal area. As the prostate is being removed, the surgeon may remove some lymph nodes for biopsy as a precaution. An effort is made to spare the nerves which are responsible for erectile function. Because the urethra has a dual function, when the prostate is removed, the urethra must be attached directly to the neck of the bladder over a urinary catheter which stays in place for two to three weeks. Drains are put in place to direct excess fluid and blood out of the body and the incision is closed with stitches or other material. The patient will stay in the recovery room for about two hours.

What to Know Before the Procedure

Choosing a surgeon to perform a prostatectomy may be a more important decision than the type of procedure. With the concerns many men have over erectile dysfunction and urinary incontinence following the surgery, the more skilled and experienced the surgeon, the less likely it is that there will be damage to the nerves and bladder. Preparation for the procedure requires a liquid diet followed by a bowel cleansing, a health assessment, blood work, x-rays, changes/additions to medications to avoid excess blood loss during surgery, and instructions from the physician about medication and water intake just prior to the operation. The hospital stay is expected to be two to three days for an uncomplicated procedure and recovery.

What to Know After the Procedure

The abdominal drains are usually removed the following morning and dressings will be removed once the incisions are dry. There may be blood in the urine for the first two days. After the catheter is removed, some men experience difficulty urinating which may require re-insertion of the catheter for a few days. In general, the procedure is well-tolerated, the results are excellent, and patients recover quickly. The patient will need to clean the urethral opening around the catheter until it is removed. There will be swelling in the scrotum, bladder spasms, and a delay of normal bowel function for a few days. Showers are permitted but baths must be avoided until the incisions are healed. Patients resume most routine activities in ten days and can engage in all activities in three to four weeks. Returning to work depends on the activities required and the doctor should be consulted for advice.

If you Need to Travel Outside of your Local Hospital

Prior to making a decision about the location for this procedure, consult with the doctor regarding any post-operative travel restrictions which could impact it. Consideration should also be given to the patient's discomfort which may be significant during recovery. Long-distance travel is well tolerated after the initial recovery period and can provide significant cost-saving benefits. With such a complicated procedure that may have several post-operative side-effects, the experience and skill of the surgeon should be the primary concern when choosing a doctor to perform this procedure.