Alternative Names simple prostatectomy for BPH, open procedure for an enlarged prostate gland
Definition A simple prostatectomy is a surgical procedure done to remove part or all of the prostate gland. This procedure is most commonly performed to treat a condition known as benign prostatic hyperplasia (BPH), which is an enlarged prostate gland.
Who is a candidate for the procedure? Men who are suffering blocked urine flow because of an enlarged prostate, or BPH, may be considered for this surgery. Usually, it is done on men who cannot be successfully treated with medications.
The choice of procedure depends on the size of the enlarged prostate. If the gland is less than 100 grams, a minimally invasive procedure such as a transurethral resection of the prostate (TURP) may be used. If the prostate is larger than 100 grams, a simple prostatectomy is often chosen. A simple prostatectomy may also be selected if the man has bladder diseases that can be taken corrected at the same time. These conditions can include abnormal outpouchings of the bladder, called diverticuli, or large stones in the bladder. A simple prostatectomy may also be chosen over a TURP if the man has other problems, such as trouble moving his hips, which make him unable to be positioned properly for a TURP surgery.
How is the procedure performed? The operation is done in the hospital under regional anaesthesia or general anaesthesia. An intravenous tube is inserted into the man's vein, usually in the arm, to allow fluids and medications to be given. To begin the surgery, the surgeon makes a cut in the lower portion of the belly. This exposes the prostate and the bladder. Next, a cut is made in the prostate gland and the inner portion is removed. Sutures and special tools are used to stop bleeding. A drainage tube, called a urinary catheter, is inserted through the penis and into the bladder. Finally, the prostate and bladder, if it has been opened, are stitched closed. If surgery has been performed on the bladder as well, another catheter may be inserted that exits through the skin of the lower abdomen. This is known as a suprapubic catheter.
What happens right after the procedure? The man generally stays in the hospital after the procedure. The urinary catheter is kept in place for several days, and water is flushed through the catheter to decrease blood in the urine. Once the urine is free of blood, the catheter can be removed and the man can be discharged. If a suprapubic catheter has been inserted, this may be left in for a period after the man leaves the hospital. This will depend on how well he is able to pass urine after the urinary catheter is removed.
What happens later at home? The man should drink plenty of fluids to help clear the bladder and urine of blood. If it's not flushed out, the blood can form clots and block the flow of urine. Also, the man should avoid lifting heavy objects for 4 to 6 weeks. The lifting could strain the site of the incision or cause bleeding around the prostate. Men who have a catheter through the skin of the lower abdomen will need to have it removed in the surgeon's office in 1 to 2 weeks.
What are the potential complications after the procedure? Overall, this surgery has very few dangerous complications. It is considered a low risk operation. All surgery carries a risk of bleeding, infection, and reactions to any analgesia used. Specific complications include:
urine leakage from internal incisions around the bladder or prostate. Sometimes a drain is placed in the pelvic space at the time of the operation to take care of this problem.
retrograde ejaculation, a condition in which sperm travel backward into the bladder rather than out the end of the penis during ejaculation. This occurs in most men who have the operation. Men who wish to father children should discuss this possibility with the surgeon before the surgery.
narrowing of the bladder neck, which may cause problems urinating. This occurs in a small number of men, and can be easily treated.
Author: Stuart Wolf, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
