Prostatectomy

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Definition

A prostatectomy is a surgery to remove the prostate gland. The prostate gland is part of the male reproductive system. It makes and stores the milky fluid that forms part of semen. The gland sits below the bladder and in front of the rectum. The tube that urine flows out through also runs through the prostate.

The procedure may be:

Simple prostatectomy—removal of part of prostate
Radical prostatectomy—removal of entire prostate and some surrounding tissue

Anatomy of the Prostate

Reasons for Procedure

A simple prostatectomy may be done to remove an enlarged prostate that is non-cancerous. A common cause of this type of growth is called benign prostatic hyperplasia (BPH). It can interfere with the flow of urine out of the body. The surgery is done to allow urine to flow through again.

A radical prostatectomy may be done to remove a prostate gland containing cancer.

Possible Complications

If you are planning to have a prostatectomy, your doctor will review a list of possible complications, which may include:

Bleeding
Infection
Inability to control urinary stream (incontinence)
Inability to get an erection (impotence) and other sexual difficulties
Blood clots in the legs or lungs
Sterility
Injury to the rectum or other nearby structures

Factors that may increase the risk of complications include:

Obesity
Chronic or recent illness
Lung, kidney, liver, or heart disease
Smoking
Alcohol abuse or drug use
Use of certain prescription medicines
Diabetes

What to Expect

Prior to Procedure

Before surgery your doctor may do the following:

Physical exam
Blood and urine tests
Chest x-ray
Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
Ultrasound—a test that uses sound waves to visualize the inside of the body
Bone scan or CT scan, if your doctor is concerned about a spreading cancer

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
The night before, have a light meal. Do not eat or drink anything after midnight.

Anesthesia

General or spinal anesthesia will be used. With general anesthesia, you will be asleep. Spinal anesthesia will make a section of your body numb.

Description of Procedure

The procedure can be done as:

Open surgery—incision is made in the skin to allow the doctor to see the prostate
Laparoscopic surgery—only very small incisions are needed; the surgery is done with specialized tools and a tiny camera that is passed through the incisions
Robot-assisted surgery—similar to laparoscopic with use of small incisions but the surgery is done with robotic tools that the surgeon controls

Simple Prostatectomy

An incision is made in the lower abdomen. The doctor will be able to see the prostate through this incision. The inner part of your prostate gland will then be removed. This procedure is not as common in the United States. It is considered when you have a non-cancerous enlargement of the prostate.

Radical Retropubic Prostatectomy

An incision will be made in the lower abdomen between the belly button and pubic bone. The prostate gland and pelvic lymph nodes will be visible through this incision. The prostate will be detached from the bladder and urethra. The urethra is then re-attached to the bladder. A main goal of treatment is to try to preserve nerve function related to bladder function and erections. Lymph node tissue may also be removed for testing. Your doctor may use these test results to decide whether or not to remove more tissue.

Perineal Radical Prostatectomy

An incision is made in the skin between your anus and your scrotum. The prostate can be detached and removed through this incision. This is a less common surgical option because of some limits such as:

Lack of access to the lymph nodes
Higher risk of nerve damage

Robot-assisted Laparoscopic Radical Prostatectomy (RALRP)

Five small, keyhole incisions are made in the abdomen. Robotic arms and a small camera will be passed through these incisions. The robotic tools allow wider and more flexible range of motion. The robotic arms will be controlled by a doctor at a console. The prostate and other tissue will be cut out with these robotic arms. This type of procedure may cause less scarring than other methods.

After Procedure

A catheter tube will be inserted to drain your bladder. Water may be flushed through the catheter to reduce blood in the urine.

The catheter may be left in place for up to 3 weeks. This will let you urinate more easily during the healing period. After a radical prostatectomy, a drain may also be placed to help fluid drain from the surgery site.

How Long Will It Take?

Simple prostatectomy—2-4 hours
Radical prostatectomy—2-4 hours

Will It Hurt?

Anesthesia prevents pain during the procedure. You can expect some pain and discomfort for:

7-10 days after open surgery
3-4 days after laparoscopic surgery

Average Hospital Stay

The usual length of stay is 2-3 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:

Take medicines as directed.
- Your doctor may give you antibiotics to prevent infection. Stool softeners may also be given to prevent constipation.
- You may need to take a medicine for several weeks to normalize your bladder function.
- For a while, you may need prescription pain medicines. You will then be switched to non-prescription pain relievers (such as acetaminophen) as needed. Avoid taking aspirin or aspirin-containing products.
When resting in bed, keep legs elevated and moving. This will help to prevent blood clots from forming in your legs.
To promote healing, resume normal activities as soon as possible.
Drink plenty of liquids. Doing so will help to clear your bladder of urine and blood.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Wash the incision gently with mild soap and water.
Do not drive unless your doctor has given you permission to do so. You may need to wait up to one month.
Avoid vigorous exercise for six weeks after surgery.
Resume sexual activity when able.
Avoid caffeine, alcohol, spicy foods, or any other food or drink that might aggravate your stomach, intestines, bladder, or urinary tract.
Be sure to follow your doctor’s instructions.

Complete healing from surgery usually occurs within six weeks.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occur:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
Pain that you cannot control with the medicines you have been given
Pain, burning, urgency or frequency of urination, or persistent blood in the urine
Poor drainage from Foley catheter
Abdominal swelling or pain
Cough, shortness of breath, or chest pain,
Headaches, muscle aches, dizziness, or general ill feeling
Constipation
New, unexplained symptoms
Drainage from your incision

In case of an emergency, call for medical help right away.

RESOURCES

American Urological Association http://www.urologyhealth.org

Center for Prostate Disease Research US Department of Defense http://www.cpdr.org

National Kidney and Urologic Diseases Information Clearinghouse National Institutes of Health http://kidney.niddk.nih.gov

CANADIAN RESOURCES

Canadian Prostate Cancer Network http://www.cpcn.org

Men's Health Centre http://www.menshealthcentre.net

The Prostate Centre http://www.prostatecentre.ca

Urology Resource Center Canada http://urologyresourcecentre.org

References

Griffith HW, Moore S, Yoder K. Complete Guide to Symptoms, Illness & Surgery. New York, NY: Putnam Publishing Group; 2000.

Le CQ, Gettman MT. Laparoscopic and robotic radical prostatectomy. Exper Rev Anticancer Ther. 2006;6:1003-1011.

Mitchell RE, Lee BT, Cookson MS, et al. Immediate surgical outcomes for radical prostatectomy in the University HealthSystem Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48 000 patients. BJU Int. 2009 Aug 13. [Epub ahead of print].

Benign prostatic hypertrophy (BPH). EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/. Updated August 27, 2012. Accessed September 11, 2012.

Prostate cancer. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/. Updated August 20, 2012. Accessed September 11, 2012.

General information about prostate cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/prostate. Accessed September 11, 2012.

6/2/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

Reviewer: Adrienne Carmack, MD
Review Date: 09/2012 -
Update Date: 00/92/2012 -

Eastside Medical Center