Prostatectomy Health Article

Definition

Prostatectomy is surgical removal of part of the prostate gland (transurethral resection, a procedure performed to relieve urinary symptoms caused by benign enlargement), or all of the prostate (radical prostatectomy, the curative surgery most often used to treat prostate cancer).

Benign disease

When men reach their mid-40s, the prostate gland begins to enlarge. This condition, benign prostatic hyperplasia (BPH) is present in more than half of men in their 60s and as many as 90% of those over 90. Because the prostate surrounds the urethra, the tube leading urine from the bladder out of the body, the enlarging prostate narrows this passage and makes urination difficult. The bladder does not empty completely each time a man urinates, and, as a result, he must urinate with greater frequency, night and day. In time, the bladder can overfill, and urine escapes from the urethra, resulting in incontinence. An operation called transurethral resection of the prostate (TURP) relieves symptoms of BPH by removing the prostate tissue that is blocking the urethra. No incision is needed. Instead a tube (retroscope) is passed through the penis to the level of the prostate, and tissue is either removed or destroyed, so that urine can freely pass from the body.

Malignant disease

Prostate cancer is the single most common form of non-skin cancer in the United States and the most common cancer in men over 50. Half of men over 70 and almost all men over the age of 90 have prostate cancer, and the American Cancer Society estimates that 198,000 new cases will be diagnosed in 2001. This condition does not always require surgery. In fact, many elderly men adopt a policy of "watchful waiting," especially if their cancer is growing slowly. Younger men often elect to have their prostate gland totally removed along with the cancer it contains—an operation called radical prostatectomy. The two main types of this surgery, radical retropubic prostatectomy and radical perineal prostatectomy, are performed only on patients whose cancer is limited to the prostate. If cancer has broken out of the capsule surrounding the prostate gland and spread in the area or to distant sites, removing the prostate will not prevent the remaining cancer from growing and spreading throughout the body.

Precautions

Potential complications of TURP include bleeding, infection, and reactions to general or local anesthesia. About one man in five will need to have the operation again within 10 years.

Open (incisional) prostatectomy for cancer should not be done if the cancer has spread beyond the prostate, as serious side effects may occur without the benefit of removing all the cancer. If the bladder is retaining urine, it is necessary to insert a catheter before starting surgery. Patients should be in the best possible general condition before radical prostatectomy. Before surgery, the bladder is inspected using an instrument called a cystoscope to help determine the best surgical technique to use, and to rule out other local problems.

TURP

This procedure does not require an abdominal incision. With the patient under either general or spinal anesthesia, a cutting instrument or heated wire loop is inserted to remove as much prostate tissue as possible and seal blood vessels. The excised tissue is washed into the bladder, then flushed out at the end of the operation. A catheter is left in the bladder for one to five days to drain urine and blood. Advanced laser technology enables surgeons to safely and effectively burn off excess prostate tissue blocking the bladder opening with fewer of the early and late complications associated with other forms of prostate surgery. This procedure can be performed on an outpatient basis, but urinary symptoms do not improve until swelling subsides several weeks after surgery.