The prostate is a gland located underneath the bladder, in front of the rectum. It plays an important role in the part of the male reproductive system that produces fluids that carry sperm.
Surgery for partial or complete removal of the prostate is called a prostatectomy. The most common causes for prostate surgery are prostate cancer and an enlarged prostate, or benign prostatic hyperplasia (BPH).
Pretreatment education is the first step to making a decisions about your treatment. All types of prostate surgery can be done with general anesthesia, which puts you to sleep, or spinal anesthesia, which numbs the lower half of your body.
Your doctor will recommend a type of anesthesia based on your situation.
The goal of your surgery is to:
- cure your condition
- maintain urinary continence
- maintain the ability to have erections
- minimize side effects
- minimize pain before, during, and after surgery
Read on to learn more about the types of surgery, risks, and recovery.
The goal of prostate surgery also depends on your condition. For example, the goal of prostate cancer surgery is to remove cancerous tissue. The goal of BPH surgery is to remove prostate tissue and restore the normal flow of urine.
Open prostatectomy is also known as traditional open surgery or an open approach. Your surgeon will make an incision through your skin to remove the prostate and nearby tissues.
There are two main approaches, as we explain here:
Radical retropubic: Your surgeon will make the cut from your bellybutton to your pubic bone. In most cases, your surgeon will remove only the prostate. But if they suspect the cancer may have spread, they will remove some lymph nodes for testing. Your surgeon may not continue the surgery if they discover that the cancer has spread.
Radical perineal approach: Your surgeon will make a cut in the space between the rectum and scrotum. This is often done when you have other medical conditions that complicate retropubic surgery. In this position, your surgeon can’t remove the lymph nodes. This surgery takes less time than retropubic surgery, but there is a higher risk for erectile dysfunction.
For both approaches, you can be under general anesthesia or spinal or epidural anesthesia.
Laparoscopic surgery is a minimally invasive approach to prostate surgery. There are two main approaches for this kind of procedure as well:
Laparoscopic radical prostatectomy: This surgery requires multiple tiny cuts so the surgeon can insert small surgical instruments. Your surgeon will use a thin tube with a camera to see into the area.
Robotic-assisted laparoscopic radical prostatectomy: Some surgeries include a robotic interface. With this type of surgery, the surgeon sits in an operating room and directs a robotic arm while viewing a computer monitor. A robotic arm may provide more maneuverability and precision than the other procedures.
Are there differences between ORP, LRP, and RALRP?
According to a 2010 review of different surgery types for prostate cancer, the outcomes for open radical prostatectomy (ORP), laparoscopic (LRP), and robotic-assisted prostatectomy (RALRP) are not significantly different.
But people who choose LRP and RALRP may experience:
- less blood loss
- less pain
- shorter hospital stay
- faster recovery time
Also, people who choose RALRP report faster recovery in continence (the ability to control the bladder and bowels) and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeon’s experience and skill.
Prostate laser surgery
Prostate laser surgery primarily treats BPH without making any cuts outside of your body. Instead, your doctor will insert a fiber-optic scope through the tip of the penis and into your urethra. Then your doctor will remove prostate tissue that’s blocking urine flow. Laser surgery may not be as effective.
Similar to the laser surgery, endoscopic surgery doesn’t make any incisions. Your doctor will use a long, flexible tube with a light and lens to remove parts of the prostate gland. This tube goes through the tip of the penis and is considered less invasive.
Widening the urethra
Transurethral resection of the prostate (TURP) for BPH: TURP is the standard procedure for BPH. A urologist will cut pieces of your enlarged prostate tissue with a wire loop. The tissue pieces will go into the bladder and flush out at the end of the procedure.
Transurethral incision of the prostate (TUIP): This surgical procedure consists of a few small cuts in the prostate and bladder neck to widen the urethra. Some urologists believe that TUIP has a lower risk for side effects than TURP.
Before you wake up from the surgery, the surgeon will place a catheter into your penis to help drain your bladder. The catheter needs to stay in for one to two weeks. You may need to stay in the hospital for a few days, but generally you can go home after 24 hours. Your doctor or nurse will also give you instructions on how to handle your catheter and care for your surgical site.
A healthcare worker will remove the catheter when ready and you’ll be able to urinate on your own.
Whatever type of surgery you had, the incision site will probably be sore for a few days. You may also experience:
- blood in your urine
- urinary irritation
- difficulty holding urine
- urinary tract infections
- inflammation of the prostate
These symptoms are normal for a few days to a few weeks after recovery. Your recovery time will depend on the type and length of surgery, your overall health, and whether you follow your doctor’s instructions. You may be advised to decrease activity levels, including sex.
All surgical procedures come with some risk, including:
- reaction to anesthesia
- infection of the surgical site
- damage to organs
- blood clots
Signs that you may have infection include fever, chills, swelling, or drainage from the incision. Call your doctor if your urine is blocked, or if the blood in your urine is thick or getting worse.
Other, more specific side effects in relation to prostate surgery may include:
Urinary problems: This includes painful urination, difficulty urinating, and urinary incontinence, or problems controlling urine. These problems typically go away several months after surgery. It’s rare to experience continuous incontinence, or loss of ability to control your urine.
Erectile dysfunction (ED): It’s normal to not have an erection eight to 12 weeks after surgery. The chances of long-term ED increase if your nerves are injured. One UCLA study found that choosing a doctor who has performed at least 1,000 surgeries increases the chances of post-surgery recovery of erectile function. A surgeon who is gentle and handles the nerves delicately also can minimize this side effect. Some men noticed a slight decrease in penis length due to the shortening of the urethra.
Sexual dysfunction: You may experience changes in orgasm and loss in fertility. This is because your doctor removes the semen glands during the procedure. Talk to your doctor if this is a concern for you.
Other side effects: The chances of accumulating fluid in the lymph nodes (lymphedema) in the genital area or legs, or developing a groin hernia is also possible. This can cause pain and swelling, but both can be improved with treatment.
Give yourself time to rest, as you may feel more tired post-surgery. Your recovery time will depend on the type and length of surgery, your overall health, and whether you follow your doctor’s instructions.
Instructions may include:
- Keeping your surgical wound clean.
- No driving for one week.
- No high-energy activity for six weeks.
- No climbing stairs more than necessary.
- No soaking in bathtubs, swimming pools, or hot tubs.
- Avoiding one sitting position for more than 45 minutes.
- Taking medications as prescribed to help with pain.
While you’ll be able to do everything on your own, it may be a good idea to have someone around to help you for the time period where you have the catheter.
It’s also important to have bowel movements within a day or two. To help with constipation, drink fluids, add fiber to your diet, and exercise. You can also ask your doctor about laxatives if these options don’t work.
If your scrotum starts to swell after surgery, you can create a sling with a rolled towel to lessen the swelling. Place the towel roll underneath your scrotum while you’re lying down or sitting and loop the ends over your legs so it provides support. Call your doctor if the swelling doesn’t go down after a week.