Problems with urination can reduce your quality of life. Getting up in the night to urinate or having to urinate very often can interfere with daily activities. You may even get frequent infections or bladder stones. These are all symptoms of benign prostatic hyperplasia (BPH), which means your prostate gland is enlarged. To reduce these symptoms, your doctor may recommend surgery.
According to the National Institutes of Health, nearly all men experience prostate enlargement as they age. However, less than half experience uncomfortable symptoms. Symptoms occur when the prostate gland has grown large enough to interfere with the urethra, the tube that carries urine from your bladder to your penis. The prostate surrounds the urethra (NIH, 2011).
There are varying degrees of enlargement.
If your prostate has grown only slightly, there are many minimally invasive surgeries that can be done to remove part of the gland, such as transurethral resection of the prostate (TURP).
However, if your prostate is very large, none of the minimally invasive methods will be possible. A surgeon will need to remove the core of the gland through a large incision in your abdomen. This kind of surgery is called a simple prostatectomy.
Most men who undergo this type of surgery are age 60 or older. (Miles et al., 2011)
If you are diagnosed with BPH (also called benign prostatic hypertrophy) and have uncomfortable urinary symptoms, you may need surgery. Special diets, changes in drinking habits, and medications are often tried before surgery is recommended.
If your prostate is small enough, a minimally invasive prostate resection can be done. However, your prostate may have become too large for this kind of surgery. A prostate is considered too large for minimally invasive prostate resection if it is larger than 75 grams (Miles et al., 2011). In this situation, a simple prostatectomy can be done.
Your doctor may recommend a simple prostatectomy if your prostate is very large and you are suffering from:
- extremely slow urination
- frequent urinary tract infections (UTIs)
- urinary retention (difficulty emptying your bladder)
- frequent bleeding from the prostate
- bladder stones
- damage to the kidneys
A simple prostatectomy involves removing the inner core of the prostate gland. This is the part of the prostate that is pressing on your urethra. Removing the prostate tissue that presses on your urethra should relieve urinary symptoms.
This surgery is not used to treat prostate cancer. A radical prostatectomy is the main surgery used to treat prostate cancer. In a radical prostatectomy, the entire prostate gland is removed as well as certain other structures.
The prostate is inside the pelvis and is surrounded by other organs, including the rectum, the bladder, and sphincter (muscles that control urine flow), as well as many important nerves and blood vessels.
There are several different ways that the prostate can be removed in a simple prostatectomy. All of these surgeries are done in the hospital using anesthesia so that you do not feel pain. You may have to stay up to four days in the hospital after the surgery.
Each surgical method involves a different way of approaching the prostate. Different methods for prostate removal are explained below.
Open Retropubic Simple Prostatectomy
A surgeon makes a cut from just below the belly button to just above the penis. Through this incision, doctors move aside the bladder, cut into the prostate, and remove the core of the gland. This is almost like removing the inside of an orange. The shell of the prostate is stitched up and then the outer incision is closed.
Open Suprapubic Simple Prostatectomy
Doctors make a cut from just below the belly button to just above the penis. Then the surgeon cuts into the bladder and removes the prostate tissue through the bladder.
Laparoscopic Simple Prostatectomy
Much smaller cuts into the body are required for this type of surgery. Five small “keyholes” are cut into the abdomen. Then lighted magnifying devices and cameras are put into the holes to help the surgeon move organs aside to cut into the prostate and remove the enlarged prostate core. This core is removed through one of the small holes in the abdomen.
This type of surgery often has less pain afterward and less recovery time. Sometimes, this surgery is done using robotic tools. In this case, the doctor uses a computer to control a robot that moves the instruments and the scalpels. This is called robot-assisted simple prostatectomy (RASP).
In all of these surgeries, a drain (tube) is inserted near the surgery site to remove fluid that may build up around the prostate shell. Fluid collects in a bulb attached to the end of the tube on the outside of your body.
Your doctor will do a thorough check of your health. If you have health conditions such as diabetes, heart disease, lung problems, or high blood pressure, they need to be under control before surgery. If your health is poor and you are unable to undergo anesthesia or surgery, a simple prostatectomy is unlikely to be your best option.
Your doctor will order many tests and scans before your surgery to learn as much as possible about your condition. These will likely include:
- blood tests to check for other health conditions
- an ultrasound to get images of the prostate gland and nearby organs
- a biopsy of the prostate (where a small sample is removed so it can be analyzed under a microscope)
- a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis to get images of these areas
Make sure to tell all of your doctors and nurses what drugs and vitamins you take, especially any medicines that might thin your blood. These might cause complications and excessive bleeding during surgery. Examples include warfarin (Coumadin), clopidogrel (Plavix), aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), and vitamin E.
Do not eat or drink after midnight the night before the surgery, or you may have complications with anesthesia. You may need to drink only clear liquids and take a special laxative the day before the surgery to clear your digestive system.
Any surgery carries a risk for potential complications, including blood clots in the legs, breathing problems, reactions to anesthesia, bleeding, infection, heart attack, and stroke. Your doctor and care team will work hard to prevent these problems.
Problems specific to prostate surgery can potentially include:
- urinary incontinence (problems with controlling the urge to urinate)
- bowel incontinence (difficulty controlling bowel movements)
- urethral stricture (scar tissue blocking part of the urethra)
- problems maintaining an erection (impotence)
- injury to internal organs
Immediately after surgery, you will be in the hospital for several days. You will be able to drink and eat normally soon after the surgery.
While recovering in the hospital, you will have:
- dressings over your incision sites
- a drain to remove excess fluid from the surgery site. The drain will be removed after one or two days.
- a catheter (tube) threaded through your penis and into your urethra to help you drain urine into a bag for one to two weeks while you heal. Urine that drains from the catheter may be bloody or cloudy. Some men will have a suprapubic catheter in the abdomen, rather than the urethra, to drain the bladder.
To avoid common postsurgical complications, you may need to wear special socks to prevent blood clots in your legs or use a breathing device to keep your lungs healthy.
If you have stitches in your incision, they will absorb into your body and do not need to be removed. You will be given pain medication both in the hospital and while recovering at home.
You will likely still have a catheter when you go home. Sometimes your doctor will allow you to remove this at home when it is time. Otherwise you will need to have this done at an office visit.
You should fully recover in about six weeks and regain normal urinary function.