If you need to have your prostate gland removed because it has become too big, your doctor may recommend a suprapubic prostatectomy.
Suprapubic means that the surgery is done through an incision in your lower abdomen, above your pubic bone. An incision is made in your bladder, and the center of your prostate gland is removed. This part of your prostate gland is known as the transition zone.
Suprapubic prostatectomy is an inpatient procedure. This means that the procedure is done in the hospital. You may need to stay in the hospital for a short period of time to recover. Like any surgery, this procedure carries some risks. Talk to your doctor about why you may need the surgery, what the risks are, and what you need to do to prepare for the procedure.
Suprapubic prostatectomy is done to remove part of an enlarged prostate gland. As you get older, your prostate naturally gets larger because tissue grows around the prostate. This growth is called benign prostatic hyperplasia (BPH). It is not related to cancer. An enlarged prostate due to BPH can make it harder to urinate. It can even cause you to feel pain when urinating or make you feel like you’re not able to fully empty your bladder.
Before advising surgery, your doctor may try medication or outpatient procedures to reduce the symptoms of an enlarged prostate. Some procedures include microwave therapy and thermotherapy, also known as heat therapy. These can help destroy some of the extra tissue around the prostate. If procedures like these don't work and you continue to experience pain or other problems when urinating, your doctor may recommend a prostatectomy.
Once you and your doctor have decided that you need a prostatectomy, your doctor may want to perform a cystoscopy. In a cystoscopy, your doctor uses a scope to look at your urinary tract and your prostate. Your doctor will likely order a blood test and other tests to examine your prostate.
A few days before the procedure, your doctor will ask you to stop taking pain medications and blood thinners to reduce your risk of excess bleeding during surgery. Examples of these medications include:
- ibuprofen (Advil, Motrin)
- naproxen (Aleve, Anaprox, Naprosyn)
- warfarin (Coumadin)
Your doctor may require you to fast for a period of time before your surgery. That means you cannot eat or drink anything other than clear liquids. Your doctor may also have you administer an enema to clear your colon before the surgery.
Before you enter the hospital for the procedure, make arrangements for time off with your workplace. You may not be able to return to work for several weeks. Plan for a friend or family member to take you home after you are discharged from the hospital. You won't be allowed to drive during your recovery period.
Before your surgery, you will remove clothing and jewelry and change into a hospital gown.
In the operating room, an intravenous (IV) tube will be inserted to give you medicine or other fluids during surgery. If you are going to receive general anesthesia, it may be administered through your IV or through a mask over your face. If necessary, a tube may be inserted into your throat to administer anesthesia and to support your breathing during surgery.
In some cases, only localized (or regional) anesthesia is needed. Local anesthesia is administered to numb the area where the procedure is being done. With local anesthesia, you stay awake during surgery. You won’t feel pain, but you might still feel discomfort or pressure in the area being operated on.
Once you’re asleep or numbed, the surgeon will make an incision in your abdomen from below your navel to above your pubic bone. Next, the surgeon will make an opening in the front of your bladder. At this point, your surgeon may also insert a catheter to keep your urine drained throughout the surgery. Your surgeon will then remove the center of your prostate through the opening. Once this part of the prostate has been removed, your surgeon will close up the incisions in your prostate, bladder, and abdomen.
Depending on your condition, your doctor may recommend robotic-assisted prostatectomy. In this type of procedure, robotic tools are used to assist the surgeon. A robotic-assisted prostatectomy is less invasive than traditional surgery and may result in less blood loss during the procedure. It also usually has a shorter recovery time and fewer risks than traditional surgery.
Your recovery time in the hospital could range from one day to a week or more, based on your overall health and the level of success of the procedure. Within the first day or even within a few hours after surgery, your doctor will suggest that you walk around to keep your blood from clotting. Nursing staff will assist you, if necessary. Your medical team will monitor your recovery and remove your urinary catheter when they believe you’re ready.
After you've been released from the hospital, you may need 2-4 weeks to recover before you can resume work and daily activities. In some cases, you may have to keep a catheter in for a short time after you leave the hospital. Your doctor may also give you antibiotics to prevent infections, or laxatives to make sure that you continue to have regular bowel movements without straining the surgical site.
The procedure itself carries little risk. As with any surgery, there’s a chance you may get an infection during or after the surgery, or bleed more than expected. These complications are rare and don't usually lead to long-term health issues.
Any surgery that involves anesthesia carries some risks, such as pneumonia or stroke. Complications of anesthesia are rare, but you may be at greater risk if you smoke, are obese, or have conditions such as high blood pressure or diabetes.
Overall, the outlook for a suprapubic prostatectomy is good. Health issues resulting from this procedure are rare. After you recover from your surgery, it should be easier for you to urinate and control your bladder. You should not have issues with incontinence, and you should no longer feel like you still need to urinate after you’ve already gone.
Once you’ve recovered from your prostatectomy, you may not need any further procedures to manage BPH.
You may need to see your doctor again for a follow-up appointment, especially if you have any complications from the surgery.