Prostate surgery treats diseases that affect the prostate gland. This includes prostate cancer and other noncancerous conditions. There are different types, depending on the specific condition.
The prostate is a small, walnut-shaped gland that wraps around the urethra at the bladder neck in males. It plays a vital role in the male reproductive system by producing the fluids that carry sperm.
Prostate cancer is the
Education is the first step in making decisions about your treatment. It is a good idea to talk with your doctor so that they can answer any questions that you may have.
That said, you may need to have surgery for partial or complete removal of the prostate. This is called a prostatectomy.
Read to read more about this procedure when it’s necessary, as well as the types of prostate surgery, the risks, and the recovery process.
- To treat prostate cancer: This is when cells of the prostate gland grow out of control.
- To treat benign prostatic hyperplasia (BPH): This is a noncancerous enlarged prostate.
- To reduce symptoms: Sometimes prostate surgery can help relieve symptoms like difficulty urinating without curing cancer.
In all cases, the main goals of prostate surgery are to:
- cure your condition
- maintain bladder control
- maintain the ability to have erections
- minimize side effects
- minimize pain before, during, and after surgery
The goal of prostate surgery depends on your individual condition. For example, surgery for prostate cancer is to remove cancerous tissue. In contrast, the goal of surgery for BPH is to restore the typical flow of urine.
Your doctor will recommend a type of anesthesia based on your individual situation.
Open prostatectomy is also a traditional open surgery or an open approach. It can be done to treat cancer and other noncancerous conditions. Your surgeon will make an incision through your skin to remove the entire prostate gland and nearby tissues.
In cases of cancer, the surgery of choice is usually an open radical prostatectomy
There are two main types of open radical prostatectomy: retropubic and perineal.
Radical retropubic prostatectomy
This is the
A doctor specializing in urinary tract conditions called a urologist will make an incision in your abdomen to access your prostate.
They will usually also remove some surrounding tissue, including the lymph nodes, for testing. This helps them to determine the stage and spread of cancer.
Your surgeon may discontinue the surgery if they discover that the cancer has spread. This is because you may require additional treatment to cure your condition than surgery alone. That said, these days, it is less common to discover this during surgery as imaging and evaluations before surgery will usually tell the surgeon if the cancer has spread and how far.
Radical perineal prostatectomy
This surgery is not performed as frequently as the retropubic approach to treat prostate cancer.
It is an excellent option if lymph node removal is not required because lymph nodes cannot be accessed through this incision site. During this surgery, the entire prostate gland is removed through an incision between the anus and the scrotum.
This surgery is often done when you have other medical conditions that complicate retropubic surgery. This surgery takes less time than retropubic surgery. However, while all attempts are made to protect the nerves that control an erection, there is a higher risk of damage to the nerves of the penis.
- Erectile dysfunction (ED): also known as impotence, it is the inability to achieve or maintain an erection
- Sterility: because radical prostatectomy cuts the connection between the urethra and testicles, you may be unable to provide sperm for a biological child. However, you may still be able to achieve an orgasm, though it will be a dry orgasm, which means you will not release sperm.
- Urinary incontinence: uncontrollable dribbling or leaking of urine, which usually improves with time.
- Lymphedema: although rare, removal of lymph nodes may lead to swelling, inflammation, and pain in the soft tissues of your legs or genital region
- Change in penis size:
Researchshows males can experience a decrease in penis size after radical prostatectomy. The older a person is at the time of surgery, the more their size may decrease.
You can be under general anesthesia or spinal or epidural anesthesia for both surgical approaches.
Anesthesia may be associated with risks such as:
- medication reactions
- difficulty breathing
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 (LRP)
This surgery requires 3-4 small incisions in your abdomen. Your surgeon will then be able to manually insert small surgical instruments, including a thin tube with a camera, to help them see into the area during the procedure.
Robotic-assisted laparoscopic radical prostatectomy (RALRP)
Some surgeries include a mechanical 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 manual procedures. Only some surgeons or hospitals may have the capability of doing robotic-assisted surgery.
Are there differences between ORP, LRP, and RALRP?
But, LRP and RALRP are associated with the following:
- 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 compared to LRP. But the overall outcomes still depend on the surgeon’s experience and skill.
Other types of prostate surgery
Prostate laser surgery
Prostate laser surgery primarily treats BPH without making any cuts into your body. Instead, your doctor will insert a fiber-optic scope through the tip of your penis and into your urethra. Then, your doctor will remove prostate tissue that’s blocking urine flow in your urethra. While this procedure is minimally invasive, laser surgery may not be as effective as other types of prostate surgery.
Similar to 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.
The most common type of endoscopic surgery is the transurethral resection of the prostate (TURP)
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.
Another procedure, transurethral incision of the prostate (TUIP), consists of small prostate and bladder neck cuts to widen the urethra. Some urologists believe TUIP has a lower risk for side effects than TURP.
All surgical procedures come with some
Signs of an 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 concerning prostate surgery may include:
This includes pain, difficulty urinating, 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 typical not to have an erection eight to 12 weeks after surgery. Approximately
Penile rehabilitation is part of the recovery process. However, a nerve-sparing procedure comes with a risk of incompletely removing cancer from the edges of the prostate.
You may experience changes in orgasm and loss in fertility. This is because your doctor removes the semen glands during the procedure. You will be able to have an orgasm, but it will be a dry orgasm, meaning you will not ejaculate. This also means you can’t provide sperm for a biological child. Talk with your doctor if this is a concern for you.
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 handling your catheter and care for your surgical site.
A healthcare worker will remove the catheter when ready, and you can 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 the following:
These symptoms are expected 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.
Give yourself time to rest, as you may feel more tired after postsurgery. 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 1-2 weeks after surgery.
- No high-energy activity for eight weeks.
- No climbing stairs more than necessary.
- No soaking in bathtubs, swimming pools, or hot tubs.
- Taking medications as prescribed to help with the pain.
While you’ll be able to do everything on your own, having someone around to help you when you have the catheter may be a good idea.
It’s also essential to have bowel movements within a day or two. To help with constipation, drink fluids, add fiber to your diet. You’ll need to limit 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 lying down or sitting and loop the ends over your legs to provide support. Call your doctor if the swelling doesn’t go down after a week.
What should I wear after prostate surgery?
You’ll want to wear loose-fitting clothing after prostate surgery. This will make it easier and more comfortable as a urinary catheter is placed in your penis after surgery.
Is prostate surgery a major surgery?
Removal of your prostate is considered major surgery. You will want to take time off of work and any strenuous activities to allow yourself time to recover.
What is the prostate surgery time typically?
Depending upon the type of prostate surgery you are having, it will typically take about 2-4 hours.
What is the success rate of prostate surgery?
Males who undergo radical prostatectomy for early prostate cancer have an excellent outcome. The success rate is usually dependent upon the stage of prostate cancer at the time of diagnosis.
What is the average recovery time for prostate surgery?
Recovery time following prostate surgery is approximately 6-8 weeks.