Simple Prostatectomy

There are varying degrees of prostate enlargement.

If your prostate grows only slightly, many minimally-invasive surgeries can remove part of the gland, such as transurethral resection of the prostate (TURP).

However, if your prostate becomes very large (over 75 grams), your surgeon will need to perform a simple prostatectomy. This involves removing the inner core of your prostate gland. Most men who undergo this type of surgery are age 60 or older.

Special diets, changes in drinking habits, and medications are often tried before surgery is recommended.

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)
• difficulty emptying your bladder
• frequent bleeding from the prostate
• bladder stones
• damage to the kidneys

This surgery is not used to treat prostate cancer. If you have prostate cancer, you will likely need a radical prostatectomy. This procedure removes the entire prostate gland as well as other structures.

Any surgery carries a risk for potential complications, including blood clots in your 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 include:

• problems controlling the urge to urinate
• difficulty controlling bowel movements
• scar tissue that blocks part of the urethra
• infertility
• problems maintaining an erection
• injury to internal organs

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 you’re in poor health and can’t undergo anesthesia or surgery, a simple prostatectomy is probably not 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 your prostate gland and nearby organs
• a biopsy of the prostate, to obtain a small sample for analysis
• a CT scan or MRI of your abdomen and pelvis

Be sure to tell your doctor if you take any drugs or vitamins, especially any medicines that thin your blood. Blood-thinning medications can cause complications and excessive bleeding during surgery. Examples of these drugs and vitamins include:

• warfarin (Coumadin)
• clopidogrel (Plavix)
• aspirin
• ibuprofen, such as Motrin or Advil
• naproxen (Aleve)
• vitamin E
• newer blood thinners, such as eliquis, pradaxa, and xarelto

Do not eat or drink after midnight on the night before surgery. This will ensure you avoid complications with the anesthesia. You may need to drink only clear liquids and take a laxative the day before surgery to clear your digestive system.

The prostate is inside the pelvis and surrounded by other organs, including the rectum, bladder, and sphincter, the muscles that control urine flow, as well as many nerves and blood vessels.

There are several different ways to remove your prostate in a simple prostatectomy. All of these surgeries are done in the hospital and with the use of anesthesia so you don’t feel pain. You may have to stay in the hospital for up to four days after surgery.

Each surgical method uses a different approach:

Open Retropubic Simple Prostatectomy

In this procedure, your surgeon will make an incision from below your belly button to just above your penis. Through this incision, they’ll move your bladder aside, cut into your prostate, and remove the core of the gland. The shell of your prostate is then stitched up and the outer incision closed.

Open Suprapubic Simple Prostatectomy

Your surgeon will make an incision from below your belly button to just above your penis. They will then cut into your bladder to remove prostate tissue through the bladder.

Laparoscopic Simple Prostatectomy

In this procedure, five small “keyholes,” or small incisions, are cut into your abdomen. Then, lighted magnifying devices and cameras are put into the holes to help your surgeon move organs aside to cut into the prostate and remove the enlarged prostate core. The core is removed through one of the small holes in the abdomen.

This type of surgery is often less painful and involves less recovery time. Sometimes this surgery is done using robotic tools and is called robot-assisted simple prostatectomy, or 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.

Recovery

You’ll have to stay in the hospital for several days after surgery. You should be able to drink and eat as normal soon after.

While recovering in the hospital, you will have:

• dressings over your incision sites
• a drain to remove excess fluid from the surgery site
• a catheter, or tube, threaded through your penis and into your urethra. The catheter will help you drain urine into a bag for one to two weeks while you heal.

To avoid common postsurgical complications, you may need to wear special socks to prevent blood clots in your legs. You may also need a breathing device to keep your lungs healthy.

If you have stitches in your incision, they will absorb into your body. You will be given pain medication both in the hospital and while recovering at home.

You will likely have a catheter in place when you go home. Sometimes your doctor will allow you to remove it at home when you have fully recovered. Otherwise, you will need to have it removed at an office visit.

Outlook

This procedure has a high success rate. You should fully recover in about six weeks and regain normal urinary function.