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Health Information

Prostatectomy

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Definition

A prostatectomy is a surgery to remove the prostate gland. The prostate gland is part of the male reproductive system. It makes and stores the milky fluid that forms part of semen. The gland sits below the bladder and in front of the rectum. The urethra (the tube that flows urine out of the body) runs through the protate gland.

The procedure may be:

  • Simple prostatectomy—removal of part of prostate
  • Radical prostatectomy—removal of entire prostate and some surrounding tissue
Anatomy of the Prostate
Anatomy of the Prostate Gland
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

A simple prostatectomy may be done to remove an enlarged prostate that is non-cancerous. A common cause of this type of growth is called benign prostatic hyperplasia (BPH). It can interfere with the flow of urine out of the body. The surgery is done to allow urine to flow through again.

A radical prostatectomy may be done to remove a prostate gland containing cancer.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Bleeding
  • Infection
  • Inability to control urinary stream—incontinence
  • Inability to get an erection (impotence) and other sexual difficulties
  • Blood clots in the legs or lungs
  • Sterility
  • Injury to the rectum or other nearby structures
  • Additional surgery to repair a hernia of the groin

Factors that may increase the risk of complications include:

What to Expect

Prior to Procedure

Before surgery your doctor may do the following:

Leading up to the procedure:

  • Arrange for a ride home.
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • The night before, have a light meal. Do not eat or drink anything after midnight.

Anesthesia

General or spinal anesthesia will be used. With general anesthesia, you will be asleep. Spinal anesthesia will make a specific section of your body numb.

Description of Procedure

The procedure can be done as:

  • Open surgery—incision is made in the skin to allow the doctor to see the prostate
  • Laparoscopic surgery—only very small incisions are needed; the surgery is done with specialized tools and a tiny camera that is passed through the incisions
  • Robot-assisted surgery—similar to laparoscopic with use of small incisions but the surgery is done with robotic tools that the surgeon controls
Simple Prostatectomy

An incision is made in the lower abdomen. The doctor will be able to see the prostate through this incision. The inner part of your prostate gland will then be removed. This procedure is not as common in the United States. It is considered when you have a non-cancerous enlargement of the prostate.

Radical Retropubic Prostatectomy

An incision will be made in the lower abdomen between the belly button and pubic bone. The prostate gland and pelvic lymph nodes will be visible through this incision. The prostate will be detached from the bladder and urethra. The urethra is then reattached to the bladder. A main goal of treatment is to try to preserve nerve function related to bladder function and erections. Lymph node tissue may also be removed for testing. Your doctor may use these test results to decide whether or not to remove more tissue.

Perineal Radical Prostatectomy

An incision is made in the skin between your anus and your scrotum. The prostate can be detached and removed through this incision. This is a less common surgical option because of some limits such as:

  • Lack of access to the lymph nodes
  • Higher risk of nerve damage
Robot-assisted Laparoscopic Radical Prostatectomy (RALRP)

Five small, keyhole incisions are made in the abdomen. Robotic arms and a small camera will be passed through these incisions. The robotic tools allow wider and more flexible range of motion. The robotic arms will be controlled by a doctor at a console. The prostate and other tissue will be cut out with these robotic arms. This type of procedure may cause less scarring than other methods.

After Procedure

A catheter tube will be inserted to drain your bladder. Water may be flushed through the catheter to reduce blood in the urine.

The catheter may be left in place for up to 3 weeks. This will let you urinate more easily during the healing period. After a radical prostatectomy, a drain may also be placed to help fluid drain from the surgery site.

How Long Will It Take?

2-4 hours

Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 2-3 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

You will monitored in the recovery room. The hospital staff will check your breathing, blood pressure, and pulse. Right after the procedure, you may be given medication such as:

  • Pain medication
  • Medications to prevent blood clots
  • Antibiotics if an infection is present or possible

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

Complete recovery may take up to 6 weeks. During this time you may have to change or restrict activities until your doctor says it is okay. Arrange for help at home for a couple of days.

You may be given specific exercises to do at home to promote healing and maintain strength. Pain can be managed with medications.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persitent nausea and/or vomiting
  • Pain that you cannot control with medications
  • Pain, burning, urgency or frequency of urination, or persistent blood in the urine
  • Poor drainage from Foley catheter
  • Abdominal swelling or pain
  • Cough, shortness of breath, or chest pain
  • Headaches, muscle aches, lightheadedness, or general ill feeling
  • Constipation
  • New or worsening

If you think you have an emergency, call for medical help right away.

Revision Information

  • National Cancer Institute

    http://www.cancer.gov

  • Urology Care Foundation

    http://www.urologyhealth.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Prostate Cancer Canada

    http://www.prostatecancer.ca

  • Griffith HW, Moore S, Yoder K. Complete Guide to Symptoms, Illness & Surgery. New York, NY: Putnam Publishing Group; 2000.

  • Le CQ, Gettman MT. Laparoscopic and robotic radical prostatectomy. Exper Rev Anticancer Ther. 2006;6:1003-1011.

  • Mitchell RE, Lee BT, Cookson MS, et al. Immediate surgical outcomes for radical prostatectomy in the University HealthSystem Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48,000 patients. BJU Int. 2009;104(10):1442-1445.

  • Benign prostatic hypertrophy (BPH). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 27, 2014. Accessed September 25, 2014.

  • Prostate cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 10, 2014. Accessed September 25, 2014.

  • General information about prostate cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/prostate. Accessed September 25, 2014.

  • 6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

  • 10/21/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: O'Reilly EA, Burke JP, O'Connell PR. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia. Ann Surg. 2012 May;255(5):846-53.