Simple Prostatectomy

Simple prostate removal is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. It is done through a surgical cut in your lower belly.

Alternative Names

Prostatectomy - simple; Suprapubic prostatectomy; Retropubic simple prostatectomy; Open prostatectomy; Millen procedure

Description

You will be given general anesthesia (asleep, pain-free) or spinal anesthesia (sedated, awake, pain-free). The procedure takes about 2 to 4 hours.

Your surgeon will make a surgical cut in your lower belly. The cut will go from below the belly button to just above the penis. The prostate gland is removed through this cut.

The surgeon removes only the inner part of the prostate gland. The outer part is left behind. The process is similar to scooping out the inside of an orange and leaving the peel intact. After removing part of your prostate, the surgeon will close the outer shell of the prostate with stitches. A drain may be left in your belly to help remove extra fluids after surgery.

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Why the Procedure Is Performed

An enlarged prostate can cause problems with urinating. This can lead to urinary tract infections. Taking out part of the prostate gland can often make these symptoms better. Before you have surgery, your health care provider may tell you some changes you can make in how you eat or drink. You may also be asked to try taking medicine.

Prostate removal can be done in many different ways. The kind of procedure you will have depends on the size of the prostate and what caused your prostate to grow. Open simple prostatectomy is often used when the prostate is too large for less invasive surgery. This means that the prostate weighs 100 grams or more. However, this method does not treat prostate cancer. Radical prostatectomy may be needed for cancer.

Prostate removal may be recommended if you have:

Problems emptying your bladder (urinary retention)
Frequent urinary tract infections
Frequent bleeding from the prostate
Bladder stones with prostate enlargement
Very slow urination
Damage to the kidneys

Your prostate may also need to be removed if taking medicine and changing your diet do not help your symptoms.

Risks

Risks for any surgery are:

Blood clots in the legs that may travel to the lungs
Blood loss
Breathing problems
Heart attack or stroke during surgery
Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney
Reactions to medicines

Other risks are:

Damage to internal organs
Erection problems (impotence)
Loss of sperm fertility (infertility)
Passing semen back up into the bladder instead of out through the urethra (retrograde ejaculation)
Problems with bowel movement control (bowel incontinence)
Problems with urine control (incontinence)
Tightening of the urinary outlet from scar tissue (urethral stricture)

Before the Procedure

You will have many visits with your doctor and tests before your surgery:

Complete physical exam
Visits with your doctor to make sure medical problems (such as diabetes, high blood pressure, and heart or lung diseases) are being treated well

If you are a smoker, you should stop several weeks before the surgery. Your health care provider can help.

Always tell your provider what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the weeks before your surgery:

You may need to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other medicines like these.
Ask your doctor which medicines you should still take on the day of your surgery.
You may take a special laxative the day before your surgery. This will clean out the contents of your colon.

On the day of your surgery:

DO NOT eat or drink anything after midnight the night before your surgery.
Take the drugs you were told to take with a small sip of water.
You will be told when to arrive at the hospital.

After the Procedure

You will stay in the hospital for about 3 to 4 days.

You will need to stay in bed until the next morning.
After you are allowed to get up you will be asked to move around as much as possible.
Your nurse will help you change positions in bed.
You will also learn exercises to keep blood flowing, and coughing/deep breathing techniques.
You should do these exercises every 3 to 4 hours.
You may need to wear special compression stockings and use a breathing device to keep your lungs clear.

You will leave surgery with a Foley catheter in your bladder. Some men have a suprapubic catheter in their belly wall to help drain the bladder.

Outlook (Prognosis)

Many men recover in about 6 weeks. You can expect to be able to urinate as usual without leaking urine.

References

Han M, Partin AW. Retropubic and suprapubic open prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 94.

Roehrborn CG. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, and Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 91.