A prostatectomy is a resection of a part or all of the prostate gland.
The prostate is a small, muscular, rubbery gland, and is a part of the male reproductive system that generates seminal fluid to feed and protect sperm cells.
Prostectomy can be simple or radical based on the associated symptoms and the need for the surgery. There are differnet indications which are analysed and investigated to decide whether to go with simple or a radical prostectomy.
Prostatectomy indications -
There are different indications for simple or radical prostatectomies.
Indications for simple prostatectomy -
- Acute urinary retention
- Recurrent urinary tract infections
- Serious haemorrhage or hematuria
- Serious symptoms from bladder outlet obstruction due to bladder calculi etc which are not responsive to medical or minimally invasive treatment
- Renal insufficiency due to chronic bladder outlet obstruction
Simple prostatectomy is not used as a treatment for prostate cancer.
Radical prostatectomy indications -
- To treat prostate cancer.
- Unable to completely remove the bladder contents
- Frequent bleeding from the prostate gland
- Bladder stones with prostate enlargement
- Very slow urine output
High pressure on the ureters and kidneys from urinary retention (known as hydronephrosis)
Prostatectomies are of two types-
1. Simple or open prostatectomy (or subtotal prostatectomy)
In simple prostatectomy (or a subtotal prostatectomy) - Is a process of excision of only a specific part of the prostate gland. This type of surgery is recommended only to treat benign conditions.
2. A radical prostatectomy
A radical prostatectomy excises the entire prostate gland, the seminal vesicles, and the vas deferens. This procedure is performed for malignant conditions only.
Before the surgery, you will have to have some tests, such as surgical blood tests and body scans, as suggested by your doctor. This is done to determine your overall general health.
The doctor will review your medical history and check if you have any bleeding problems, allergies, other medical conditions, etc. If you're using certain medications or supplements, you may have to stop taking them.
Before surgery, you may have to undergo a cystoscopy. With cystoscopy, the doctor will examine the prostate size and your urinary system.
An enema may be given to you one night before the surgery. You also have to do overnight fasting, and maybe intravenous fluid will be administered to keep you hydrated.
Also, remember to leave your personal belongings at home, like -
During the Procedure
- Prostate surgery is performed under general anaesthesia. The anaesthetist will inject anaesthesia to put you into a deep sleep.
- When you are in a deep sleep, the surgeon will begin the surgery.
- Open radical prostatectomy -The surgeon makes an incision in the lower abdominal area. After carefully separating the prostate gland from the nearby nerves and blood vessels, the surgeon takes out the prostate gland and nearby tissues. The incision is then stitched with sutures.
- Simple prostatectomy - At the beginning, the surgeon may insert a cystoscope through the tip of the penis to internally examine the urethra, bladder and prostate area.
The surgeon will insert a Foley catheter into the tip of the penis that goes into the urinary bladder to remove urine during the surgical process. The incisions will depend on what technique the doctor prefers.
Once the diseased part of the prostate is removed, the shell of your prostate and the outer incision is closed.
After the procedure
You have to be admitted to the hospital for a few days. You will be given IV medications, and the needed dressings for the incisions will be regularly done. There will be a regular follow-up of your overall health. During this hospital stay, your doctor will instruct and update you about your health. You will be discharged when your doctor checks all your health reports and concludes that you are fit to go home.
Prostatectomy risks and complications
The risks involved with prostatectomy are as follows -
If you are suffering from prostate issues or are willing to get prostate surgery done, consult a urologist.