Prior to ProcedureYour doctor will likely do the following:
- Physical exam
- Blood tests
- Urine tests
- X-rays of kidneys and chest
- Kidney function tests
- Electrocardiogram (ECG, EKG) - a test that records the heart's activity by measuring electrical currents through the heart muscle
- Intravenous pyelogram (IVP) - a type of x-ray that makes pictures of the renal pelvis and ureter
- Ultrasound (usually transrectal) - a test that uses sound waves to visualize the inside of the body
In the days leading up to the procedure:
- Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (such as ibuprofen) for one week before the procedure
- Take antibiotics, if prescribed, to help prevent infection
- The night before, have a light meal and do not eat or drink anything after midnight
During Procedure - Anesthesia, bladder catheter
Anesthesia: Usually general, but in some cases of laparoscopic surgery, local anesthesia may be used
Description of the Procedure - There are two main methods of prostatectomy:
Open surgery: An incision is made either in the lower abdomen (a retropubic prostatectomy or suprapubic prostatectomy, and used especially if lymph nodes in the prostate area need to be removed), or between the scrotum and anus (perineal prostatectomy). The bladder and urethra are opened, and the enlarged parts of (or the entire) prostate gland are removed.
During this procedure, special care is taken to locate the nerves on either side of the prostate gland. These nerves are necessary to achieve erection, and therefore whenever possible, the surgeon will leave them intact. However, when cancer is present in the prostate and has spread to these nerves, they may need to be cut or removed. Nerve sparing decreases, but does not eliminate, the possibility of impotence. Sparing is more difficult to perform with a perineal prostatectomy
Two catheters are then placed into the bladder, along with a tube to drain secretions. One of the catheters is passed through the penis, while the second catheter (along with the drain tube) leaves the body through the surgical incision. The drain and second catheter are usually removed within a few days. The catheter passing through the penis may be removed before release from the hospital, or may be left in place for 1-3 weeks to allow for easier urination during the healing period.
Muscles are then repositioned and sewn in place. The incision is closed with stitches or clips, which are usually removed within 7-10 days of surgery.
Other surgical therapies:
Laparoscopic prostatectomy: Several tiny incisions are made in the abdomen. A laparoscope and special laparoscopic tools are inserted through these incisions and used for removal of all or part of the prostate gland. In some instances, depending on what is found once surgery begins, a laparoscopic prostatectomy may need to be converted to an open prostatectomy.
Transurethral resection of the prostate (TURP): In instances where the size of the enlarged prostate gland is relatively small (less than 100 grams), and usually only when the enlargement is not due to cancer (benign), a minimally invasive procedure known as a transurethral resection of the prostate (TURP) may be used to remove a portion of the enlarged gland.
Other, relatively new forms of surgical therapy for enlarged prostate glands involve the application of lasers, heat, microwaves, or radio frequency energy, to destroy enlarged prostate tissue.
After Procedure- To reduce blood in the urine, water may be flushed through the bladder catheter that is inserted during surgery. This catheter will either be removed before you leave the hospital, or, in some cases, left in place for 1-3 weeks to allow for easier urination during the healing period.
How Long Will It Take? 2-4 hours
Will It Hurt? Anesthesia prevents pain during the procedure. You can expect some pain and discomfort for 7-10 days after open surgery, and 3-4 days after laparoscopic surgery. Also, urination may be painful during the healing period.
Possible Complications:- Excessive bleeding
- Surgical wound infection
- Blood clots
- Inability to control urinary stream (incontinence)
- Impotence
- Retrograde ejaculation - sperm ejaculates into your bladder, rather than out through the penis; this may cause the urine to appear milky white after ejaculation
- Sterility
- Urethral stricture
- Low blood sodium after large amounts of fluid are used to irrigate the bladder during TURP; can cause confusion, dizziness, high blood pressure, vomiting, and disturbed vision
Average Hospital Stay: 3-7 days
Postoperative Care:- Take medications as directed; you may be given antibiotics to help prevent infection and/or stool softeners to help prevent constipation.
- Do not take prescription pain medication for more than 7 days. After this point, take non-prescription pain relievers (such as Advil or Ibuprofen) as necessary, but avoid taking aspirin or aspirin-containing products.
- When resting in bed, keep legs elevated and moving to avoid deep vein blood clots.
- To promote healing, resume normal activities as quickly as possible.
- Drink plenty of liquids to clear your bladder of urine and blood.
- Shower as usual, but avoid baths until the surgical incision has completely healed.
- Wash the incision gently with mild soap and water.
- Do not drive for at least one month after surgery.
- Avoid vigorous exercise for 6 weeks after surgery.
- Resume sexual activity when able.
- Avoid coffee, tea, cola, cocoa, alcohol, spicy foods, or any other food or drink that might aggravate your stomach, intestines, bladder, or urinary tract.