Prostatectomy (Prostate Gland Removal)

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is not related to prostate cancer development. It is relieved by transurethral resection or incision of the prostate (TURP or TUIP). Open surgery to remove the entire prostate is called a simple prostatectomy.

Prostate Cancer

Radical prostatectomy (complete removal of the prostate) is often considered in the early stages of prostate cancer, when it is confined to the prostate.

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Blood tests
• Urine tests
• Chest x-rays (for a simple prostatectomy)
• Kidney function tests
• Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
• Ultrasound (usually transrectal)—a test that uses sound waves to visualize the inside of the body
• Bone scan or CT scan if there is reason to suspect spread of cancer

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.
• The night before, have a light meal and do not eat or drink anything after midnight.

Anesthesia

Usually general or spinal anesthesia is used.

Description of the Procedure

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. This will allow for easier urination during the healing period. After a radical prostatectomy, many surgeons leave a JP® drain.

How Long Will It Take?

• TURP/TUIP: 1-1½ hours
• Simple prostatectomy: 2-4 hours
• Radical prostatectomy: 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
• 3-4 days after laparoscopic surgery

Possible Complications

• Excessive bleeding
• Surgical wound infection
• Blood clots
• Inability to control urinary stream (incontinence)
• Fecal 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.
  • This would occur after TURP/TUIP. After open prostatectomy, patients are not able to ejaculate.
• Sterility
• Urethral stricture
• Low blood sodium after large amounts of fluid are used to irrigate the bladder during TURP/TUIP
  
  • This can cause confusion, dizziness, high blood pressure, vomiting, and disturbed vision.
• Urine leak requiring prolonged drainage (with a catheter or drain) or reoperation
• Injury to the rectum or other adjacent structures
  
  • This is a complication after radical prostatectomy only.

Average Hospital Stay

Postoperative Care

• Take medications as directed; you may be given antibiotics to prevent infection and/or stool softeners to prevent constipation.
• Do not take prescription pain medication for more than seven 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 six 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.