The prostate gland can be partially or completely removed surgically (prostatectomy). Under the urinary bladder in the male pelvis is where the prostate gland is located. The urethra, which conducts urine from the bladder to the penis, is encircled by it.

The treatment is used to treat a variety of prostate-related diseases. Most frequently, it is used to treat prostate cancer.

Depending on the problem being treated, there are numerous procedures to do a prostatectomy. Options include standard open surgery as well as less invasive procedures carried out with robotic help.


Why is prostatectomy done?


Prostatectomy is most frequently used to treat locally advanced prostate cancer. It can be applied alone or in combination with hormone therapy, chemotherapy, and radiation. In order to treat men with locally advanced prostate cancer, a radical prostatectomy involves completely removing the prostate gland and the lymph nodes around it. A surgeon may use a variety of methods to perform a radical prostatectomy, including:


Robot-assisted radical prostatectomy. How is radical prostatectomy with robot assistance done. Your lower abdomen is incised five to six times by the surgeon in order to remove the prostate. He or she operates instruments attached to a robotic equipment while seated at a console. A more accurate response to the surgeon's hand movements is made possible by the robotic equipment. Prostatectomy with an open cut. Your lower abdomen is normally where the prostate is removed by the surgeon.


Open radical prostatectomy. To remove the prostate, the surgeon often makes an incision in your lower abdomen.

Men who have significantly enlarged prostate glands and severe urine problems may occasionally benefit from a simple prostatectomy. Benign prostatic hyperplasia, or BPH, is the medical term for enlarged prostate glands. Simple prostatectomy is typically carried out using robotic assistance as a minimally invasive surgery. Nowadays, open procedures are rarely used. In contrast to a radical prostatectomy, a simple prostatectomy does not always require the removal of the entire prostate. For a simple prostatectomy the obstruction of urine flow is treated by removing part of the prostate gland but not all of it. The procedure alleviates difficulties and symptoms related to urinary tract obstruction, such as:


  • Failure to pass urine (Urinary retention)
  • urgent need to urinate with increased frequency
  • Problems initiating urination process
  • Urination starts and stops in the process
  • Feeling the bladder is incompletely empty
  • Infections of the Urinary tract
  • Urination that is prolonged and slow
  • Increased need to urinate at night

Some hospitals have developed advanced ways to deal with the above symptoms using equipment  without any incisions.


prostate removal surgery
Image Credit: Saint Luke's Health System. During a Laser prostatectomy


What are risks that come with prostatectomy?


Despite the positive results the procedure offer it has risks that may appear to some patients. 

Risks of radical prostatectomy


The hazards of radical prostatectomy are similar to those of any surgery, and they include:

  • Urinary tract infections
  • Urinary incontinence
  • Erection problems like  Erectile dysfunction aka  impotence
  • Urethra or bladder neck narrowing
  • lymphocele lymph-fluid filled sacs formation
  • Bleeding

Risks of Simple prostatectomy.

However, compared to other enlarged prostate operations such transurethral resection of the prostate (TURP), laser PVP surgery, or holmium laser prostate surgery (HoLEP), simple prostatectomy has a higher risk of complications and a longer recovery period.

The open simple prostatectomy has:

  • Bleeding
  • Urinary tract infection
  • Urinary incontinence
  • Dry orgasm
  • Erectile dysfunction (impotence)
  • Narrowing (stricture) of the urethra or bladder neck

Considerations before the procedure


Your doctor could recommend a test called a cystoscopy, which utilizes a visual scope to check inside your urethra and bladder, before surgery. Your doctor can assess the size of your prostate and look at your urinary system during a cystoscopy. In addition, your doctor might order other testing, like blood tests or assessments of your prostate and urine flow.


Observe the pre-treatment advice given to you by your doctor. The following topics are some to bring up with your doctor:

Food and drugs 


Prescription drugs. Any prescription drugs, over-the-counter medicines, or dietary supplements you take should be disclosed to your doctor. This is crucial if you use over-the-counter painkillers like aspirin, ibuprofen (Advil, Motrin IB, others), or naproxen sodium (Aleve), as well as blood thinners like warfarin (Coumadin) or clopidogrel (Plavix). Several days prior to the procedure, your surgeon may advise you to cease taking any medications that raise your risk of bleeding.

Allergies to or reactions to medications. Any allergies or adverse drug reactions should be discussed with your medical staff.
before surgery, a fast. You'll probably be instructed by your doctor to abstain from food and liquids after midnight. Take only the medications your doctor instructs you to take with a little sip of water the morning of your surgery.

Bowel preparation prior to surgery. To help you prepare for surgery, you can be given a kit and instructions for doing an enema on yourself.


How is the procedure done?

You won't be conscious throughout a prostatectomy because it's typically performed under general anaesthetic. Prior to surgery, your doctor could also prescribe an antibiotic to assist avoid infection.


Robot-assisted radical prostatectomy. Using two hand-and-finger control devices, your physician carefully regulates the motion of the surgical tools while seated at a remote-control console near you and the operating table. In comparison to conventional laparoscopic surgery, the console's magnified, 3D image of the operating area allows the surgeon to see the procedure in great detail.

Smaller and more accurate incisions are possible with the robotic device, which for some men encourages a quicker recovery than open surgery does. The robotic approach provides nerve-sparing methods that, in the right candidate, may retain both sexual potency and continence, much like with open retropubic surgery.

Open radical prostatectomy. Your lower abdomen, from just below the navel to just above the pubic bone, is cut by the surgeon. The surgeon gently separates the prostate gland from the neighboring nerves and blood arteries, then removes the prostate and the surrounding tissue. After that, sutures are used to close the incision.

Simple prostatectomy. Your doctor may begin the operation by inserting a long, flexible viewing scope (cystoscope) through the tip of your penis to observe the urethra, bladder, and prostate region from inside. Then, to drain urine during the procedure, your doctor will implant a tube (a Foley catheter) into the tip of your penis that extends into your bladder. Depending on the approach your doctor takes, incisions may be made in different places. Your doctor might use the operation as a chance to fix any hernias or bladder issues you also have.

One to two temporary drain tubes may be put through punctures in your skin at the surgical site after your doctor has removed the portion of your prostate causing symptoms. Suprapubic tubes go into your bladder directly, while pelvic drains go into the region where the prostate was removed.

What To expect after the procedure


Here is what to anticipate following prostatectomy:

IV painkillers will be administered to you. Following the removal of the IV, your doctor could prescribe painkillers for you to take.
Your surgeon will instruct you to walk the day of or the day following surgery. While you are in bed, you will also perform foot exercises.
The day after surgery, you'll most likely return home. The pelvic drain is removed after your doctor determines that you may safely return home. To have the staples removed, you might need to visit the doctor again in a week or two.
A catheter will be in place when you go home. For seven to ten days after surgery, the majority of men require a urinary catheter. Expect  full control of urinary control after a period of one year from the procedure.


Make sure you are aware of the post-operative procedures you must follow and any limitations on driving or heavy lifting:

Your degree of activity needs to be gradually increased. Four to six weeks should pass before you can resume your regular schedule.
Make sure to go for review. To make sure everything is alright, you will need to visit your doctor several times. The majority of men visit their doctors twice in the second year following surgery, twice after roughly six weeks, and then every three months for the first year. You might need to visit your doctor sooner or more frequently if you have any issues or worries.
Wait before resuming sexual activity. After your recovery from surgery, you'll most likely be able to resume sexual activity. For some men, it can take up to 18 months to fully recover from a radical prostatectomy in terms of erectile function.


Summary 

A prostatectomy aided by a robot can have fewer side effects than a traditional prostatectomy, including less pain and blood loss, less tissue stress, a shorter hospital stay, and a quicker recovery.  A patient can resume normal activities after 4 weeks of the surgical procedure with only few restrictions

Long-lasting relief from urinary difficulties brought on by an enlarged prostate is offered by a straightforward prostatectomy. Despite being the most intrusive method of treating an enlarged prostate, severe consequences are quite uncommon. Generally speaking, most men who undergo the operation don't require any BPH follow-up care.