A prostatectomy is surgery to remove the prostate. Most often this refers to the removal of the entire prostate due to prostate cancer. There are times when parts of the prostate may be removed for benign conditions such as enlarged prostate, also referred to as benign prostate hyperplasia (BPH).
Types of Prostatectomy
There are two main types of prostatectomy: a radical prostatectomy, and an open simple prostatectomy.
Removal of the entire prostate gland along with surrounding tissue, including lymph nodes and the section of urethra traveling through the prostate gland. The remaining urethra is surgically attached to the bladder. Radical prostatectomies are commonly done in cases of prostate cancer.
Simple prostatectomy is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. Simple prostatectomy used to be an open surgery, but today, it is usually performed as a minimally invasive procedure with robotic assistance. A method called TURP (Transurethral Resection of the Prostate), allows surgeons to remove obstructing parts of the prostate gland through the penis with no incisions necessary.
Types of Radical Prostate Surgery
There are three types of Radical Prostatectomy. They are classified according to the incision site. All three can accommodate a “nerve-sparing” procedure which includes carefully dissecting the erectile nerves away from the prostate during removal. This helps reduce the chances of erectile dysfunction after surgery.
Retropubic Prostate Surgery
The retropubic incision is made in the center of the lower abdomen from the navel to the pubic bone and is often called open prostate surgery. Through this incision, the prostate can be removed, lymph nodes checked for cancer, and nerves avoided. It avoids the peritoneum (the cavity where the intestines reside).
Perineal Prostate Surgery
With this surgery, a small incision is made in the perineum (the flat area between the scrotum and anal sphincter).
Laparoscopic and Robotic Surgery
With modern technology, laparoscopic and robotic surgery has become quite common. The laparoscope, a small camera at the end of a slender, tube-like instrument allows the surgeon to see inside the abdominal cavity during surgery without having to open the body up with large incisions. The prostate can be removed through smaller incisions. At KCUC, we have added the da Vinci surgical robot to laparoscopic prostate surgery which has made the procedure easier to learn for many surgeons. Robotic-Assisted Laparoscopic surgery (RALP) uses the same incisions and tools as laparoscopic prostatectomy but uses robotic arms controlled by the surgeon while sitting at a console in the operating room. RALP has nearly replaced pure laparoscopic prostate removal.
What to Expect After a Prostatectomy
A prostatectomy usually requires a 1-3 night hospital stay. After discharge, you should expect
- Bleeding & Tenderness – a small amount of bleeding on the surgical gauze dressing as well as some swelling, bruising, and firmness at the site of the incisions.
- Erectile Dysfunction – a radical prostatectomy will cause at least temporary erectile dysfunction. Depending on the patient’s age and the degree of nerve-sparing that was possible, erections may return to some degree over 6 months to 2 years time.
- Urinary incontinence – a lack of urinary muscle control is very common immediately after surgery but generally improves with pelvic muscle exercises and time (6 to 18 months).
Cutting-Edge Urology Care in Kansas City
From robotic surgery to cutting-edge treatments, we take pride in being the first to bring the forefront of medicine to the Midwest. The urologists at Kansas City Urology and Oncology use the latest and best treatments and tools to diagnose and treat urologic conditions and cancer.