Prostatectomy

What is Prostatectomy?

Prostatectomy is a surgical procedure to remove all or a part of the prostate gland.

Is a Prostatectomy procedure an elective or an emergency procedure?

This is an elective procedure.

Types of procedure

There are two types of prostatectomies:

• Simple or Subtotal Prostatectomy: This procedure refers to the partial removal of the prostate gland. This procedure is performed for non-cancerous lesions in the prostate.
• Radical Prostatectomy: This procedure includes removing the entire prostate gland and seminal vesicles, vas deferens, and surrounding lymph nodes. It is performed for the treatment of malignant cancers of the prostate. It may be done either as a minimally invasive Laparoscopic Radical Prostatectomy or Robot-assisted Radical Prostatectomy.

Indications

Indications for removal of a prostate include:

• Prostate cancer
• Enlarged prostate
• Cancers of the pelvis
• Recurrent urinary tract infections due to an enlarged prostate
• Bladder outlet obstruction caused due to enlarging prostate

Contraindications and Risk Factors

There are no absolute contraindications. However, caution is advised before performing this procedure in individuals with severe bleeding disorders and cardiovascular disease.

Investigations before the procedure

Investigation tests that are done before performing the procedure are:

• To check the size of the prostate and to examine the urinary system
• Prostate-specific antigen (PSA) level
• Digital rectal examination
• Prostate biopsy
• Urinalysis and urine culture
• Electrolyte study
• Complete blood count
• Coagulation test
• Transrectal ultrasonography

Preoperative advice

Preoperatively before the procedure:

• The risks and benefits of the surgery are explained
• Allergic reactions to any medications are checked
• Blood-thinning medications are discontinued before the surgery
• Oral intake is discontinued after midnight the night before the surgery
• Bowels are emptied with an enema before the procedure

Intraoperative details

The Prostatectomy can be performed either laparoscopically with a robot or through an open incision in the lower abdomen.

• Anesthesia: General anesthesia.
• Duration: This procedure can take up to 2 hours.

Description of the procedure

Laparoscopic Prostatectomy/Robotic

This is a minimally invasive procedure. Several small incisions are made on the abdomen. Robotic-assisted instruments are inserted through these incisions. The surgeon controls the motion of the surgical instruments by viewing on a monitor that displays a magnified view of the surgical area. After the prostate is removed, all the surgical instruments are withdrawn slowly, and the incisions are closed with sutures. The laparoscopic approach has advantages over open prostatectomy, and they include small incisions, less risk of bleeding, less risk of infection, and shorter recovery time.

Open Prostatectomy

The abdomen is cleaned with an antiseptic solution. A large single incision is made in the lower abdomen to access the prostate. The incision that is made to reach the prostate may be either retropubic, suprapubic, or perineal. In retropubic incision, the prostate is accessed through an incision made in the lower abdomen behind the pubic bone. In a suprapubic incision, the prostate is accessed through the urinary bladder. In the perineal, the prostate is accessed through an incision between the rectum and scrotum. After reaching the prostate, the prostate is removed carefully without injuring the surrounding blood vessels and nerves. One or two drains are left in place. The incision is closed with sutures, and a sterile bandage is applied over the incision.
When the procedure is done for the treatment of prostate cancer, pelvic lymph node dissection and removal are also done to remove the affected lymph nodes.

Postoperative Details

Postoperatively after Prostatectomy:

• Pain medications are prescribed for pain and discomfort.
• A urinary catheter is left in place to drain the urine.
• A follow-up is scheduled for suture removal.

Role of Diet/ Exercise/ Lifestyle Changes

Aftercare instructions for prostatectomy:

• Resume normal activities gradually within the next 4 to 6 weeks
• Avoid heavy lifting
• Avoid strenuous exercises, sports, or other physical activities
• After Prostatectomy, orgasm during sex is possible, but very little or no semen is ejaculated

Complications

Risks and complications after this procedure include:

• Bleeding
• Urinary tract infections
• Erectile dysfunction
• Narrowing of the urethra or bladder neck
• Urinary incontinence
• Injury to the nearby structures

Prognosis

The overall prognosis of prostatectomy is good. It is an effective procedure for prostate enlargement that leads to various urinary complaints.

Indications for hospitalization if required

A procedure is performed in a hospital setting. Laparoscopic Prostatectomy also requires at least a one-day stay in the hospital. The length of stay after an open Prostatectomy depends upon the individual's medical condition.

Suggested clinical specialist/ Department to consult for the procedure

• Urologist