Essential Insights on Prostate Surgery You Should Know

Prostate surgery is a key treatment for various prostate gland conditions, including prostate cancer and benign prostate enlargement. The surgical approach varies based on the specific diagnosis.

The prostate, a small walnut-shaped gland surrounding the urethra near the bladder in men, is crucial for reproductive health as it produces seminal fluid that supports sperm.

Prostate cancer ranks as the second most prevalent cancer among men globally, with risk increasing with age.

Understanding your condition and treatment options is fundamental. Engage in thorough discussions with your healthcare provider to address any concerns.

In some cases, partial or complete surgical removal of the prostate, known as prostatectomy, becomes necessary.

Continue reading to explore when prostate surgery is indicated, the various surgical methods, potential risks, and what to expect during recovery.

Purpose of Prostate Surgery

Common reasons for prostatectomy include:

• Treating prostate cancer characterized by uncontrolled growth of prostate cells.
• Managing benign prostatic hyperplasia (BPH), a noncancerous prostate enlargement.
• Alleviating urinary symptoms, such as difficulty urinating, even if cancer is not present.

The primary objectives of prostate surgery are to:

• Resolve the underlying condition.
• Preserve bladder control.
• Maintain erectile function.
• Reduce side effects.
• Minimize pain before, during, and after the procedure.

The surgical goal depends on your diagnosis—for prostate cancer, it involves removing malignant tissue; for BPH, restoring normal urine flow.

Procedures can be performed under general anesthesia, inducing sleep, or spinal anesthesia, numbing the lower body, based on your doctor's recommendation.

Open Radical Prostatectomy (ORP)

Also known as traditional open surgery, ORP is used to treat both cancerous and noncancerous prostate conditions. The surgeon makes an incision to remove the entire prostate and adjacent tissues.

For cancer cases, ORP is typically the preferred surgical method.

Two main ORP techniques exist: retropubic and perineal.

Radical Retropubic Prostatectomy

This is the most common cancer surgery, where a urologist makes an abdominal incision to access and remove the prostate.

Nearby tissues, including lymph nodes, are often removed to assess cancer spread.

If cancer spread is detected during surgery, the procedure may be halted to explore additional treatments. Preoperative imaging usually helps anticipate this.

Radical Perineal Prostatectomy

Less commonly performed, this surgery removes the prostate via an incision between the anus and scrotum and is chosen when lymph node removal isn't necessary.

It is shorter in duration but carries a higher risk of nerve damage affecting erections.

Potential risks of both approaches include:

• Erectile dysfunction (ED), or difficulty maintaining erections.
• Infertility due to severed connections between the urethra and testicles, though orgasm remains possible (dry orgasm).
• Urinary incontinence, usually improving over time.
• Lymphedema, rare swelling from lymph node removal.
• Penile size reduction, more common with older age at surgery.

Both surgeries use general or spinal anesthesia, which carry risks such as medication reactions, infection, bleeding, and breathing difficulties.

Laparoscopic Prostatectomy

This minimally invasive surgery involves small abdominal incisions for instrument insertion, including a camera for visualization.

Laparoscopic Radical Prostatectomy (LRP)

Surgeons use 3-4 small incisions to perform the procedure with manual instruments.

Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP)

This technique employs robotic arms controlled by the surgeon for enhanced precision and maneuverability, available at select centers.

Comparing ORP, LRP, and RALRP

Research indicates similar overall outcomes among these methods; however, LRP and RALRP offer benefits like less blood loss, reduced pain, shorter hospital stays, and quicker recovery.

Patients undergoing RALRP often experience faster return of bladder control and shorter hospitalization than with LRP, though surgeon expertise significantly influences results.

Prostate Surgeries to Improve Urine Flow

Less invasive options focus on relieving urinary obstruction without extensive incisions.

Prostate Laser Surgery

Using a fiber-optic scope inserted through the penis, laser energy removes obstructive prostate tissue, primarily treating BPH. Though minimally invasive, it may be less effective than other surgeries.

Endoscopic Surgery

Involves inserting a flexible tube with a camera and tools through the urethra to excise prostate tissue. The most common procedure is transurethral resection of the prostate (TURP), which cuts away enlarged tissue to improve urine flow.

Another variant, transurethral incision of the prostate (TUIP), involves small cuts to widen the urethra and may have fewer side effects than TURP.

Potential Side Effects of Prostate Surgery

All surgeries carry risks such as anesthesia reactions, bleeding, infection, organ injury, and blood clots.

Signs of infection include fever, chills, swelling, or discharge from the incision site. Seek medical attention if urine flow is blocked or blood in urine worsens.

Urinary Issues

Temporary pain, difficulty urinating, or incontinence are common but typically improve within months.

Erectile Dysfunction

Most men experience temporary ED post-surgery, with about 85% affected. Nerve-sparing techniques reduce this risk but may compromise cancer removal.

Sexual Function Changes

Removal of seminal glands leads to dry orgasms and infertility. Discuss fertility concerns with your doctor prior to surgery.

Postoperative Expectations

A urinary catheter is placed during surgery to drain the bladder for 1-2 weeks.

Hospital stays usually last a few days, though some patients may go home within 24 hours. Instructions on catheter care and wound management will be provided.

Incision soreness, blood in urine, urinary irritation, and infections are common temporarily.

Recovery depends on surgery type, health status, and adherence to medical advice, including activity restrictions.

Guidance for Recovery

Prioritize rest and follow your doctor’s instructions carefully. Restrictions may include:

• Keeping the surgical site clean.
• Avoiding driving for 1-2 weeks.
• Limiting strenuous activities for up to eight weeks.
• Minimizing stair climbing.
• Refraining from soaking in baths or pools.
• Taking prescribed pain medications.

Having support during catheter use is beneficial.

Maintain bowel regularity through hydration, fiber intake, and possibly laxatives as advised.

Self-Care Tips

If scrotal swelling occurs, support it with a rolled towel sling. Contact your doctor if swelling persists beyond one week.

Explore further resources on postoperative care and prostate health nutrition.

Common Questions About Prostate Surgery

What clothing is best after prostate surgery?

Wear loose, comfortable clothes to accommodate the urinary catheter and reduce irritation.

Is prostate surgery considered major surgery?

Yes, prostate removal is major surgery requiring time off work and avoidance of strenuous activities for recovery.

How long does prostate surgery usually take?

Surgery duration typically ranges from 2 to 4 hours, depending on the procedure type.

What is the success rate of prostate surgery?

Radical prostatectomy for early-stage prostate cancer has excellent outcomes, with success depending largely on cancer stage at diagnosis.

What is the typical recovery period after prostate surgery?

Recovery generally spans 6 to 8 weeks, varying by individual factors.

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