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Prostatectomy

Prostatectomy is a surgical procedure in which either a part or the entire prostate gland is removed. Prostate gland is a walnut-sized gland present between the urinary bladder and penis in males.

Need for prostatectomy

Prostatectomy may be performed in the following conditions:

  • Benign prostatic hyperplasia (BPH) in which the prostate gland is enlarged
  • Treatment of localized prostate cancer in conjunction with radiotherapy and chemotherapy
  • Severe urinary symptoms such as urinary obstruction, burning sensation, incomplete urination, pain, etc.

Types of prostatectomy

Prostatectomy is of the following two types:

  • Simple prostatectomy in which only the damaged portion of the prostate gland is removed
  • Radical prostatectomy in which the entire gland along with some of the adjacent tissues are removed

Testing before the surgery

Before undergoing the surgery the doctor will perform a complete examination of the urinary system along with a physical examination of the patient. Certain tests will be performed which include the following:

  • Blood tests
  • Urine flow test
  • Cytoscopy to measure the size of the prostate gland
  • Digital rectal examination
  • Biopsy to check for suspicious tissues
  • Prostate specific antigen test

How to prepare

The below preparation is required before undergoing the surgery:

Few days before the surgery:

  • Do not smoke as it can delay the healing process
  • Inform the doctor about the supplements and medicines which are currently in use. This is because some of them can increase the risk of bleeding and should be stopped for some days before surgery

A day before the surgery:

  • Do not eat or drink anything for a whole night before the surgery
  • Take only those medicines suggested by the doctor with a sip of water
  • Enema or laxative may be given on the day of surgery to clear the bowel

Procedure

Based on the condition, prostatectomy is performed in several ways as detailed below:

Before performing the surgery, the doctor gives anesthesia. This can be either a general anesthesia which causes unconsciousness or a spinal anesthesia to cause numbness down the waist region. Antibiotics will be given to reduce the risk of infections after the surgery.

  • In open simple prostatectomy, a large sized cut is made below the navel, through the urinary bladder and only the damaged parts of the prostate are removed.
  • Laparoscopic radical prostatectomy in which small incisions are made in the lower abdominal region. Through these cuts, special surgical tools and video camera are inserted to remove the prostate gland.
  • Robot-assisted radical prostatectomy in which several small cuts are made in the lower abdomen. The surgeon sits at a console and uses instruments connected to a robot, i.e. a computer-assisted mechanical device. This robot produces response to the movements of the surgeon and assists in the operation.

After the surgery

The patient may have to stay for 1-3 days based on the type of surgery and the condition of the patient. Do not drive alone but have someone to drive home.

  • Tubes which are inserted during the surgery to drain extra fluids will be retained for 1 or 2 days
  • The catheter inserted to drain the urine will be retained for 2-3 days
  • Pain medicines will be given for a few days or weeks to relieve the pain associated with the surgery

Post surgical care

The patient will be encouraged to mobilize on the same day to prevent complications such as clots in the legs. Additionally, take the following safety measures to help in a faster healing after the surgery:

  • Take the medicines as prescribed and go for follow up visits as suggested
  • Do not perform strenuous exercises for nearly 6 weeks
  • Do not involve in sexual activities for about 6 weeks

Risks

Any surgical procedure involves certain risks. The following potential risks associated with prostatectomy are:

  • Bleeding
  • Infection of the surgical wounds
  • Erectile dysfunction
  • Sterility
  • Changes in the length of the penis
  • Loss of control over bowel and bladder movements
  • Leakage of urine
  • Tightening of the urinary opening
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