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Simple prostatectomy

Simple prostate removal is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate . It is done through a surgical cut in your lower belly.

You will be given general anesthesia (asleep, pain-free) or spinal anesthesia (sedated, awake, pain-free). The procedure takes about 2 to 4 hours.

Your surgeon will make a surgical cut in your lower belly. The cut will go from below the belly button to just above the penis. The prostate gland is removed through this cut.

The surgeon removes only the inner part of the prostate gland. The outer part is left behind. The process is similar to scooping out the inside of an orange. After removing part of your prostate, the surgeon will close the outer shell of the prostate with stitches. A drain may be left in your belly to help remove extra fluids after surgery.

Alternative Names

Prostatectomy - simple; Suprapubic prostatectomy; Retropubic simple prostatectomy; Open prostatectomy; Millen procedure

Why the Procedure Is Performed

An enlarged prostate can cause problems with urinating. This can lead to urinary tract infections. Taking out part of the prostate gland can often make these symptoms better. Before you have surgery, your doctor may tell you some changes you can make in how you eat or drink. You may also be asked to try taking medicine.

Prostate removal can be done in many different ways. The kind of procedure you will have depends on the size of the prostate and what caused your prostate to grow. Open simple prostatectomy is often used when the prostate is too large for less invasive surgery. This means that the prostate weighs 100 grams or more. However, this method does not treat prostate cancer. Radical prostatectomy  may be needed for cancer.

Prostate removal may be recommended if you have:

  • Problems emptying your bladder (urinary retention)
  • Frequent urinary tract infections
  • Frequent bleeding from the prostate
  • Bladder stones with prostate enlargement
  • Very slow urination
  • Damage to the kidneys

Your prostate may also need to be removed if taking medicine and changing your diet do not help your symptoms.

Risks

Risks for any surgery are:

Other risks are:

Before the Procedure

You will have many visits with your doctor and tests before your surgery:

  • Complete physical exam
  • Visits with your doctor to make sure medical problems (such as diabetes , high blood pressure , and heart or lung diseases) are being treated well

If you are a smoker, you should stop several weeks before the surgery. Your nurse or doctor can help.

Always tell your doctor or nurse what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the weeks before your surgery:

  • You may need to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • You may take a special laxative the day before your surgery. This will clean the contents out of your colon.

On the day of your surgery:

  • Do not eat or drink anything after midnight the night before your surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for about 3 to 4 days.

  • You will need to stay in bed until the next morning.
  • After you are allowed to get up you will be asked to move around as much as possible.
  • Your nurse will help you change positions in bed.
  • You will also learn exercises to keep blood flowing, and coughing/deep breathing techniques.
  • You should do these exercises every 3 to 4 hours.
  • You may need to wear special compression stockings and use a breathing device to keep your lungs clear.

You will leave surgery with a Foley catheter in your bladder. Some men have a suprapubic catheter in their belly wall to help drain the bladder.

Outlook (Prognosis)

Many men recover in about 6 weeks. You can expect to be able to urinate as usual without leaking urine.

References

Han M, Partin AW. Retropubic and suprapubic open prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 94.

Thiel D, Petrou SP. Electroresection and open surgery. Urol Clin North Am. 2009;36(4):461-470, vi.

Updated: 5/7/2013

Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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