|
Prostatectomy
What is
Prostatectomy?
Prostatectomy is surgical removal of part of the
prostate gland (transurethral resection, a
procedure performed to relieve urinary symptoms
caused by benign enlargement), or all of the
prostate (radical prostatectomy).
Back to Top
Effects
of Prostatectomy
This is a curative surgery most often used to
treat prostate cancer.
Back to Top
Candidates for Prostatectomy
Open (incisional)
prostatectomy for cancer should not be done if
the cancer has spread beyond the prostate, as
serious side effects may occur without the
benefit of removing all the cancer. If the
bladder is retaining urine, it is necessary to
insert a catheter before starting surgery.
Patients should be in the best possible general
condition before radical prostatectomy.
Back to Top
Your Consultation
Before
surgery, the bladder is inspected using an
instrument called a cystoscope to help determine
the best surgical technique to use, and to rule
out other local problems. As with any type of
major surgery done under general anesthesia, the
patient should be in optimal condition. Most
patients having prostatectomy are in the age
range when cardiovascular problems are frequent,
making it especially important to be sure that
the heart is beating strongly, and that the
patient is not retaining too much fluid. Because
long-standing prostate disease may cause kidney
problems from urine "backing up," it also is
necessary to be sure that the kidneys are
working properly. If not, a period of catheter
drainage may be necessary before doing the
surgery.
Back to Top
The
Prostatectomy Procedure
TURP-
This procedure does not require an abdominal
incision. With the patient under either general
or spinal anesthesia, a cutting instrument or
heated wire loop is inserted to remove as much
prostate tissue as possible and seal blood
vessels. The excised tissue is washed into the
bladder, then flushed out at the end of the
operation. A catheter is left in the bladder for
one to five days to drain urine and blood.
Advanced laser technology enables surgeons to
safely and effectively burn off excess prostate
tissue blocking the bladder opening with fewer
of the early and late complications associated
with other forms of prostate surgery. This
procedure can be performed on an outpatient
basis, but urinary symptoms do not improve until
swelling subsides several weeks after surgery.
Back to Top
Recovery
Following TURP, a catheter is placed in the
bladder to drain urine and remains in place for
two to three days. A solution is used to
irrigate the bladder and urethra until the urine
is clear of blood, usually within 48 hours after
surgery. Whether antibiotics should be routinely
given remains an open question. Catheter
drainage also is used after open prostatectomy.
The bladder is irrigated only if blood clots
block the flow of urine through the catheter.
Patients are given intravenous fluids for the
first 24 hours, to ensure good urine flow.
Patients resting in bed for long periods are
prone to blood clots in their legs (which can
pass to the lungs and cause serious breathing
problems). This can be prevented by elastic
stockings and by periodically exercising the
patient's legs. The patient remains in the
hospital one to two days following surgery and
can return to work in one to two weeks.
Back to Top
Risks
The
complications and side effects that may occur
during and after prostatectomy include:
-
Excessive bleeding, which in rare cases may
require blood transfusion.
-
Incontinence when, during retropubic
prostatectomy, the muscular valve (sphincter)
that keeps urine in the bladder is damaged.
Less common today, when care is taken not to
injure the sphincter.
-
Impotence, occurring when nerves to the penis
are injured during the retropubic operation.
Today's "nerve-sparing" technique has
drastically cut down on this problem.
-
Some
patients who receive a large volume of
irrigating fluid after TURP develop high blood
pressure, vomiting, trouble with their vision,
and mental confusion. This condition is caused
by a low salt level in the blood, and is
reversed by giving salt solution.
-
A
permanent narrowing of the urethra, called a
stricture, occasionally develops when the
urethra is damaged during TURP.
Back to Top
Frequently Asked Questions
Q:
What are the symptoms of prostate enlargement
and blockage?
A:
Symptoms of prostate enlargement and blockage
(obstruction) include:
·
Frequent urination
with small amounts of urine
·
Recent
need to urinate at night (nocturia)
·
Difficulty starting a stream of urine
·
Slow stream of urine
·
Urine dripping out of urethra after urination
(dribbling)
·
Feeling that bladder is never empty
·
Urinary tract infection
Q:
What are the other forms of operation for this
treatment?
A:
Aside
from TURP, the other options available are:
-
Perineal Prostatectomy: In this operation, the
prostate is removed through an incision
between the rectum and the scrotum.
Potentially cancerous lymph nodes in the area
may also require removal. To reach them, the
doctor will insert a thin metal tube called a
laparoscope through 3 or 4 small incisions in
the lower abdomen. All told, the surgery lasts
2 to 3 hours. You'll remain in the hospital
for 4 to 6 days.
-
Retropubic and Suprapubic Prostatectomy: These
operations require a larger incision in the
lower abdomen, through which the prostate and
nearby lymph nodes can be removed. Like
perineal surgery, the operation takes 2 to 3
hours and is followed by a 4 to 6 day stay in
the hospital.
Q:
What should normal results indicate?
A:
In patients with BPH who have the TURP
operation, urination should become much easier
and less frequent, and dribbling or incontinence
should cease. In patients having radical
prostatectomy for cancer, a successful operation
will remove the tumor and prevent its spread to
other areas of the body (metastasis). If
examination of lymph nodes shows that cancer
already had spread beyond the prostate at the
time of surgery, other measures are available to
control the tumor.
Back to Top
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
|
