Definition and Overview

Prostatectomy, or prostate resection, is a surgical procedure that removes a part (simple) or the entire prostate gland. In some cases, the surrounding tissues and lymph nodes (radical prostatectomy) are also removed. It is performed to treat localised prostate cancer, remove blockages, reduce swelling, and prevent further infections.

The prostate gland is a small male organ that releases fluid for the nourishment of the sperm. If it encounters problems that affect the male urinary system, one of the treatment options is to remove it. Different techniques can be used when performing prostate surgery depending on whether the procedure is simple or radical.

Prostatectomy comes with certain risks and complications including male sexual dysfunction. Hence, doctors exhaust all non-invasive methods including therapies and medicine before it is even recommended.

Who Should Undergo and Expected Results

Prostate removal is recommended for men with:

  • Localised prostate cancer – This means that the cancer has originated in the prostate and has not spread or metastasised to other organs and tissues yet. Radical prostatectomy is done in this case. The procedure can be performed before other treatment like chemotherapy and radiation therapy are given.

  • Enlarged prostate – An enlarged prostate occurs when there’s a benign growth in the gland that blocks the flow of urine and causes the bladder to become very sensitive. Some of the common signs and symptoms of this condition are frequent need to urinate, urinary changes (such as dribbling or leaking), incontinence, pain, and blood in the urine. In this case, simple open prostate resection is done to remove the blockage.

  • *Recurrent infections *

It is expected that by performing prostatectomy, the patient will:

  • Experience relief

  • Decrease the possibility of metastasis

  • Increase his mobility

  • Restore the function of his urinary system

How Does the Procedure Work?

Prostatectomy, or prostate cancer surgery, is performed by a surgeon with an extensive background in urology, the medical field that focuses on the male reproductive system.

Prior to the procedure, the patient undergoes various tests including:

  • PSA test – A blood test that measures PSA levels. PSA, or prostate-specific antigen, is found in the semen and produced by both cancerous and noncancerous tissue in the prostate.

  • Cystoscopy – A diagnostic test that checks the condition of the urinary system such as the bladder, urethra, and prostate.

  • Prostate biopsy – This test is used to determine the stage of prostate cancer. The information obtained is used to predict prognosis and determine the best treatment method. A Gleason score is given based on its microscopic appearance. The higher the Gleason score, the more aggressive the prostate cancer is.

During the procedure, the patient is placed under general anaesthesia with his vital signs monitored by a machine and an anaesthesiologist.

In a radical prostate resection, the incision is made in the perineum or scrotum base and the anus (perineal) or in the lower part of the abdomen (retropubic). Using surgical tools, the glands and seminal vesicles are removed. If the blood vessels that promote erection are left, the procedure is called nerve sparing. If the lymph nodes are also removed, it can be called limited or extended lymph node dissection, depending on where the lymph nodes are located. The urethra that runs through the prostate is then reattached to the bladder before the incisions are sutured closed.

In an open simple prostatectomy, a cystoscope is used, which is inserted through the penis until it reaches the prostate area. An incision is then made around the bladder to access the prostate and to remove the blockage or the mass. The incision is then sutured closed. While the patient is recovering, a catheter is left to drain the urine.

In the last couple of years, more hospitals are adopting minimally invasive techniques such as robot-assisted (robotic prostatectomy) and laparoscopic methods, which use significantly smaller incisions instead of a large one and microsurgical instruments. This promotes faster healing and recovery time as well as minimal surgical pain and bleeding.

Depending on the procedure, the surgery may take at least an hour.

Possible Risks and Complications

Common surgical risks and complications of prostate removal surgery are bleeding, infection of the wound site, and laceration of the stitches. In certain instances, the complications can be life-threatening, such as a blood clot formation or stroke. However, these are very rare. Moreover, minimally invasive surgeries decrease these common risks from happening and hasten recovery time.

The biggest possible complication is erectile dysfunction, which can happen if the blood vessels and nerves that encourage erection are damaged during the procedure.

References:

  • Cunningham GR, et al. Transurethral procedures for treating benign prostatic hyperplasia. http://www.uptodate.com/home

  • Wein AJ, et al., eds. Radical retropubic and perineal prostatectomy. In: Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com.

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