Open prostatectomy is surgery to remove part of an enlarged prostate that's causing urinary symptoms.
Open prostatectomy is generally reserved for men who have a very large prostate, severe urinary symptoms or other problems that need to be corrected during surgery. During open prostatectomy, the part of your prostate blocking urine flow is removed through a cut (incision) below your navel. Or it may be done by making several smaller incisions in the abdomen (laporascopically). Sometimes, robot assistance is used during prostatectomy.
Open prostatectomy is one of several options for treating an enlarged prostate, a condition also called benign prostatic hyperplasia (BPH). To determine the best treatment choice for you, your doctor will consider the severity of your symptoms, what other health problems you have, and the size and shape of your prostate. Open prostatectomy is generally reserved for men who have relatively large prostates and for men for whom other surgical treatment options are not available.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
Open prostatectomy eases urinary symptoms and complications resulting from blocked urine flow. These can include:
Open prostatectomy may also be done to treat or prevent complications due to blocked urine flow, such as:
Open prostatectomy works well at relieving urinary symptoms, but it's more involved and has a higher risk of complications than other enlarged prostate procedures. It also requires a longer recovery time. For this reason, open prostatectomy is done in only certain circumstances. It may be an option if you have:
New techniques and technology have made less invasive procedures an alternative to open prostatectomy for many men. Other enlarged prostate procedures include transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the prostate (HoLEP) or laser photovaporization of the prostate (PVP), and transurethral resection of the prostate (TURP).
Open prostatectomy can cause temporary problems after surgery and can also cause long-term side effects or complications. Risks of open prostatectomy include:
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:
What you can expect
Open prostatectomy usually takes an hour and a half to three hours.
Before surgery, your doctor will give you a general anesthetic, which means you'll be unconscious during the procedure. Or you may receive a spinal anesthetic, which means you'll be conscious during surgery but won't feel any pain.
Your doctor will also give you an antibiotic right before surgery, to prevent infection.
During the procedure
Your doctor will then insert a tube (catheter) into the tip of your penis and extend it into your bladder. The tube drains urine during the procedure. After your surgery area has been shaved and sterilized, your doctor will make a cut (incision) below your navel. Depending on what technique your doctor uses, he or she may need to make an incision through the bladder to reach the prostate. In some cases, the procedure is done with robot assistance or laporascopically. Laparoscopic surgery requires a few smaller incisions rather than a single large incision.
If you also happen to have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it. Having mesh in place from a previous hernia repair may limit the ability to use robotic or laparoscopic techniques during prostatectomy.
Once your doctor has removed the part of your prostate causing symptoms, you may have one to two temporary drain tubes inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder (suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After the surgery, your doctor will close the inside and outside of the surgery site with stitches or staples.
After the procedure
Make sure you understand the post-surgery steps you need to take, and any restrictions.
Open prostatectomy provides long-term relief of urinary symptoms due to an enlarged prostate. Although it's the most invasive procedure to treat an enlarged prostate, serious complications are rare. Most men who have the procedure generally don't need any follow-up treatment.
Last Updated: 2011-05-12
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