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Prostatectomy

(Prostate Gland Removal)

by Deanna M. Neff, MPH

Click here to view an animated version of this procedure.

Definition

A prostatectomy is a surgery to remove the prostate gland. The prostate gland is part of the male reproductive system. It makes and stores the milky fluid that forms part of semen. The gland sits below the bladder and in front of the rectum. The urethra (the tube that flows urine out of the body) runs through the prostate gland.

The procedure may be:

  • Simple prostatectomy—removal of part of prostate
  • Radical prostatectomy—removal of entire prostate and some surrounding tissue

Anatomy of the Prostate

Anatomy of the Prostate Gland
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

A simple prostatectomy may be done to remove an enlarged prostate that is noncancerous. A common cause of this type of growth is called benign prostatic hyperplasia (BPH). It can interfere with the flow of urine out of the body. The surgery is done to remove extra tissue that is blocking flow.

A radical prostatectomy may be done to remove a prostate gland and lymph nodes that have cancer.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Bleeding
  • Infection
  • Inability to control urinary stream—incontinence
  • Erectile dysfunction and other sexual side effects
  • Blood clots in the legs or lungs
  • Infertility
  • Injury to the rectum or other nearby structures
  • Narrowing of the urethra or bladder neck

Factors that may increase the risk of complications include:

  • Obesity
  • Chronic or recent illness
  • Lung, kidney, liver, or heart disease
  • Smoking
  • Problems with alcohol or drug use
  • Use of certain prescription medicines
  • Diabetes or other chronic conditions

What to Expect

Prior to Procedure

Before surgery your doctor may do the following:

Leading up to the procedure:

  • Arrange for a ride home.
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to 1 week before the procedure.
  • The night before, have a light meal. Do not eat or drink anything after midnight.

Anesthesia

General or spinal anesthesia will be used. With general anesthesia, you will be asleep. Spinal anesthesia will make a specific section of your body numb.

Description of Procedure

The procedure can be done as:

  • Open surgery—An incision is made in the skin to allow the doctor to see the prostate.
  • Laparoscopic surgery—Only very small incisions are needed. The surgery is done with specialized tools and a tiny camera that is passed through the incisions.
  • Robot-assisted surgery—Similar to laparoscopic with use of small incisions, but the surgery is done with robotic tools that the surgeon controls.

Simple Prostatectomy

An incision is made in the lower abdomen. The doctor will be able to see the prostate through this incision. The inner part of your prostate gland will then be removed. This procedure is not as common in the US. It is considered when you have a noncancerous enlargement of the prostate.

Radical Retropubic Prostatectomy

An incision will be made in the lower abdomen between the belly button and pubic bone. The prostate gland and pelvic lymph nodes will be visible through this incision. The prostate will be detached from the bladder and urethra. The urethra is then reattached to the bladder. A main goal of treatment is to try to preserve nerve function related to bladder and sexual functions. Lymph node tissue may also be removed for testing. Your doctor may use these test results to decide whether or not to remove more tissue.

Perineal Radical Prostatectomy

An incision is made in the skin between the anus and scrotum. The prostate can be detached and removed through this incision. This is a less common surgical option because of some limits such as:

  • Lack of access to the lymph nodes
  • Higher risk of nerve damage

Robot-assisted Laparoscopic Radical Prostatectomy (RALRP)

Five small, keyhole incisions are made in the abdomen. Robotic arms and a small camera will be passed through these incisions. The robotic tools allow wider and more flexible range of motion. The robotic arms will be controlled by a doctor at a console. The prostate and other tissue will be cut out with these robotic arms. This type of procedure may cause less scarring than other methods.

After the Procedure

A catheter tube will be inserted to drain your bladder. Water may be flushed through the catheter to reduce blood in the urine.

The catheter may be left in place for up to 3 weeks. This will let you urinate more easily during the healing period. After a radical prostatectomy, a drain may also be placed to help fluid drain from the surgery site.

How Long Will It Take?

2 to 4 hours

Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medicines.

Average Hospital Stay

The usual length of stay is 2 to 3 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

After surgery you should expect that:

  • You'll be given IV pain medicines. Your doctor may give you pain pills to take after the IV is removed.
  • You will be asked to walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.

At Home

You'll return home with a catheter in place. Most men need a urinary catheter for 5 to 10 days after surgery. Complete recovery may take up to 6 weeks. During this time you may have to change or restrict activities until your doctor says it is okay. Arrange for help at home for a couple of days. You may need to return to the doctor in 1 or 2 weeks to have staples taken out.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with the medicines you were given
  • Pain, burning, urgency or frequency of urination, or persistent blood in the urine
  • Poor drainage from catheter
  • Abdominal swelling or pain
  • Cough, shortness of breath, or chest pain
  • Headaches, muscle aches, light-headedness, or general ill feeling
  • Constipation

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Cancer Institute
https://www.cancer.gov
Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca
Prostate Cancer Canada
http://www.prostatecancer.ca

References:

Benign prostatic hypertrophy (BPH). EBSCO DynaMed website. Available at: https://www.dyname.... Updated December 11, 2019. Accessed January 7, 2020.
Mitchell RE, Lee BT, et al. Immediate surgical outcomes for radical prostatectomy in the University HealthSystem Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48,000 patients. BJU Int. 2009;104(10):1442-1445.
Prostate cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/prostate-cancer. Updated October 6, 2018. Accessed January 7, 2020.
Prostate cancer treatments-Health Profesional. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated December 19, 2019. Accessed January 7, 2020.
6/2/2011 DynaMed Systematic Literature Surveillance http://www.dynamed...: Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
10/21/2013 DynaMed Systematic Literature Surveillance https://www.dyname...: O'Reilly EA, Burke JP, et al. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia. Ann Surg. 2012;255(5):846-853.
Last reviewed September 2019 by EBSCO Medical Review Board Nicole Meregian, PA
Last Updated: 10/13/2020