Description

You will be given general anethesia (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, 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 (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.

Why the Procedure is Performed

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

Prostate removal can be performed in many different ways, depending 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. However, this method does not treat prostate cancer (see: Radical prostatectomy).

Prostate removal may be recommended if you have:

• Difficulty emptying your bladder (urinary retention)
• Frequent urinary tract infections
• Frequent bleeding from the prostate
• Bladder stones with prostate enlargement
• Extremely 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:

• Blood clots in the legs that may travel to the lungs
• Blood loss
• Breathing problems
• Heart attack or stroke during surgery
• Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney
• Reactions to medications

Other risks are:

• Damage to internal organs and structures
• Erection problems (impotence)
• Loss of sperm fertility (infertility)
• Passing semen back up into the bladder instead of out through the urethra (retrograde ejaculation)
• Problems with bowel movement control (bowel incontinence)
• Problems with urine control (incontinence)
• Urethral stricture (tightening of the urinary outlet from scar tissue)

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 problems, 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 be asked 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.
• Sometimes, 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. Afterwards, you will be asked to move around as much as possible. Your nurse will help you change positions in bed, show you exercises to keep blood flowing, and recommend coughing/deep breathing techniques. You should do these 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 return from 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 fully in about 6 weeks. You can expect to regain normal urination function, without leakage.

Alternative Names

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

References

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

Han M, Partin AW. Retropubic and suprapubic open prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 89.

Update Date: 3/28/2012

Reviewed by: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.