Prostatectomy includes a number of surgical procedures to remove part or all of the prostate gland. The prostate gland is situated in the lower abdomen of men, below the urinary bladder. It surrounds the urethra, which carries urine from the bladder to the penis.

There are different types of prostatectomy, depending on the treatment involved:

Radical prostatectomy is surgery to remove the entire prostate gland and surrounding lymph nodes. This surgery is a treatment for men with localized prostate cancer. A surgeon can perform a radical prostatectomy using different techniques, including:

  • Robotic-assisted radical prostatectomy. The surgeon makes several small incisions in your lower abdomen to remove the prostate. He or she sits at a console, using instruments attached to a mechanical device (robot). Using the robotic device allows a more precise response to movement of the surgeon's hands.
  • Open radical prostatectomy. The surgeon makes an incision in your lower abdomen to remove the prostate (retropubic surgery). Rarely, this incision is made between your anus and scrotum (perineal surgery).
  • Laparoscopic radical prostatectomy. The surgeon makes several small incisions in your lower abdomen and inserts special tools to remove the prostate.

Open simple prostatectomy is generally recommended for men who have severe urinary symptoms and very enlarged prostate glands. This enlargement of the prostate is called benign prostatic hyperplasia, or BPH. The surgery does not remove the entire prostate, as is done in a radical prostatectomy, but removes just the obstructive part of the prostate that is blocking the flow of urine.

Your surgical team will discuss the advantages and disadvantages of each technique, as well as your preferences, to determine which approach is best for you.

Prostatectomy is most often done to treat localized prostate cancer. It may be used alone, or in conjunction with radiation, chemotherapy and hormone therapy. Prostatectomy to treat prostate cancer involves removing the entire prostate and some surrounding tissue, including lymph nodes.

Prostatectomy to treat prostate cancer includes open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy.

Prostatectomy also may be used to treat a blocked urethra caused by BPH. Prostatectomy to treat BPH doesn’t always involve removing the entire prostate.

Prostatectomy to treat benign prostatic hyperplasia (BPH) includes open simple prostatectomy. This surgery eases urinary symptoms and complications resulting from blocked urine flow caused by BPH. These can include:

  • A frequent, urgent need to urinate
  • Difficulty starting urination
  • Slow (prolonged) urination
  • Increased frequency of urination at night (nocturia)
  • Stopping and starting again while urinating
  • The feeling you can't completely empty your bladder
  • Urinary tract infections
  • Inability to urinate

Open simple prostatectomy has a higher risk of complications and a longer recovery time than other procedures to treat BPH.

In addition to the risks associated with any surgery, risks with radical prostatectomy include:

  • Urinary tract infection
  • Urinary incontinence
  • Erectile dysfunction (impotence)
  • Injury to the rectum (rare)
  • Narrowing (stricture) of the urethra or bladder neck
  • Formation of cysts containing lymph (lymphocele)

Open simple prostatectomy risks

Although open simple prostatectomy works well at relieving urinary symptoms, it has a higher risk of complications and a longer recovery time than other enlarged prostate procedures. Risks of open simple prostatectomy include:

  • Heavy bleeding
  • Urinary tract infection
  • Urinary incontinence
  • Dry orgasm
  • Erectile dysfunction (impotence)
  • Narrowing (stricture) of the urethra or bladder neck

Before surgery, 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 specifically measure your prostate and to measure urine flow.

Follow your doctor's instructions on what to do before your treatment. Here are some issues to discuss with your doctor:

  • Your medications. Tell your doctor about any prescription or over-the-counter medications or supplements you take. This is especially important if you take blood-thinning medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others). Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days before the surgery.
  • Fasting before surgery. Your doctor will likely ask that you not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
  • Bowel prep before surgery. Your surgeon may ask you to do an enema prior to surgery. You may be given a kit and instructions for giving yourself an enema to clear your bowels the morning of surgery.
  • Arrangements after surgery. Ask your doctor how long to expect to be in the hospital. And arrange ahead of time for a ride home. You won't be able to drive yourself home.
  • Activity restrictions. You may not be able to work or do strenuous activity for several weeks after surgery. Ask your doctor how much recovery time you may need.

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 may also give you an antibiotic right before surgery to help prevent infection.

During the procedure

Robotic radical prostatectomy. Your surgeon sits at a remote control console a short distance from you and the operating table and precisely controls the motion of the surgical instruments using two hand-and-finger control devices. The console displays a magnified, 3-D view of the surgical area that enables the surgeon to visualize the procedure in much greater detail than in traditional laparoscopic surgery. The robotic system allows smaller and more-precise incisions, which for some people promotes faster recovery than traditional open surgery does. The robotic approach also enables nerve-sparing techniques that may preserve both sexual potency and continence in the appropriately selected person.

Robotic prostatectomy can result in reduced pain and blood loss, reduced tissue trauma, a shorter hospital stay, and a quicker recovery period than a traditional prostatectomy. You usually can return to normal activity, with minor restrictions, two to four weeks after surgery.

Open radical prostatectomy. Your surgeon makes an incision in your lower abdomen, from below your navel to just above your pubic bone. Rarely, this incision is made between your anus and scrotum (perineal surgery). After carefully dissecting the prostate gland from surrounding nerves and blood vessels, the surgeon removes the prostate along with nearby tissue. The incision is then closed with sutures.

Open simple prostatectomy. Once the anesthetic is working, your doctor may perform a cystoscopy. A long, flexible viewing scope (cystoscope) is inserted through the tip of your penis to see inside the urethra, bladder and prostate area.

Your doctor will then insert a tube (Foley catheter) into the tip of your penis that extends into your bladder. The tube drains urine during the procedure. 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.

If you also have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it.

Once your doctor has removed the part of your prostate causing symptoms, you may or may not 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 procedure

After surgery you should expect that:

  • You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the IV is removed.
  • Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.
  • You'll likely go home the day after surgery. When your doctor thinks it's safe for you to go home, the pelvic drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.
  • You'll return home with a catheter in place. Most men need a urinary catheter for five to 10 days after surgery.

Make sure you understand the post-surgery steps you need to take, and any restrictions.

  • You'll need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks.
  • You won't be able to drive for at least a few days after going home. Don't drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it's OK.
  • You'll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about six weeks and then again after a few months. If you have any problems, you may need to see your doctor sooner or more often.
  • You'll probably be able to resume sexual activity 6 to 8 weeks after surgery. After simple prostatectomy, you can still have an orgasm during sex, but you'll ejaculate very little or no semen.

Robotic prostatectomy can result in reduced pain and blood loss, reduced tissue trauma, a shorter hospital stay, and a quicker recovery period than a traditional prostatectomy. You usually can return to normal activity, with minor restrictions, two to four weeks after surgery.

Open simple 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 for their BPH.

April 24, 2015