What is prostate surgery?

Prostate surgery includes both open and minimally invasive procedures on the prostate, a walnut-sized gland found between the bladder and the penis. It secretes prostate fluid, which becomes part of semen. There are two main types of prostate surgery: prostatectomy and prostate resection, such as transurethral resection of the prostate (TURP).

A prostatectomy is major surgery, removing all or part of the prostate gland; a radical prostatectomy removes the entire prostate gland and surrounding tissues. Prostate resection removes part of a tumor or prostate gland, but leaves some of the healthy gland and tissue in place. This can help minimize side effects of prostate surgery.

Why is prostate surgery performed?

Prostate surgery is performed as part of a treatment plan for prostate cancer or to relieve symptoms of BPH, such as difficulty urinating, increasing need to urinate at night, a weak urine stream, incontinence, and inability to empty your bladder.

Who performs prostate surgery?

A urologist performs prostate surgery. Some specialists use the term urologic surgeon, but board certification in urology requires extensive training in surgery, including prostate surgery. If you require prostate surgery for cancer, look for a surgeon who specializes in prostate cancer surgery. This doctor may be a urologist, urologic surgeon, or surgical oncologist.

Urologists specialize in surgical procedures in the urinary tract system and the male reproductive system, including the prostate. Surgical oncologists specialize in cancer surgery. All of these providers may specialize further in the surgical approach, such as laparoscopic surgery or robotic prostate surgery.

Regardless of the specialty, be sure your surgeon performs a high volume of surgeries per year of the exact procedure you are having, and at a hospital with a record of high quality—a low rate of complications. This expertise and experience will improve your chances of a successful operation and recovery. Check hospital quality at healthgrades.com.

How is prostate surgery performed?

Surgeons perform prostate resections to remove only part of the prostate gland when it is enlarged. These are minimally invasive procedures with no incisions in your skin. They are often done with local anesthetic or regional anesthesia, although you may require general anesthesia. If you have a local anesthetic or regional block, you will also receive a sedative to relax you during the procedure.

Each procedure listed below involves inserting a scope with a lighted camera through the tip of the penis, through the urethra to the prostate. The camera allows the surgeon to view the surgical area. Regardless of the approach, before the procedure begins, a urinary catheter is inserted through the tip of your penis and advanced to your bladder to drain urine during and after the procedure.

Here are the different prostate resection procedures:

TURP: The procedure takes between 60 and 90 minutes. Your surgeon inserts a resectoscope to reach the prostate and, using this instrument, your surgeon removes some of the prostate tissue and/or tumor. TURPs are performed in hospital operating rooms.
Transurethral needle ablation (TUNA): The surgeon inserts needles into the prostate. Ultrasound heats the needles and destroys some prostate tissue. TUNA can be performed in a hospital or in a specialized doctor’s office or clinic.
Transurethral microwave thermotherapy (TUMT): This procedure is similar to TUNA, except it delivers heat using microwave pulses to destroy the prostate tissue. TUMT can be performed in a hospital, doctor’s office, or clinic.
Transurethral electrovaporization (TUVP): Instead of using heat, this procedure uses electric currents to destroy prostate tissue. Your doctor may perform TUVP in a hospital, doctor’s office, or clinic.
Laser prostatectomy: Prostate tissue is destroyed by laser. This procedure can be performed in a doctor’s office or clinic. There are different types of lasers and procedure details vary. Holmium laser enucleation of the prostate (HoLEP) is an example. You may want to ask your doctor what type of laser he or she uses and why.
Transurethral incision (TUIP): Your surgeon inserts a scope to access the prostate and makes small cuts between the prostate and your bladder.

Surgeons perform prostate removal surgeries while you are under general anesthesia in a hospital operating room. There are several approaches your surgeon may choose from, depending on your diagnosis and overall health:

Simple prostatectomy: Once the urinary catheter is in place, your surgeon will make an incision in your pubic area, below your navel, to access and remove your prostate gland. Simple prostatectomy with a perineal incision may be another option. A perineal incision is between the scrotum and anus.
Radical retropubic prostatectomy: To remove more tissue along with the prostate, your surgeon may perform a standard retropubic radical prostatectomy. The incision is made from just below your navel to the pubic bone. Your surgeon removes the entire prostate gland, seminal vesicles, and vas deferens.
Radical perineal prostatectomy: This approach is not as common as the retropubic approach because one of the complications following surgery can be difficulty obtaining or maintaining an erection. However, it does not take as long to perform, and the recovery is often shorter and easier than the retropubic approach.
Laparoscopic radical prostatectomy: Laparoscopic surgery is minimally invasive surgery. Instead of one larger incision, your doctor makes several smaller incisions and inserts specialized surgical instruments, one with a camera, through the incisions to visualize and access the prostate and surrounding area. Gas may be pumped into your abdomen to help the surgeon see the organs.
Robotic-assisted radical prostatectomy: Your surgeon makes the same incisions as for a laparoscopic procedure. However, instead of the surgeon standing at the operating table handling the instruments, the surgeon manipulates the surgical instruments from a control panel. This procedure requires extensive training with the robotic system.

What to expect the day of your prostate surgery

In general, this is what happens the day of your surgery:

For hospital or surgical center procedures, a surgical team member will transport you to the operating room.
You’ll receive an intravenous (IV) line to provide you with fluids and medications as necessary.
You will receive a sedative to help you sleep. If you are having a general anesthetic, you may have a tube placed in your throat—in your trachea. The tube attaches to a ventilator to help you breathe throughout the surgery.
The surgeon will make the incision(s) or perform a transurethral procedure.
You will have a urinary catheter inserted just prior to surgery.
You may also have a drain in your incision that will draw out fluid from the wound.
If you received a general anesthetic, you will wake in the recovery room.
With minimally invasive procedures, most people go home the same day after the sedative has worn off.

What are the risks and potential complications of prostate surgery?

All surgical procedures have a risk of complications. The general risks of surgery include:

Anesthetic reaction
Bleeding, which can be extensive with some open procedures
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs causing a pulmonary embolism.
Confusion or delirium from the anesthesia, particularly among older men
Damage to nearby organs
Infection

Potential complications of prostate surgery

Possible complications include:

Difficulty urinating
Urinary tract infection
Urinary incontinence
Overactive bladder
Erectile dysfunction (impotence)
Dry orgasm
Loss of fertility
Lymphedema
Inguinal hernia

If you have had a prostate resection, there is also the risk the prostate will become enlarged again.

Reducing your risk of complications

You can reduce your risk of certain complications by:

Avoiding heavy lifting after your surgery for as long as your surgeon instructs, usually about 3 weeks
Walking to increase circulation
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have allergies
Eating a healthy diet
Stop smoking if you are a smoker

How do I prepare for prostate surgery?

You can prepare for prostate surgery by following preoperative instructions, such as fasting from the night before. Remember to ask your doctor which medications you should stop taking and which you should take the day of the surgery. You will undergo a presurgical examination, usually including blood tests. This is a good time to discuss concerns you may have about the procedure. If you are overweight, consider safely losing weight before the surgery, to minimize the risk of complications. Your doctor can help you with a realistic goal.

Questions to ask your doctor

You may not realize what types of questions to ask before the surgery. Asking some of these questions may give you a better understanding of the procedure and what will happen afterwards:

Why do I need the surgery?
Are there any other options other than surgery?
What results do you typically see with patients like me? Do you have outcomes data on this procedure you can share with me?
How will you manage complications if they occur?
Will I have a general anesthetic or a local anesthetic?
How long will I have to stay in the hospital after the surgery?
When should I resume taking my medications after the surgery?
When will you remove the stitches or staples?
How long will the catheter remain after surgery? Who will remove the catheter?
How will I manage pain? What types of pain relievers can I take?
When can I resume having sex?
Should I consider sperm banking?

What can I expect after prostate surgery?

Undergoing prostate surgery can cause some anxiety. Knowing what to expect may help reduce stress and help you plan for a successful recovery.

How long will it take to recover?

You have to take it easy for a few days, especially while the catheter is still in place. After catheter removal, you can resume your activities slowly as your doctor allows. Most men can return to their regular activities, except for lifting heavy objects, within 1 to 2 weeks of surgery. Full recovery takes about 6 weeks if there are no complications.

Will I feel pain?

If your procedure was done through a scope, you may feel some pain and discomfort in your penis and pressure in your rectum. You may also feel bladder spasms, which will ease with time. If you had surgery, you might feel pain at the incision sites as well. If your surgeon used gas during the procedure, you may feel pain and pressure that can radiate to your back and shoulders. Ask your doctor before the surgery about how best to manage your pain, so you are prepared at home with the right (over-the-counter) medicines.

While some pain is to be expected, increasing pain could be a sign of a complication, so tell your doctor or nurse if your pain is increasing rather than decreasing.

When should I call my doctor?

Discuss follow-up appointments either before the procedure or while you are still in the hospital or clinic. Call your doctor right away or seek immediate medical care if are unable to urinate or you have:

Increasing pain or the pain does not go away
Increasing redness or swelling around the incision, oozing from the incision, high fever or chills
Swelling and tenderness in your thighs or calves
Sudden difficulty breathing, confusion or chest pain

How might prostate surgery affect my everyday life?

Prostate resections help remove tissue that blocked your urethra. When the tissue is removed, difficulty urinating and other urinary symptoms will be relieved if not altogether gone. Prostate surgery for cancer is part of the overall treatment plan. It removes the tumor and as little surrounding healthy tissue as possible. This lets your oncologist move ahead with your prostate cancer therapy.

Prostate Surgery