What is Prostatectomy and why is it done?The term “prostatectomy” refers to the partial or complete surgical removal of the prostate gland. Prostate is a small, walnut-sized endocrine gland that plays one of the key roles in the production of male seminal liquid. Prostate is located below the bladder and surrounds the urethra.
There are several medical conditions that require prostatectomy. Prostate gland sometimes becomes enlarged, often as a result of the benign prostatic hyperplasia. The enlargement of the prostate can restrict the flow of the urine through the urethra and thus leads to discomfort and difficulties with urinating. The condition can be treated with some drugs at the early stages but when disease is not responding to the treatment, the removal of the prostate must be considered. The failure to do so may result in the renal dysfunction and even kidney damage.
Another common reason for prostatectomy is prostate cancer. Prostate cancer is one of the most common malignancies among males, which is particularly common in older men. The disease develops slow but may become life-threatening if not properly treated in time. The treatment for prostate cancer almost always involves the surgical removal of the prostate.
How Prostatectomy is done?Due to the close location of the prostate to other essential organs, nerves and blood vessels, successful removal of the prostate in some cases can be a challenging task. There are three major approaches to perform the prostatectomy: transurethral resection, open prostatectomy, and laparoscopic prostatectomy. The decision on the use of a particular procedure depends on the nature of medical condition that calls for prostatectomy.
- Transurethral resection - Transurethral resection of the prostate is done with the use of a special device, called cystoscope, which is inserted through the urethra. The procedure is commonly used for the treatment of benign prostatic hyperplasia and has a high success rate.
- Open Surgery - Open surgery involves making an incision, either in the lower abdomen (retropubic prostatectomy) or in the halfway between the scrotum and the anus (perineal prostatectomy). The incision allows direct access to the prostate and the surrounding tissues and organs. The prostate is removed and the urethra reattached directly to the bladder. Depending on the stage of the disease, the neighboring lymph nodes might also need to be removed.
- Laparoscopic prostatectomy - Laparoscopic prostatectomy is a newer procedure which is associated with a lower risk of post-operative complications. It is done with the use of specialized computer-controlled equipment through the series of small incisions in the abdomen. The method allows avoiding the substantial blood loss common in open surgery and involves less post-operative pain. The surgery, however, takes longer time and the removal of lymph nodes with the use of this approach is difficult.
The success rate of all surgical procedures, including the robotic ones, depends in significantly on the expertise and experience level of the surgeon. At the present time, there are no clear scientific evidences indicating that the robotic procedure provides better long-term outcome in comparison with the open surgery
Recovery after ProstatectomyOpen surgery is associated with the greater blood loss and slower recovery. Depending on the particular type and nature of the surgery, patients might need to spend several days in the hospital. The patients who undergone the laparoscopic prostatectomy are often discharged from the hospital on the next day.
The common complications of prostatectomy may be the loss of urinary control and erectile dysfunction. The problems with urinary control are more common after open surgery. Normal urinary and erectile functions can eventually be restored but usually it takes time. Finding an experienced surgeon with expertise in nerve preservation techniques can significantly reduce the probability of having these complications.