Prostatectomy Surgery Procedure

Introduction

Prostatectomy is a surgical procedure that involves the partial or complete removal of the prostate gland. This surgery is most often performed to treat prostate cancer or severe symptoms of benign prostatic hyperplasia (BPH). Over the years, prostatectomy techniques have evolved significantly, offering better outcomes and reduced recovery time. The procedure can be performed using different methods, including open surgery, laparoscopic surgery, or robotic-assisted techniques, depending on the patient’s condition, surgeon’s expertise, and hospital facilities.

Understanding the surgical steps involved in prostatectomy surgery procedure helps patients prepare for the process and know what to expect. Whether performed for cancer or for benign enlargement, the goal of the procedure is to remove the problematic prostate tissue while preserving critical functions like urinary continence and sexual ability as much as possible. Below is a detailed explanation of how prostatectomy is carried out from start to finish.

Prostatectomy Surgery Procedure

1. Preoperative evaluation and preparation :- Before the surgery, the patient undergoes a thorough preoperative assessment to evaluate general health, rule out surgical risks, and determine the best surgical approach. This includes a physical examination, blood tests, imaging studies like MRI or CT scans, and possibly a biopsy if cancer is involved. The surgeon will also assess the size and position of the prostate and look for any spread of disease if applicable. Patients are often advised to stop taking blood thinners or certain medications several days before surgery. On the night before surgery, fasting is usually required. Informed consent is obtained after discussing the risks, benefits, and expectations of the procedure.
2. Anesthesia administration :- On the day of surgery, the patient is brought to the operating room and administered general anesthesia to ensure unconsciousness and pain-free experience throughout the procedure. In some cases, spinal or epidural anesthesia may be used in addition to general anesthesia to provide pain relief during the early postoperative period. Once the anesthesia takes effect, a urinary catheter is inserted into the bladder to help drain urine during and after surgery. The surgical area is sterilized, and the patient is positioned appropriately depending on the surgical technique being used.
3. Surgical approach and incision :- The surgeon begins the procedure by selecting the appropriate surgical method—open, laparoscopic, or robotic-assisted. In an open prostatectomy, a single large incision is made in the lower abdomen to access the prostate gland directly. In laparoscopic or robotic-assisted surgery, several small incisions are made, and a camera along with specialized surgical instruments are inserted through these incisions to perform the operation. Robotic surgery uses a console to allow precise movements and better visualization of the internal organs. Regardless of the approach, the goal is to access the prostate gland while minimizing damage to surrounding structures such as nerves and blood vessels.
4. Removal of the prostate gland :- Once the prostate is visualized, the surgeon carefully dissects the gland away from surrounding tissues. In a radical prostatectomy, the entire prostate gland is removed along with the seminal vesicles, and sometimes nearby lymph nodes if cancer staging is necessary. In a simple prostatectomy for BPH, only the inner enlarged portion of the prostate that is blocking urine flow is removed, leaving the outer capsule intact. During dissection, great care is taken to preserve the nerves responsible for erectile function, unless the cancer is too close to these structures. Bleeding is controlled using cautery or clips, and meticulous technique is used to avoid injury to nearby organs like the bladder and rectum.
5. Bladder and urethra reconnection :- After removing the prostate, the surgeon must reconnect the bladder to the urethra to restore the urinary passage. This process, known as urethrovesical anastomosis, involves stitching the bladder neck to the urethra using absorbable sutures. This is a delicate step that requires precision to ensure a watertight seal and proper alignment for normal urination. A catheter is left in place to allow the new connection to heal properly over the next several days. The catheter typically remains for one to two weeks post-surgery.
6. Placement of surgical drains and closure :- In some cases, a small drain may be placed near the surgical site to allow fluid or blood to escape and reduce the risk of infection or fluid accumulation. After ensuring hemostasis and checking for any leaks or complications, the surgeon closes the incisions using sutures or surgical staples. In laparoscopic or robotic surgery, the small incisions are typically closed with absorbable sutures and covered with sterile dressings. The patient is then moved to the recovery room where vital signs are monitored as the anesthesia wears off.
7. Immediate postoperative care :- After surgery, the patient is monitored for several hours or overnight depending on the complexity of the procedure and the patient’s overall condition. Pain management is initiated using intravenous or oral medications. The catheter remains in place, and patients are instructed on how to care for it at home. Early mobilization is encouraged to prevent blood clots and promote healing. Some patients may experience temporary urinary incontinence or erectile dysfunction, but these symptoms often improve over time with pelvic floor exercises and rehabilitation. Hospital stay may range from one to three days, depending on the surgical approach and patient recovery.
8. Recovery and follow-up :- Full recovery from prostatectomy can take several weeks to a few months. Patients are advised to avoid heavy lifting, strenuous activity, and sexual intercourse during the initial recovery phase. The catheter is usually removed after 7 to 14 days, and urination is assessed to ensure proper function. Follow-up appointments are scheduled to monitor healing, review pathology results, and check PSA levels if cancer was the reason for surgery. Most men are able to return to work and resume normal activities within 4 to 6 weeks, especially after minimally invasive surgery. Long-term follow-up is important to monitor for recurrence, manage any lingering side effects, and ensure overall urological health.

Conclusion

Prostatectomy surgery is a complex but highly effective procedure performed to treat conditions such as prostate cancer and severe BPH. With the advent of modern surgical techniques like robotic-assisted surgery, outcomes have improved significantly in terms of precision, reduced blood loss, and faster recovery. The procedure involves several critical steps starting from preoperative evaluation to complete recovery, each designed to ensure patient safety and long-term success. Although the surgery can lead to temporary side effects like incontinence or sexual dysfunction, many of these can be managed or improved with appropriate therapy and time. Understanding the detailed steps involved in prostatectomy helps patients feel more informed, confident, and prepared for their surgical journey.