Simple prostatectomy

An enlarged prostate gland can occur as men age, or occasionally when there is another underlying medical condition. This urological condition, known as benign prostatic hyperplasia (or BPH), can manifest symptoms such as frequent urination, especially during the night (nocturia), dribbling, incontinence, painful or difficult urination, or traces of blood in the urine.

Since the swollen prostate is pressing on the bladder or blocking the urethra, it can affect the entire urinary tract. If caught earlier on, it can sometimes be treated with minimally invasive procedures. If left untreated for some time, it may require surgery. One of the surgical options to treat BPH is called a robotic simple prostatectomy.

What Is a robotic simple prostatectomy?

Simple prostatectomy is a surgical procedure used to treat men with severely enlarged prostate glands.  Generally, this procedure is reserved for patients having a prostate greater than 80 gm in size as measured by transrectal ultrasound.

This procedure is a specialized technique performed by a robotically trained Urologist.  The procedure aims to remove enlarged tissue but keep the prostate itself intact, as opposed to a radical prostatectomy which removes the entire prostate gland when localized prostate cancer is present. Simple prostatectomy involves accessing the inner tissue of the prostate gland through small laparoscopic incisions made in the abdomen.   The outer portion of the prostate is left intact and the surgical cut is closed with sutures (stitches).  This technique is analogous to taking the fruit from an orange while leaving the peel behind.  The capsule (or peel) is where the nerves for erectile function and continence reside.

While simple prostatectomy surgery is considered more invasive than other procedures to treat BPH, the success rate is quite high, and the need for additional treatment — even years down the line — is very rare in comparison to other methods.

What Should I Expect During Simple Prostatectomy Surgery?

Patients are anesthetized, either generally or spinally, which means they are either asleep or awake, but either way, they do not feel any pain. The surgery itself lasts between two and four hours and requires staying in the hospital for one to two days.

Since anesthesia is used, you will need to fast prior to the surgery, typically from midnight the night before. You may also need to stop taking certain medications a few days in advance. In addition, the doctor may ask you to use an enema to assist you will a bowel movement that morning. Our specialists will guide you on the specific instructions to prepare for your procedure.

What Is the Recovery Time?

Since you will have a catheter in for up to two weeks after the surgery, you will need to refrain from sex and strenuous physical activity for at least four to six weeks. You may also need a drain for fluids while recovering in the hospital. Patients will usually be able to determine when they feel well enough to add light activity back in.

The doctor will give you postoperative care guidelines, but usually, we recommend taking off of work for up to one week after the procedure if possible. You will be prescribed pain medication and possibly an antibiotic to prevent infection.

Sutures are internal, so they will gradually dissolve on their own and a scar will form over the incision site. You will be given specific instructions on how to care for the site. Compliance is critical so that the site does not become infected and the scar tissue heals optimally.

You may have pain when urinating or difficulty urinating for some time after the surgery as your body heals. Since the enlarged prostate tissue will no longer be blocking urine flow, the urinary tract will be adjusting to the lack of strain. This could also result in incontinence.

You may notice blood in the urine, or pink-tinged urine, which is a common side effect. This should clear up on its own within a week or two, but if bleeding becomes worse, is thick and ketchup-like, or if you develop a fever or severe pelvic pain, call your doctor immediately.

How Successful Is Simple Prostatectomy and What Are the Risks?

Since this procedure is a more invasive surgery, complications are more likely, but most men do not have long-term side effects. One of the common sexual side effects after simple prostatectomy is the emission of very little semen during orgasm, called retrograde ejaculation. For this reason, the doctor will likely not recommend this surgery if you are planning to conceive in the future.

Serious complications could include bleeding from the surgical site, erectile dysfunction, urinary incontinence, or the inability to urinate without a catheter due to constriction around the urethra if the site does not heal properly. Many complications result from patients not taking care of their sutures properly, but following the doctor’s guidelines will greatly decrease this risk.

Unlike other procedures, simple prostatectomy typically only needs to be done once, so follow-up surgeries five or ten years later are not usually necessary. A full recovery with normal urinary function is the most common outcome.