What is a prostatectomy

What is a prostatectomy?

Prostatectomy is an operation in which the prostate is completely or partially removed with the aid of general anesthesia.

Statistically this surgical operation remains the treatment used in the majority of cases of prostate hypertrophy.

In England, more than 40,000 prostatectomies are performed each year. For France, we are advancing a number of 70,000!

In the United States it is the fourth most common operation in men, after cataract extraction, repair of a hernia and operations of the gallbladder.

Doctors usually have prostatectomy for one of the following reasons:

1- Because the patient has benign prostatic hypertrophy;
2 - Because a prostate cancer was diagnosed and it was determined that surgical intervention would be the best solution.

What is the success rate of prostatectomy?

In eliminating obstruction and alleviating symptoms, the success rate is very high. From the doctors' point of view, urethral clearance is achieved in 90% of cases. And from the patients' point of view, symptom relief corresponds to a success rate of 80%.

How is the prostate removed?

The prostate is located in a very inaccessible region of the body, so its ablation can be a very difficult operation.

There are 2 ways to get to the prostate:

1- Through the bladder, in an operation called "transurethral prostatectomy" (PTUR)
2- Via abdomen, in an operation called "open prostatectomy".

The results are almost identical in both cases, but open prostatectomy is a more delicate operation than transurethral prostatectomy, so it is expected that the patient will feel more uncomfortable, waiting for a longer recovery (the time it takes to internal tissues to heal). Demanding plenty of rest and limited movements for a few days.

What is a transurethral prostatectomy (PTUR)?

It involves ablation of the prostate through the urethra without any incision in the skin. It should be noted that transurethral prostatectomy is the surgical method used in 90% of cases of prostatectomy.

It has the advantage of not having to perform surgical incision, or general anesthesia. It is less invasive and safer. In addition, it inflicts less pain and discomfort to the patient.

It is a much less traumatizing technique for the body, being preferred by patients. However, it requires a hospitalization of 4 to 5 days.

What is an open prostatectomy?

In only 10% of cases this open prostatectomy technique applied. It is mainly applied for the ablation of a particularly enlarged prostate, or for the case where it is necessary to perform a simultaneous bladder surgery for example to extract bladder stones). Open prostatectomy is performed under general anesthesia and usually requires a hospitalization of 7 to 10 days.

What are the side effects of an open prostatectomy?

It can happen that the hemorrhage is so abundant that it becomes necessary to resort to blood transfusions.
All blood clots that can form in the bladder after surgery will usually be eliminated by the catheter, which should be kept for several days, precisely for this purpose.

When the catheter is removed, it is normal for patients to report frequently that their urinary output has been affected, becoming more painful and more frequent. Some patients even suffer from benign incontinence for a few weeks. It is important that patients drink plenty of fluids to help eliminate any blood residue from the urine.

Most patients resume normal activity after a few weeks. Those who have undergone open prostatectomy will certainly take longer than those who undergo transurethral prostatectomy.

What are the other surgical techniques to perform Prostatectomy?

There are currently 3 ways to remove the prostate, surgery can be done by laparoscopy (through small openings in the belly where they pass instruments to remove the prostate, or by laparotomy where a greater cut is made in the skin.

Surgical techniques to remove the prostate are:

1- Retropubic radical prostatectomy consists of a small cut in the skin near the navel to remove the tumor from the prostate;

2- Perineal radical prostatectomy: consists of a cut that is made between the anus and the scrotum and the tumor is removed. This technique is used less frequently than the previous one, because the nerves responsible for the erection are easy to be affected, being very likely to cause impotence;

3 - Robotic-assisted radical prostatectomy: a physician performs the surgery through a machine with robotic arms and, therefore, the technique is more accurate, with a lower risk of sequelae.

Posted by Dr. João Carrilho

Dr. João Carrilho
Doctor in Traditional Chinese Medicine by Southwest Medical University, China.
Licensed Acupuncturist (N.0500096) and Phytotherapist (N.0400028) by the Portuguese Health Ministry.
Post-Graduated in Health Sciences at Oporto University, Portugal

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