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Alternative namesProstatectomy; TURP; Suprapubic prostatectomy; Transurethral resection of the prostate; TUIP; Open prostatectomy
DefinitionThis surgery involves removal of part or all of the prostate gland.
The prostate gland is a fibrous organ that surrounds the urethra at the base of the bladder in men. An enlarged prostate gland can compress the urethra, thus causing problems with urination. Prostate enlargement may be caused by prostate gland overgrowth ( benign prostatic hypertrophy or hyperplasia ) or prostate cancer .
The three most common procedures for surgically removing the prostate for benign disease include: transurethral resection of the prostate (TURP), suprapubic prostatectomy, and transurethral incision of the prostate (TUIP).
The decision regarding the type of prostatectomy to perform depends on the size of your prostate gland. Generally, for prostates less than 30 grams, TUIP is recommended.
For glands bigger than 30 grams and less than 80 grams (this number depends on the experience of the surgeon), TURP is performed. If the prostate is bigger than 80 grams, open prostatectomy is recommended.
A special cutting instrument is inserted through the cystoscope to remove the prostate gland piece by piece. Blood vessels are cauterized (using heat to stop the bleeding ) with electric current during the surgery.
A Foley catheter (artificial tube to remove urine from the body) is placed to help drain the bladder after surgery. The urine will initially appear very bloody, but will clear with time.
A bladder irrigation solution may be attached to the catheter to continuously flush the catheter, thus keeping it from becoming clogged with blood or tissue. The bleeding will gradually decrease, and the catheter will be removed within 1-3 days. You will remain in the hospital for 1 to 5 days.
To perform an open prostatectomy (sometimes called suprapubic or retropubic prostatectomy), an incision is made in the lower abdomen between the umbilicus (belly-button) and the penis through which the prostate gland is removed. This is a much more involved procedure and usually requires a longer hospitalization and recovery period.
Open prostatectomy is performed using general or spinal anesthesia. You will return from surgery with a Foley catheter in place. Occasionally, a suprapubic catheter will be inserted in the abdominal wall to help drain the bladder.
A bladder irrigation solution may be attached to the catheter to continuously flush the catheter, thus keeping it from becoming clogged with blood. A drainage tube may also be placed in the abdominal cavity to drain excess blood and fluids from the area.
A small incision is made in the prostatic tissue to enlarge the lumen (opening) of the urethra and bladder outlet, thus improving the urine flow rate and reducing the symptoms of BPH.
A Foley catheter may be placed to help drain the bladder after surgery. The catheter will usually remain in place for a few days after surgery. Another key advantage to the TUIP is the preservation of normal ejaculation.
Although orgasm is the same in both the TURP and TUIP, the TURP causes the ejaculate fluid to be projected into the bladder instead of out the penis. The TUIP usually continues to allow the ejaculate fluid to be expressed out the penis. Unfortunately, many patients are not candidates for this surgery due to configuration of their prostates.
These procedures have demonstrated short term efficacy in select patients, but have not had adequate long-term testing.
IndicationsProstate removal may be recommended for:
RisksRisks for any anesthesia are:
Expectations after surgeryTURP is typically successful at removing the symptoms of an enlarged prostate, although some sources report that within 10 years, about 20% of the people will require another surgery to remove additional prostate tissue.
TUIP has been shown to successfully relieve the symptoms of benign prostatic hyperplasia ( BPH ) in people with a relatively small prostate gland.
Open prostatectomy is successful in relieving the symptoms of benign prostatic hyperplasia.
ConvalescenceHospital stay for open prostatectomy is about 7 to 10 days. Complete recovery from surgery can take 3 weeks. Drink plenty of fluids to help flush fluids through the bladder. Avoid coffee , cola drinks, and alcoholic beverages as these can cause irritation of the bladder and urethra.
Update Date: 5/25/2002Young Kang M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT