Prostatectomy

July 1, 2024

This page was reviewed under our medical and editorial policy by Wesley Yip, M.D., assistant professor, Division of Urology and Urologic Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

A prostatectomy is a surgery to remove all or part of the prostate gland to treat several conditions. One of the most common is prostate cancer.

What Is a Prostatectomy?

A prostatectomy is a surgery to remove all or part of the prostate gland. It may be part of the treatment for benign prostatic hyperplasia (BPH), when the prostate has grown too big, or as a treatment for prostate cancer.

Prostate removal surgery is recommended for prostate cancer Stages 1 to 3 (when the cancer has not spread beyond the prostate gland) and the prostate is able to be removed completely.

Simple Prostatectomy

In a simple prostatectomy, only the affected area of the prostate gland is removed, leaving the rest of the organ intact and able to function normally.

A simple prostatectomy is reserved for those with benign prostatic hyperplasia and is not used for patients with prostate cancer.

Patients are given a general anesthetic to put them to sleep, or medications to relax them along with medication injected into the lower back to numb their body from the waist down.

The surgeon then cuts through the skin of the lower belly, either from the belly button down to just above the pubic bone (vertically) or across the lower belly (horizontally). Then the surgeon scoops out the overgrown tissue.

At the end of the surgery, a drainage tube (catheter) is placed in the penis to allow urine to drain easily and stays in place for several days. Sometimes, the surgeon may place a small drainage tube directly through the skin into the bladder.

This surgery may also be performed laparoscopically or with robotic assistance, as described below.

Radical Prostatectomy

A radical prostatectomy differs from a simple prostatectomy in that surgeons remove the entire prostate gland and seminal vesicles, which help produce semen, as well as some surrounding tissue. They may also remove and test some nearby lymph nodes to see whether the cancer has spread. The two main approaches used are open prostatectomy and laparoscopic prostatectomy.

Open prostatectomy: In this approach, the surgeon operates through an incision in the skin of either the lower belly (radical retropubic prostatectomy) or the area between the scrotum and anus (radical perineal prostatectomy). This type of surgery has become less common.

Laparoscopic prostatectomy: Several small cuts are made in the skin of the belly. The surgeon inserts a special lighted camera called a laparoscope through one of the openings, then uses special tools to remove the prostate gland and other tissue through the other openings.

All patients receive either a general anesthetic to put them to sleep throughout the procedure or a spinal anesthetic, in which medication is injected into the spine to numb their body from the waist down.

At the end of the surgery, while the anesthetic is still working, a catheter is inserted into the penis and stays in place for one to two weeks after surgery to allow the bladder to drain. A small catheter may also be placed through the belly and into the bladder.

Patients may stay in the hospital overnight and typically spend the next few weeks recovering.

Robotic Prostatectomy

Like with a laparoscopic procedure, patients receive either a general anesthetic or a numbing spinal anesthetic. The surgeon then makes several small cuts in the patient’s belly. A special lighted camera is inserted through one of the holes, and special instruments held by robotic arms are placed through the other holes.

The surgeon sits at a monitor panel, controlling the robotic arms using 3D images of the surgical area for guidance. This approach allows the surgeon to make more fine-tuned adjustments in cutting, to reduce the risk of damaging blood vessels or nerves near the prostate, thereby limiting effects on urinary or sexual function. A catheter is inserted into the penis at the end of the surgery.

Compared to open surgery, robotic laparoscopic prostatectomies cause less pain, reduced scarring and faster healing. It has become the preferred approach for prostatectomy in the United States and many other countries.

Side Effects of Prostate Removal

Side effects are to be expected after any surgery. The body needs time to heal. Depending on the procedure performed, these effects may resolve themselves over time, they may remain but improve, or for some patients, they may be permanent.

Some side effects of prostate removal include those listed below.

Urinary incontinence: Patients with urinary incontinence have trouble controlling their urine. Common after surgery, these symptoms usually subside for most men within several weeks. A wide selection of incontinence products is available to address an array of incontinence issues, such as:

• Stress incontinence, which occurs with exertion, such as coughing, sneezing or sudden movements (as with exercise)
• Overflow incontinence, which occurs when the bladder does not empty fully and may accompany challenges with urine stream or dribble
• Urgency incontinence, which occurs when nerves in the bladder become overly sensitive to stretching, creating an urgent need to go to the bathroom
• Continuous incontinence, a rare side effect in which the patient loses all control over urine

Erectile dysfunction: Patients with erectile dysfunction (impotence) have trouble getting or keeping an erection.

• The nerves that control penile erection run along both sides of the prostate. If the patient is able to have an erection before surgery, the surgeon will try a nerve-sparing approach to avoid damaging those nerves. This may not be possible if the prostate is too big or the cancer has spread to surrounding tissue. If both nerves are cut, the patient will be unable to get an erection. If only one is cut, he may regain the ability.
• Even if the nerves are not damaged, full function may take a few months to a few years to return.

Many treatments are available to help. Many doctors recommend men try to get an erection as soon as possible after a healing period of several weeks. The patient should talk to his doctor about this and ask whether medications may help.

Changes in orgasm: The seminal vesicles provide most of the liquid that carries the semen. If they are removed, the patient will experience a dry orgasm. The orgasm may be less intense, and in rare cases, it may be painful.

Loss of fertility: During surgery, the vas deferens, tubes from the testicles that allow the semen to reach the penis, are cut. As a result, patients will not be able to father children in the usual way. If the patient still wants to have children, he may talk to his doctor about banking sperm.

Lymphedema: In rare cases, when lymph nodes have been removed, lymph fluid does not circulate through the body as efficiently as before. It may pool in the lower belly and legs, causing swelling and pain. While physical therapy may help control it, it may not go away fully.

Inguinal hernia: An inguinal hernia is a weakness in the muscle in the groin. Sometimes part of the bowel or fatty tissue may push through, causing a lump under the skin. It happens more often after an open surgery, usually within the first few years.

Fecal incontinence: The patient may have some issues with stool leakage, ranging from enough to stain the underwear to larger amounts.

Penile shortening: Some patients have noticed that their penis is shorter after surgery. This may be caused by removal of part of the urethra, the tube that carries urine from the bladder to the opening at the end of the penis.

Some side effects are unavoidable, but having a surgeon who is highly experienced in these techniques helps patients move toward a smooth recovery with fewer complications. That’s why it’s important for patients to choose a surgeon who has successfully performed these procedures many times.

Following prostatectomy, the care team may connect the patient with a prostate cancer support program to help monitor and manage complications or side effects, including changes to sexual and/or urinary function.