Open Prostatectomy

Prostatectomy is a procedure that removes the prostate, either wholly or partially, and may be done to treat BPH (benign prostatic hyperplasia) or prostate cancer. BPH is a non-cancerous (benign) enlargement of the prostate gland. Open prostatectomy is a procedure usually done in cases when the prostate gland is large enough to be removed through the urethra.

The benefits of open prostatectomy are:

1. Urinary symptoms may improve after the surgery
2. Removing cancer, in case cancer has not spread outside the prostate
3. Lowers the need to repeat treatment
4. Even if cancer relapses, you will be able to have more prostate treatments
5. Relief from symptoms of BPH.
6. Less need of blood transfusion.
7. The patient spends minimal time (two to three hours) under anaesthesia in comparison with robotic surgery.

Men with the following conditions need open prostatectomy:

1. Prostate cancer
2. Persistent bleeding from the prostate
3. Very less urination
4. Unable to empty the bladder
5. Stones in the bladder with prostate enlargement
6. Hydronephrosis (increased pressure on the kidneys and ureters due to retention of urine) 

Your surgeon will:

1. Inject general anaesthesia
2. Make a cut below your belly button to reach your pubic bone
3. Remove the prostate gland along with two tiny fluid-filled sacs called seminal vesicles
4. Reattach the urethra to the bladder at the bladder neck
5. Take sample lymph nodes from the pelvis to test them for cancer
6. Attach a drain, Jackson-Pratt drain, to your abdomen to drain the fluid or blood after surgery
7. Leave a catheter (tube) in place in the urinary bladder for a few days to a few weeks to drain the urine 
8. The surgery takes around 90 minutes to four hours (depending on your condition).

Before the surgery, your doctor will:

1. Explain the procedure/surgery and answer all your questions
2. Go through your medical history
3. Do a physical examination to check if you are fit
4. Do blood tests and other diagnostic tests
5. Ask you to stop smoking 
6. You must notify your doctor:
7. If you are allergic to latex, any medication, tape, contrast dyes, iodine, and anaesthetic agent (general or local anaesthesia)
8. If you are taking any blood-thinning medicine (aspirin) or have a history of bleeding disorder
9. All the medicines (prescribed or over the counter) and herbal supplements you take

You will be told to:

1. Sign a consent form to permit them to proceed with the surgery.
2. Clear your bladder before the surgery
3. Take medicines with a small sip of water
4. Arrive at the hospital at the given time

Position during surgery:

You will be made to lie down in a supine (lying on your back) position with the suprapubic area over the table break.

Cleaning and Draping: 

Proper draping and cleaning will be done to prevent infection and protect your privacy and comfort.

The recovery process in Hospital:

You will be:

1. In the hospital for two to five days
2. Given pain-relieving medicines
3. Encouraged to walk around the bed
4. Informed to keep the urinary catheter in place for about one to three weeks.

The recovery process after hospital discharge:

You will be:

1. Told to keep the surgical area dry and clean
2. Given certain bathing instructions, such as allowed to shower but avoid swimming or bathing. 
3. Recommended pain-relieving medicine
4. Instructed regarding the use of urinary catheters and other home care directions
5. Informed that after the catheter is removed, you may experience some urine leakage
6. Instructed on how to improve your bladder control
7. Feeling tired for several weeks
8. Told to avoid strenuous activities or heavy lifting for three to four weeks
9. Advised to avoid exercises that strain your abdominal muscles for four to six weeks
10. Told to avoid driving till the urinary catheter is attached, and you are on pain-relieving medications
11. Told to resume work after two to three weeks of surgery. This depends on your recovery and the nature of the job.

Your first follow up appointment will be planned after a week of hospital discharge. During this follow-up, your catheter, stitches or staples will be removed.[9] In the case of cancer, long-term monitoring is required for most patients to check the PSA (prostate-specific antigen) level, which aids in detecting any chances of cancer returning. This PSA test will be planned for around three months after the surgery. Subsequent tests take place every six months for a minimum of five years. Also, sexual function and urinary continence are checked in the follow-up appointments.

Possible side effects that can occur after the surgery are:

1. Bleeding
2. Side effects of anaesthesia 
3. Breathing difficulty
4. Rectal injury-causing faecal urgency or incontinence

Risk/complications of the surgery:

1. Urinary incontinence (involuntary, uncontrollable urine leakage)
2. Impotence (erectile dysfunction)
3. Sterility (man becomes unable to provide sperm as the connection between the urethra and testicles is cut off)
4. Decrease in the length of the penis 
5. Lymphedema (fluid accumulation in the soft tissue causing swelling in the genital area or legs)
6. Infection at the surgical site
7. Inguinal hernia in the future
8. Retention of urine
9. Urinary tract infection
10. Developing a narrow bladder neck or bladder neck stricture