Prostatectomy

Prostatectomy is the most commonly performed surgical procedure for partial or complete removal of the prostate gland.

1. One of the main reasons for prostatectomy is to treat benign hyperplasia or benign prostatic cancer.
2. Prostatectomy may be done alone or along with other procedures, such as radiation therapy, chemotherapy, and hormone therapy.
3. Prostatectomy is recommended for men with an enlarged prostate gland, called benign prostatic hyperplasia or BPH. It also helps relieve urinary symptoms and complications resulting from blocked urine flow. These symptoms include:
   1. If you feel a frequent, urgent need to urinate
   2. If you face difficulty starting to pee
   3. If there is increased urination frequency at night
   4. If you have a problem with stopping and starting again while urinating
   5. If you feel that you can't empty your bladder
   6. Urinary tract infections
   7. If you are unable to pee

1. If you delay surgery, your symptoms may worsen, causing extreme discomfort.
2. If the surgery is for the treatment of prostate cancer, cancer may metastasise and could prove fatal.
3. The symptoms of benign prostatic hyperplasia, such as urinary incontinence and the inability to urinate may increase, which may lead to UTI  infections.

1. A urologist performs a prostatectomy. There are several approaches for prostatectomy, such as:
   1. Robot-assisted prostatectomy: During robot-assisted prostatectomy, a three-dimensional endoscope and image processing equipment are inserted that provides a magnified view of the prostate gland. The surgeon assists the robotic system from outside the body. A keyhole incision is made, and the prostate is removed.
   2. Open radical prostatectomy: It is a traditional method, the surgeon makes an 8-10 inch incision in the lower part of the abdomen to insert surgical tools and to visualise the site clearly. Your surgeon may approach retropubic or suprapubic. The complete prostate gland is removed.
   3. Laparoscopic prostatectomy: In this surgery, Five small incisions are made across the abdomen, to insert surgical instruments and a camera. The surgeon visualises the entire operation on a screen to remove the prostate gland from the surrounding tissue.
2. The most common method among these is radical prostatectomy.
3. You will be given either general or spinal anaesthesia. 
4. You will be placed in the supine position, on the operative table. Then, the area of concern is cleansed with antiseptic solutions. 
5. The doctor will then introduce a urethral catheter into the bladder and fill the bladder with approximately 250 mL of sterile water or normal saline. 
6. The doctor will make a vertical incision from below the umbilicus. 
7. The doctor then places 2 stay sutures in the anterior wall of the bladder and makes a vertical cystotomy (endoscopy) to clearly see the bladder, neck, and prostate. A transverse stay suture may also be placed.
8. The doctor then retracts the superior bladder edge upwards and the inferior portion distal to the trigone to visualise the posterior bladder neck. The urethral orifices are then clearly displayed.
9. Your doctor then incises bladder mucosa over the prostate between the benign tumour and capsule of the prostate. 
10. Perform a gentle blunt digital dissection, completing the remaining dissection posteriorly and circumferentially around the prostatic apex and urethra.
11. The prostatic urethra is then detached by pinching 2 fingers together. It is done cautiously so that the prostate or sphincter at this level is not harmed.
12. After removing the adenoma, the prostate is inspected thoroughly. Sometimes, surrounding tissues and lymph nodes are also removed.
13. The doctor will control bleeding with electrocautery or suture ligatures.
14. The doctor will then insert a 3-way catheter in the urethra.
15. The bladder is then closed with the help of sutures.
16. The catheter is then inflated to prevent retraction into the prostatic space.

1. Your doctor will examine your urinary system. Your urethra and bladder will be examined with the help of cystoscopy to check the size of your prostate.
2. Your doctor may also perform some blood tests and tests to measure the size of your prostate and the urine flow.
3. The surgery will be discussed with you by your doctor, and you can also ask any questions you might have.
4. Your doctor will tell you about the common side effects of prostatectomy.
5. Your doctor will ask you about the medications you are currently taking and if you are taking any non-prescribed pain relievers like ibuprofen, acetaminophen, etc.
6. Inform your doctor if you are allergic to medications, latex, iodine, or anaesthesia. 
7. Do not take any blood-thinning medicines like aspirin.
8. Clear your bowels before surgery.
9. Fast for at least 8 hours before your surgery.

1. You will have to sign a form providing consent to the doctor to start the procedure and perform emergency care in case of any complications.
2. You have to wear a gown
3. Remove any jewellery, dentures, or eyeglasses that you might be wearing.
4. You’ll be prescribed antibiotics to prevent infection.
5. Shave your pubic hair

1. You will be taken to the operation theatre and will be placed in the correct position for the procedure.
2. You will be administered general anaesthesia and an IV line will be started.
3. Your vitals, like heart rate, pulse, blood pressure, and oxygen saturation, will be monitored.
4. Your doctor will then make an incision below your belly button to reach your pubic bone.
5. Your prostate sample is sent for biopsy to rule out malignancy. 
6. After the procedure is done, an urethral catheter is placed.

1. You will be relocated to the recovery room for observation.
2. Stay in the hospital for a few days. The stay duration will depend on the type of surgery you had.
3. You will have a catheter placed in your bladder to drain urine.
4. You may feel pain and tenderness and will be prescribed pain relievers and antibiotics to prevent any infection. 
5. It might take anywhere between 4-6 weeks before you can start your daily chores. 
6. You will need a family member to drive you home after you are discharged.
7. Avoid strenuous activity for a few months.
8. Don’t engage in sexual intercourse for a while.

1. Your doctor will brief you on when to visit for the follow-up.
2. It is usually after about 6 weeks and then every three months for the first year.
3. Your sutures or staples will be removed during the first follow-up.
4. If you experience symptoms like:
   1. Fever and chills
   2. Drainage or bleeding from the incision
   3. Redness, swelling, or tenderness 
   4. Inability to defecate
   5. Difficulty in urination when the catheter is removed, so consult your doctor immediately

You should consult your doctor if you have the following symptoms:

1. Loss of control over bladder and bowel
2. Urinary leakage
3. Tightening of the urinary opening due to scar formation.
4. Excessive bleeding
5. Any change in length of the penis
6. Erectile dysfunction
7. Redness or swelling
8. Pain around the incision area