Open simple prostatectomy is a surgery used to relieve urinary symptoms caused by an enlarged prostate, a condition called benign prostatic hyperplasia (BPH). Open simple prostatectomy is generally recommended for men who have severe urinary symptoms and very enlarged prostates. The surgery does not remove the entire prostate, as is done in a prostate cancer operation, but removes just the obstructive part of the prostate that blocks the flow of urine.
During open simple prostatectomy, the part of your prostate blocking urine flow is removed through a cut (incision) below your navel. It may be done by making several smaller incisions in the abdomen through a technique called laparoscopy or with the assistance of a robot to accomplish the same thing.
Why it's done
Open simple prostatectomy eases urinary symptoms and complications resulting from blocked urine flow. These can include:
- A frequent, urgent need to urinate
- Difficulty starting urination
- Slow (prolonged) urination
- Increased frequency of urination at night (nocturia)
- Stopping and starting again while urinating
- The feeling you can't completely empty your bladder
- Urinary tract infections
- Inability to urinate
Open simple prostatectomy may also be done to treat or prevent complications due to blocked urine flow, such as:
- Recurring or persistent urinary tract infections
- Kidney or bladder damage
- Inability to control urination (incontinence)
- Recurring blood in your urine
- Bladder stones
Because open simple prostatectomy has a higher risk of complications and a longer recovery time than other procedures, it is typically reserved for men who have:
- A very enlarged prostate
- Bladder problems or other problems that can also be repaired during surgery
- Bladder stones
- Severe bleeding (hemorrhage) from the prostate
Although open simple prostatectomy works well at relieving urinary symptoms, it has a higher risk of complications and a longer recovery time than other enlarged prostate procedures. Risks of open simple prostatectomy include:
- Heavy bleeding. Some men lose enough blood during open simple prostatectomy to require a blood transfusion. You may store your own blood ahead of time in case this occurs, or you may be given donor blood if needed. In some cases, bleeding occurs after surgery and requires further treatment.
- Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other treatment.
- Difficulty holding urine. In some men, open simple prostatectomy causes loss of bladder control and an urgent need to urinate. In most cases, this gets better after several weeks to several months.
- Dry orgasm. Open simple prostatectomy causes retrograde ejaculation, which means the semen released during sexual climax (ejaculation) enters your bladder rather than exiting the penis. It isn't harmful and generally doesn't affect sexual pleasure, but it can interfere with your ability to father a child.
- Erectile dysfunction. In some cases, open simple prostatectomy causes erectile dysfunction — the inability to maintain an erection firm enough to have sex. Erectile function can improve over time, but in some men it's permanent.
- Narrowing (stricture) of the urethra or bladder neck. Sometimes surgery narrows the tube that carries urine from the bladder (urethra), or the area where the urethra attaches to the bladder (bladder neck). This can make urination difficult and may require additional treatment to correct.
How you prepare
Before surgery, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to specifically measure your prostate and to measure urine flow.
Follow your doctor's instructions on what to do before your treatment. Here are some issues to discuss with your doctor:
- Your medications. Tell your doctor about any prescription or over-the-counter medications or supplements you take. This is especially important if you take blood-thinning medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others). Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days before the surgery.
- Fasting before surgery. Your doctor will likely ask that you not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
- Bowel prep before surgery. You surgeon may ask you to do an enema prior to surgery. You may be given a kit and instructions for giving yourself an enema to clear your bowels the morning of surgery.
- Arrangements after surgery. Ask your doctor how long to expect to be in the hospital. And arrange ahead of time for a ride home. You won't be able to drive yourself home.
- Activity restrictions. You may not be able to work or do strenuous activity for several weeks after surgery. Ask your doctor how much recovery time you may need.
What you can expect
Before surgery, your doctor will give you a general anesthetic, which means you'll be unconscious during the procedure. Or you may receive a spinal anesthetic, which means you'll be conscious during surgery but won't feel any pain.
Your doctor may also give you an antibiotic right before surgery to prevent infection.
During the procedure
Once the anesthetic is working, your doctor may perform a cystoscopy. A long, flexible viewing scope (cystoscope) is inserted through the tip of your penis to see inside the urethra, bladder and prostate area.
Your doctor will then insert a tube (Foley catheter) into the tip of your penis that extends into your bladder. The tube drains urine during the procedure. Your doctor will make a cut (incision) below your navel. Depending on what technique your doctor uses, he or she may need to make an incision through the bladder to reach the prostate. In some cases, the procedure is done with robot assistance or laparoscopically. Laparoscopic and robotic surgery requires a few smaller incisions rather than a single large incision.
If you also have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it.
Once your doctor has removed the part of your prostate causing symptoms, you may or may not have one to two temporary drain tubes inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder (suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After the procedure
After surgery you should expect that:
- Your doctor may inflate a balloon inside the area where part of your prostate was removed. This puts pressure on the surgery area to stop bleeding. To keep blood clots from forming, you will have saline solution flowing through (irrigating) the bladder.
- You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the IV is removed.
- Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.
- The suprapubic tube is generally removed after a few days. It may be taken out before you go home from the hospital. Or you may need to keep it in place and return to the hospital or doctor's office to have it removed.
- You'll likely go home a few days after surgery. When your doctor thinks it's safe for you to go home, the pelvic drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.
- You may return home with a catheter in place. Most men need a urinary catheter for seven to 10 days after surgery.
Make sure you understand the post-surgery steps you need to take, and any restrictions.
- You'll need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks.
- You won't be able to drive for at least a few days after going home. Don't drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it's OK.
- You'll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about six weeks and then again after a few months. If you have any problems, you may need to see your doctor sooner or more often.
- You'll probably be able to resume sexual activity 6 to 8 weeks after surgery. After simple prostatectomy, you can still have an orgasm during sex, but you'll ejaculate very little or no semen.
Open simple prostatectomy provides long-term relief of urinary symptoms due to an enlarged prostate. Although it's the most invasive procedure to treat an enlarged prostate, serious complications are rare. Most men who have the procedure generally don't need any follow-up treatment for their BPH.