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Prostatectomy – Procedure, Techniques & Recovery

A prostatectomy is a surgical procedure to remove all or part of the prostate gland. It is most commonly performed to treat prostate cancer.

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Things worth knowing about "Prostatectomy"

A prostatectomy is a surgical procedure to remove all or part of the prostate gland. It is most commonly performed to treat prostate cancer.

What is a Prostatectomy?

A prostatectomy is the surgical removal of the prostate gland, a walnut-sized gland located below the bladder in men that plays a key role in producing seminal fluid. Depending on the extent of the procedure, a distinction is made between a radical prostatectomy, in which the entire prostate gland along with the seminal vesicles is removed, and a partial prostatectomy, in which only a portion of the gland is removed.

Indications

The most common indication for a prostatectomy is prostate cancer (prostatic carcinoma). The procedure may also be considered in the following conditions:

Benign Prostatic Hyperplasia (BPH): Non-cancerous enlargement of the prostate causing severe urinary symptoms that do not respond to conservative treatments
Urinary Retention: Chronic inability to fully empty the bladder
Recurrent Urinary Tract Infections: Repeated infections caused by a significantly enlarged prostate

Surgical Techniques

Radical Retropubic Prostatectomy

This open surgical approach involves removing the prostate through an incision in the lower abdomen. It provides the surgeon with a clear view of the operative field and allows for nerve-sparing techniques aimed at preserving erectile function.

Laparoscopic Prostatectomy

This minimally invasive method uses small incisions, a camera, and specialized instruments to perform the operation. It is associated with reduced blood loss and a shorter recovery time compared to open surgery.

Robot-Assisted Prostatectomy (da Vinci)

In this technique, the surgeon operates using a robotic system (e.g., the da Vinci Surgical System). This approach allows for exceptional precision and tissue preservation and has become the standard procedure at many specialized centers.

Perineal Prostatectomy

In this approach, the prostate is accessed through the perineum (the area between the scrotum and the anus). It is used less frequently but may be advantageous in certain anatomical situations.

Preparation and Diagnosis

Before a prostatectomy, the following assessments are typically carried out:

PSA Level (Prostate-Specific Antigen): A blood test used to assess cancer risk
Biopsy: Tissue sampling to confirm a cancer diagnosis
MRI or CT Scan: Imaging to determine the exact location and extent of the tumor
Bone Scintigraphy: To rule out bone metastases in advanced cancer

Potential Risks and Side Effects

As with any surgical procedure, a prostatectomy carries certain risks:

Urinary Incontinence: Temporary or permanent loss of bladder control; continence typically improves within months for most patients
Erectile Dysfunction: Reduced or lost ability to achieve an erection, depending on whether the nerve bundles could be preserved
Dry Orgasm: Since the seminal vesicles are removed, natural ejaculation is no longer possible after a radical prostatectomy
Bleeding and Infection: General surgical risks
Injury to Adjacent Structures: Rare but possible damage to the bowel, urethra, or blood vessels

Aftercare and Rehabilitation

Following surgery, a urinary catheter is placed for several days. The hospital stay typically ranges from 2 to 5 days depending on the surgical method used. A structured pelvic floor training program is strongly recommended afterward to restore urinary continence. Regular PSA follow-up tests are essential after prostatectomy for cancer to detect any potential recurrence at an early stage. If needed, medications to support erectile function or additional urological interventions can be considered.

References

Mottet N. et al. - EAU Guidelines on Prostate Cancer. European Association of Urology, 2023.
Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds.) - Campbell-Walsh Urology, 12th edition. Elsevier, 2020.
National Cancer Institute (NCI): Prostate Cancer Treatment (PDQ) - Patient Version, 2023. Available at: https://www.cancer.gov

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