A B C D E F G H I J K L M N O P R S T U V W

PROSTATECTOMY : OPEN OPERATION

Why is a Prostatectomy performed ?

This operation is performed rarely because the alternative transurethral method is often preferred. However, a few prostate glands are too large to be removed piecemeal by the transurethral method. In these cases, a prostatectomy is performed which requires a cut to be made in the lower abdomen. Often the need for an open operation will not be obvious until the urologist has made a full inspection under anaesthetic. Usually, however, the urologist will suspect beforehand that the prostate may be too large for a transurethral operation and should explain that he will probably proceed to an open operation if necessary under the same anaesthetic.

Preparations needed for a Prostatectomy

Although the operation usually takes only 45 minutes, pre-operative checks are necessary to ensure safety. Sometimes the blood tests, urine tests, x-rays and electrical heart tracing (ECG) will be done a few days before hospital admission, to check that general health is satisfactory. Alternatively, these checks will be made on the day before surgery. Because an incision has to be made, expect a hospital stay of 6 to 8 days. Some convalescence will also be required; usually full activity can be resumed 6 weeks after leaving hospital.

What Happens during a Prostatectomy

In this operation, the prostate is removed, through either a vertical or horizontal cut made in the lower abdomen, under a general anaesthetic. When the prostate has been removed, a catheter tube is placed in the bladder and emerges from the end of the penis. This will remain for 5 to 7 days to allow the bladder to heal, and allow the urine (and any blood) to drain from the bladder. It does not cause pain but can be uncomfortable when moving. In addition, the urologist will probably leave one or two plastic tube drains which emerge through the skin close to the incision. These will remain for 2 to 3 days before being removed.

Possible Complications during a Prostatectomy

Prostatic surgery is a very frequently performed operation, with a low complication rate. A little bleeding and a stronger than usual desire to pass urine can occur quite commonly in the first month following operation. Some discomfort on passing urine may also persist for 2 3 weeks. The full benefits of the operation may therefore take a month or so to be evident. Excessive bleeding sometimes occurs immediately after the operation and can be treated by blood transfusion. A second operation to stop the bleeding is seldom required. The bladder may need to be flushed through with fluid to wash out blood clot. A failure to pass urine properly when the catheter is removed may be due to a blood clot or to a remaining piece of prostate. The catheter will need to be replaced and sometimes further operation is necessary. Inability to control the flow of urine is very rare following a prostate operation. It is difficult but not impossible to treat. There are additional complications to be considered because a cut has been made. These include wound infection and wound leakage. There is also a slightly higher risk of other problems, such as chest infections, and blood clot in the veins of the legs. This is because of the longer period of bed rest following the operation. You will be given leg-moving and breathing exercises to reduce the likelihood of these problems developing.

After a Prostatectomy

A little discomfort and bleeding on passing water is common for the first few weeks. More severe bleeding may occur in the second to fourth week after operation. This is bright red persistent bleeding and is called secondary haemorrhage. If this occurs, contact the doctor. Re-admission to hospital for observation and possibly transfusion will probably be needed. A persistent strong desire to pass urine may also occur, but usually gets better with time. It may take 3 4 months. You will be given an appointment to see the urologist a couple of months following the operation. By this time, most of the discomfort should have settled. You should be passing urine much more easily, but the purpose of the check is to ensure that all is well. Following the operation it is wise to take one month off work or from strenuous activity. Bicycle riding, sport and sexual activity should be avoided in the first 6 post-operative weeks. When sexual activity is resumed, you will probably notice that the semen is no longer emitted from the end of the penis. The sensation of orgasm is present but altered, as the semen is ejected backwards into the bladder. It will therefore not be possible to father children, although the performance of the sexual act should not be altered. The ability to get an erection will very occasionally be affected by a prostate operation. At present, urologists are unable to predict whether you will have this problem.

If a Prostatectomy is not performed

In about a quarter of patients, the symptoms remain unchanged. Often the symptoms gradually or suddenly worsen. The bladder may hardly empty at all or may cause back pressure on the kidneys, leading to kidney failure. This can produce unwellness and sickness, but can also get to quite an advanced stage without causing symptoms. If the bladder cannot empty properly, the urine may become infected, causing pain and fever. It may happen that you are unable to pass any urine at all. This is usually painful and emergency hospital admission is required to drain the urine with a tube called a urethral catheter. If this happens, a prostate operation would almost certainly be needed. Occasionally the bladder distends more slowly and without pain. Eventually the urine begins to leak. This is called chronic urinary retention and also requires treatment by bladder catheter and then operation.