How To Remove The Prostate

How Do I Prepare For My Turp

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for TURP by:

• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and at all times.

• Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a , EKG , blood tests, and other tests as needed.

• Losing excess weight before the surgery through a healthy diet and exercise plan

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Stopping as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen , and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctors office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

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The Prostate Cancer Outcomes Study

This study involved 1,291 men ages 3979 who filled out questionnaires asking about specific changes in urinary and sexual functioning following radical prostatectomy. When questioned 18 months or longer after treatment, 8.4% of men reported being incontinent, and 59.9% reported being impotent. These percentages indicate incontinence and impotence may be more common than other studies, which relied on patients volunteering specific information, have found.

Source: Stanford JL, Feng Z, Hamilton AS, et al. Urinary and Sexual Function after Radical Prostatectomy for Clinically Localized Prostate Cancer: The Prostate Cancer Outcomes Study. Journal of the American Medical Association 2000 283:354-60. PMID: 10647798.

And what did the radiation oncologists advise?

I was really impressed with both men. They talked about the implantation of radioactive seeds . I said to one of them, You know, Im getting all this information and Im in overload here. So if you were in my position, what would you do?

And he said, Well, Im 20 years younger than you. So if I had prostate cancer, I would have surgery. Because Im most concerned about living a long life.

And I said to myself, Look, pal, I want to live a long life too!

Did he provide evidence that surgery would make an individual patient live longer?

Did either of the radiation oncologists mention external beam radiation?

So then what happened?

Have you talked with him since then? Has there been any improvement?

What impressed you?

Types Of Prostate Surgery

There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.

Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.

Keyhole surgery

Keyhole surgery .

• Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
• Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Open surgery

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What Is The Life Expectancy After The Removal Of The Prostate Gland

Prostate removal prolongs life with about three years in men with prostate cancer. However, prognosis depends on many factors. A doctor should know the patients medical history in detail and put this information together with survival statistics in order to offer an informed answer.

Option treatments have evolved over the years and life after prostate removal is now associated with less complications and a higher success rate.

Dealing With Prostate Cancer

Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.

Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

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Types Of Radical Prostatectomy

The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.

Open prostatectomy

In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and .

Laparoscopic prostatectomy

In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.

Robot-assisted laparoscopic prostatectomy

Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.

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Questions To Ask Your Doctor Or Nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

• What type of surgery do you recommend for me and why?
• What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
• How many of these operations have you done and how many do you do each year?
• Can I see the results of radical prostatectomies youve carried out?
• What pain relief will I get after the operation?
• How and when will we know whether the operation has removed all of the cancer?
• How often will my PSA level be checked?
• What is the chance of needing further treatment after surgery?
• What is the risk of having urinary problems or erection problems and what support can you offer me?

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Side Effects Of Prostate Surgery

The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

• Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
• Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
• Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
• Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

There are several options for treating erectile dysfunction:

Who Should Choose Active Surveillance For Prostate Cancer

When detected early, prostate cancer is considered one of the most treatable forms of disease. Additionally, some forms of prostate cancer are relatively slow-growing and are not likely to impact a mans life expectancy in certain cases. For men with low-stage, low-grade disease, men who have a remaining life expectancy of less than ten years, and/or men who have significant health problems or are not candidates for surgery, active surveillance may be recommended as a prostate cancer management tool. With active surveillance, patients typically have regular PSAs and digital rectal exams to monitor the potential progression of their disease and determine if and when intervention may be warranted.

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Caring For Your Incision

The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.

Things You Should Expect After Prostate Surgery

Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.

In the immediate hours after surgery:

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Treatment Options For Urinary Incontinence Can Include:

• Pelvic floor physical therapy. These specialized physical therapists are trained to help men strengthen their pelvic floor muscles. These muscles help you control the flow of urine. The exercises are called Kegel exercises just as you might do bicep curls to strengthen your arm muscles Kegel exercises help you learn to tighten and relax the muscles that control your flow.
• Bladder training. The bladder is a muscular organ that can be trained. A pelvic floor physical therapist or your urologist will provide simple behavioral changes to help retrain your bladder.
• Medication. Prescription medicines help the muscles in your bladder and sphincter . These medications work well for men with urge incontinence.
• Surgery. Surgery may be scheduled if you have a blockage. Other surgical procedures include injecting collagen to strengthen the urinary sphincter that controls urine release or implanting an artificial urinary sphincter.

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What Are The Potential Risks And Complications Of Robotic Prostatectomy

The risks of robotic prostatectomy are much the same as those of open surgery. There are general risks associated with all types of surgery, such as the risks of Anaesthetic problems / complications which occur rarely e.g.:

• Cardiac complications such as a heart attack, arrhythmia, etc.
• Major bleeding requiring blood transfusion or re-operation to stop bleeding â please inform Dr Nathan, the anaesthetist and the hospital staff if you do not wish to receive blood products .
• Blood clots developing in the legs and/or lungs .
• Very rarely death as a result of major surgery .
• Pressure effects as a result of immobilisation during surgery causing symptoms such as pain or bruising, or damage to nerves, which may lead to transient or permanent numbness, tingling or muscle weakness.

Specifically, with robotic radical prostatectomy there are risks of:

It is important to be aware that the majority of these risks are not common, and that most of these with the exception of open conversion are also risks of the open radical prostatectomy.

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What Is A Prostatectomy

A prostatectomy is a surgical procedure for the partial or complete removalof the prostate. It may be performed to treatprostate cancerorbenign prostatic hyperplasia.

A common surgical approach to prostatectomy includes making a surgicalincision and removing the prostate gland . This may beaccomplished with either of two methods, the retropubic or suprapubicincision , or a perineum incision .

Prior to having a prostatectomy, it’s often necessary to have aprostate biopsy. Please see this procedure for additional information.

How To Reduce Prostate Size

This article was medically reviewed by . Dr. Litza is a board certified Family Medicine Physician in Wisconsin. She is a practicing Physician and taught as a Clinical Professor for 13 years, after receiving her MD from the University of Wisconsin-Madison School of Medicine and Public Health in 1998.There are 13 references cited in this article, which can be found at the bottom of the page.wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 86% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 99,787 times.

The prostate gland is a part of the male reproductive system that can enlarge with age, putting uncomfortable pressure on the urethra. This can cause urinary difficulties, urinary tract infections , and even bladder stones. By making lifestyle changes and using medication, most men can reduce their urinary troubles. A few men, though, may need to consider minimally invasive or traditional surgery options to feel their best.

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Who Should Get A Radical Prostatectomy

Men younger than 75 years old with limited prostate cancer and who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.

Before doing a radical prostatectomy, doctors first try to confirm that the prostate cancer has not spread beyond the prostate. They can figure out the statistical risk of spread by looking at tables comparing the results of a biopsy and PSA levels.

Other tests to check for signs of spread, if needed, can include CT scans, bone scans, MRI scans, ultrasound, PET scans, and bone scans.

If it appears that the prostate cancer hasnât spread, your surgeon may first offer you other options besides surgery. These can include radiation therapy, hormone therapy, or simply watching the prostate cancer over time, since many prostate cancers grow slowly.

Depending on how high your risk of the cancer spreading is, your surgeon may also consider doing an operation called pelvic lymph node dissection.

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Using Medication To Reduce Symptoms

1Recognize the symptoms of an enlarged prostate. Look for a weak stream of urine, dribbling at the end of urination, or an increased need to urinate at night. You may also have difficulty starting urination or need to strain to empty your bladder. If you notice these symptoms, make an appointment with your doctor for an official diagnosis.XTrustworthy SourceMayo ClinicEducational website from one of the worlds leading hospitalsGo to source

2Try alpha-blockers if you have trouble urinating. Talk to your doctor about alpha-blockers, which can relax muscles around the bladder and prostate. These drugs help increase the flow of urine when you use the bathroom and keep you from needing to urinate too frequently.XResearch source

While adverse side effects are infrequent, alpha-blockers can cause dizziness. The good news is, they typically help relieve symptoms within a few weeks.

Take alpha-blockers, like tamsulosin, as directed by your doctor.

Most alpha-blockers are safe to take with other medications. Consult your pharmacist for any potential drug interactions with your current medication regimen.

3Explore enzyme-inhibitors if you have a very enlarged prostate. Ask your doctor if enzyme-inhibitors, like finasteride and dutasteride, would be a good fit for your symptoms. These drugs shrink prostate tissue to reduce urinary problems and are often most effective on severely enlarged prostates.XResearch source

Like alpha-blockers, dizziness is the most common side effect.

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When You Might Have A Radical Prostatectomy

Your doctor might recommend a radical prostatectomy if:

• your cancer hasn’t spread outside the prostate gland. This is localised prostate cancer
• your cancer has broken through the covering of the prostate and spread to the area just outside the prostate gland. This is locally advanced prostate cancer
• you are well enough to have this operation

The aim of a radical prostatectomy operation is to cure prostate cancer.

How The Surgery Is Done

Different surgical methods may be used to remove the prostate:

• open radical prostatectomy usually done through one long cut in the lower abdomen
• laparoscopic radical prostatectomy small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen for guidance
• robotic-assisted radical prostatectomy laparoscopic surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and move robotic arms that hold the instruments.

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