Simple prostatectomy
Prostatectomy - simple; Suprapubic prostatectomy; Retropubic simple prostatectomy; Open prostatectomy; Millen procedure
Simple prostate removal is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. It is done through a surgical cut in your lower belly.
Description
You will be given general anesthesia (asleep, pain-free) or spinal anesthesia (sedated, awake, pain-free). The procedure takes about 2 to 4 hours.
Your surgeon will make a surgical cut in your lower belly. The cut will go from below the belly button to just above the pubic bone or it may be made horizontally just above the pubic bone. The bladder is opened and the prostate gland is removed through this cut.
The surgeon removes only the inner part of the prostate gland. The outer part is left behind. The process is similar to scooping out the inside of an orange and leaving the peel intact. After removing part of your prostate, the surgeon will close the outer shell of the prostate with stitches. A drain may be left in your belly to help remove extra fluids after surgery. A catheter may also be left in the bladder. This catheter may be in the urethra or in the lower abdomen or you may have both. These catheters allow the bladder to rest and heal.
Why the Procedure Is Performed
An enlarged prostate can cause problems with urinating. This can lead to urinary tract infections. Taking out part of the prostate gland can often make these symptoms better. Before you have surgery, your health care provider may tell you some changes you can make in how you eat or drink. You may also be asked to try taking medicine.
Prostate removal can be done in many different ways. The kind of procedure you will have depends on the size of the prostate and what caused your prostate to grow. Open simple prostatectomy is often used when the prostate is too large for less invasive surgery. However, this method does not treat prostate cancer. Radical prostatectomy may be needed for cancer.
Prostate removal may be recommended if you have:
- Problems emptying your bladder (urinary retention)
- Frequent urinary tract infections
- Frequent bleeding from the prostate
- Bladder stones with prostate enlargement
- Very slow urination
- Damage to the kidneys
Your prostate may also need to be removed if taking medicine and changing your diet do not help your symptoms.
Risks
Risks for any surgery are:
- Blood clots in the legs that may travel to the lungs
- Blood loss
- Breathing problems
- Heart attack or stroke during surgery
- Infection, including in the surgical wound, lungs (pneumonia), or bladder or kidney
- Reactions to medicines
Other risks are:
- Damage to internal organs
- Erection problems (impotence)
- Loss of the ability for sperm to leave the body resulting in infertility
- Passing semen back up into the bladder instead of out through the urethra (retrograde ejaculation)
- Problems with urine control (incontinence)
- Tightening of the urinary outlet from scar tissue (urethral stricture)
Before the Procedure
You will have many visits with your provider and tests before your surgery:
- Complete physical exam
- Visits with your provider to make sure medical problems (such as diabetes, high blood pressure, and heart or lung diseases) are being treated well
- Additional testing to confirm bladder function
If you are a smoker, you should stop several weeks before the surgery. Your provider can help.
Always tell your provider what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.
During the weeks before your surgery:
- You may need to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other medicines like these.
- Ask your surgeon which medicines you should still take on the day of your surgery.
- You may take a special laxative the day before your surgery. This will clean out the contents of your colon.
On the day of your surgery:
- DO NOT eat or drink anything after midnight the night before your surgery.
- Take the drugs you were told to take with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
You will stay in the hospital for about 2 to 4 days.
- You will need to stay in bed until the next morning.
- After you are allowed to get up you will be asked to move around as much as possible.
- Your nurse will help you change positions in bed.
- You will also learn exercises to keep blood flowing, and coughing/deep breathing techniques.
- You should do these exercises every 3 to 4 hours.
- You may need to wear special compression stockings and use a breathing device to keep your lungs clear.
You will leave surgery with a Foley catheter in your bladder. Some men have a suprapubic catheter in their belly wall to help drain the bladder.
Outlook (Prognosis)
Many men recover in about 6 weeks. You can expect to be able to urinate as usual without leaking urine.
References
Benjamin TGR, Kreshover JE. Simple prostatectomy. In: Bishoff JT, Kavoussi LR, Kayoussi N, Bishoff T, eds. Atlas of Laparoscopic and Robotic Urologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2023:chap 30.
Han M, Partin AW. Simple prostatectomy: open and robot-assisted laparoscopic approaches. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 147.
Roehrborn CG, Strand DG. Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 144.
Review Date: 4/1/2023
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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