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Alternative Names
simple prostatectomy for BPH, open procedure for an enlarged prostate gland
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Definition
A simple prostatectomy is a surgical procedure done to remove part or all of the
prostate gland. This procedure is most commonly performed to treat a condition known as
benign prostatic hyperplasia (BPH), which is an enlarged prostate gland.
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Who is a candidate for
the procedure?
Men who are suffering blocked urine flow because of an enlarged prostate, or
BPH, may be considered for this surgery. Usually, it is done on men who cannot be
successfully treated with medications.
The choice of procedure depends on the size of the enlarged prostate. If the gland is less
than 100 grams, a minimally invasive procedure such as a transurethral resection of the
prostate (TURP) may be used. If the prostate is larger than 100 grams, a simple
prostatectomy is often chosen. A simple prostatectomy may also be selected if the man has
bladder diseases that can be taken corrected at the same time. These conditions can
include abnormal outpouchings of the bladder, called diverticuli, or large stones in the
bladder. A simple prostatectomy may also be chosen over a TURP if the man has other
problems, such as trouble moving his hips, which make him unable to be positioned properly
for a TURP surgery.
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How is the procedure
performed?
The operation is done in the hospital under regional anesthesia or general
anesthesia. An intravenous tube is inserted into the man's vein, usually in the arm, to
allow fluids and medications to be given. To begin the surgery, the surgeon makes a cut in
the lower portion of the belly. This exposes the prostate and the bladder. Next, a cut is
made in the prostate gland and the inner portion is removed. Sutures and special tools are
used to stop bleeding. A drainage tube, called a urinary catheter, is inserted through the
penis and into the bladder. Finally, the prostate and bladder, if it has been opened, are
stitched closed. If surgery has been performed on the bladder as well, another catheter
may be inserted that exits through the skin of the lower abdomen. This is known as a
suprapubic catheter.
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How is the procedure
performed?
The operation is done in the hospital under regional anesthesia or general
anesthesia. An intravenous tube is inserted into the man's vein, usually in the arm, to
allow fluids and medications to be given. To begin the surgery, the surgeon makes a cut in
the lower portion of the belly. This exposes the prostate and the bladder. Next, a cut is
made in the prostate gland and the inner portion is removed. Sutures and special tools are
used to stop bleeding. A drainage tube, called a urinary catheter, is inserted through the
penis and into the bladder. Finally, the prostate and bladder, if it has been opened, are
stitched closed. If surgery has been performed on the bladder as well, another catheter
may be inserted that exits through the skin of the lower abdomen. This is known as a
suprapubic catheter.
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What happens right
after the procedure?
The man generally stays in the hospital after the procedure. The urinary
catheter is kept in place for several days, and water is flushed through the catheter to
decrease blood in the urine. Once the urine is free of blood, the catheter can be removed
and the man can be discharged. If a suprapubic catheter has been inserted, this may be
left in for a period after the man leaves the hospital. This will depend on how well he is
able to pass urine after the urinary catheter is removed.
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What happens later at home?
The man should drink plenty of fluids to help clear the bladder and urine of
blood. If it's not flushed out, the blood can form clots and block the flow of urine.
Also, the man should avoid lifting heavy objects for 4 to 6 weeks. The lifting could
strain the site of the incision or cause bleeding around the prostate. Men who have a
catheter through the skin of the lower abdomen will need to have it removed in the
surgeon's office in 1 to 2 weeks.
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What are the potential
complications after the procedure?
Overall, this surgery has very few dangerous complications. It
is considered a low risk operation. All surgery carries a risk of bleeding, infection, and
reactions to any pain medication used. Specific complications include:
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urine leakage from internal incisions around the bladder or prostate. Sometimes a
drain is placed in the pelvic space at the time of the operation to take care of this
problem.
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retrograde ejaculation, a condition in which sperm travel backward into the
bladder rather than out the end of the penis during ejaculation. This occurs in most men
who have the operation. Men who wish to father children should discuss this possibility
with the surgeon before the surgery.
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narrowing of the bladder neck, which may cause problems urinating. This occurs in
a small number of men, and can be easily treated.
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