The prostate gland is an organ at the base of the bladder in men. The tissues in the gland may need to be surgically removed or destroyed if the prostate is swollen.

See also: Benign prostatic hypertrophy

An enlarged prostate can cause problems urinating and urinary tract infections. These symptoms can often be relieved by removing all or part of the prostate gland. Prostate removal can be performed in a number of different ways, depending on the size of the prostate and the cause of the prostate enlargement.

The three most common procedures for removing the prostate when there is no cancer are:

• Transurethral resection of the prostate (TURP)
• Laser prostatectomy
• Open prostatectomy

The decision regarding the type of prostatectomy to perform depends on the size of your prostate gland. For glands bigger than 30 grams and less than 80 grams (this number depends on the experience of the surgeon), TURP is performed. If the prostate is bigger than 90 grams, open prostatectomy is recommended.

TURP

Transurethral resection of the prostate is the most common surgical procedure for benign prostatic hyperplasia (BPH). TURP is performed using spinal or general anesthesia. A tube-like instrument called a cystoscope is inserted into the penis through the urethra and up to the prostate gland.

A special cutting instrument is inserted through the cystoscope to remove the prostate gland piece by piece. An electric current is used to stop the bleeding during surgery. This is called cauterization.

After surgery, a Foley catheter is placed into the body to help remove urine. The urine will first look bloody, but will clear with time.

A liquid solution may be attached to the catheter to flush the area and keep the tube from becoming clogged with blood or tissue. The bleeding will gradually decrease, and the catheter will be removed within 1 to 3 days. You will remain in the hospital for 1 to 3 days.

LASER PROSTATECTOMY

Laser prostatectomy uses beams of light to destroy prostate tissue. This procedure is usually performed on an outpatient basis and usually does not require a hospital stay.

The laser beam destroys any prostate tissue that is blocking the opening of the urethra and bladder outlet. This improves the urine flow rate and reduces the symptoms of BPH. A Foley catheter may be placed to help drain the bladder after surgery. The catheter will usually remain in place for a few days after surgery.

TRANSURETHRAL NEEDLE ABLATION (TUNA)

TUNA is a minimally invasive treatment for an enlarged prostate. It is done while you are under local anesthesia or sedation. The surgeon uses a camera to see the prostate, and passed needles into the area. High-frequency sound waves (ultrasound) heat the needles and prostate tissue. A Foley catheter may be placed to help drain the bladder. Over 2 to 12 weeks, the heated prostate tissue shrinks. The procedure is commonly performed in a doctor's office.

OPEN PROSTATECTOMY

Although the transurethral approach is more commonly used, other surgical approaches to removal of the prostate gland (such as the transvesical, retropubic, and suprapubic approach) are sometimes used. The primary advantage of the transurethral approach is that it does not create an external incision. However, it is difficult to remove a large prostate using TURP.

To perform an open prostatectomy (sometimes called suprapubic or retropubic prostatectomy), an incision is made in the lower abdomen between the umbilicus (belly-button) and the penis through which the prostate gland is removed. This is a much more involved procedure and usually requires a longer hospitalization and recovery period.

Open prostatectomy is performed using general or spinal anesthesia. You will return from surgery with a Foley catheter in place. Occasionally, a suprapubic catheter will be inserted in the abdominal wall to help drain the bladder.

A bladder irrigation solution may be attached to the catheter to continuously flush the catheter, thus keeping it from becoming clogged with blood. A drainage tube may also be placed in the abdominal cavity to drain excess blood and fluids from the area.

Urine may initially appear very bloody, but this should resolve in a few days. The Foley catheter and suprapubic catheters will remain in place for 5 days to a few weeks until the bladder has sufficiently healed.

ADDITIONAL TECHNIQUES

Other techniques for removing the prostate include Holmium laser enucleation of the prostate (HoLep) and Transurethral incision of the prostate (TUIP). TUIP is similar to TURP, but is usually performed in people who have a relatively small prostate. This procedure is usually performed on an outpatient basis and usually does not require a hospital stay.

Prostate removal may be recommended for:

• Inability to completely empty the bladder (urinary retention)
• Recurrent bleeding from the prostate
• Bladder stones with prostate enlargement
• Extremely slow urination
• Stage A and B prostate cancer
• Increased pressure on the ureters and kidneys (hydronephrosis) from urinary retention

• Blood clotting disorders
• Bladder disease (neurogenic bladder)

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection

• Problems with urine control (incontinence)
• Difficulty achieving and maintaining an erection (impotence)
• Loss of sperm fertility (infertility)
• Passing the semen into the bladder instead of out through the urethra (retrograde ejaculation)
• Urethral stricture (tightening of the urinary outlet)

TURP is typically successful at removing the symptoms of an enlarged prostate, although some sources report that within 10 years, about 20% of the people will require another surgery to remove additional prostate tissue.

Patients recovering from surgery for an enlarged prostate may have burning with urination, blood in the urine, urinary frequency, and urgent urination.

Hospital stay for open prostatectomy is about 4 to 7 days. Complete recovery from surgery can take 3 weeks. Drink plenty of fluids to help flush fluids through the bladder. Avoid coffee, cola drinks, and alcoholic beverages as these can cause irritation of the bladder and urethra. You should not do any lifting for 3 to 4 weeks. A stool softener may be used to help prevent constipation, which can delay the healing process.