Prostatectomy

There are several types of prostatectomy procedures used to treat prostate conditions, each designed to address different stages or severities of prostate enlargement or cancer. Below are the most commonly performed prostatectomy techniques.

• TURP (Transurethral Resection of the Prostate)
  TURP is the gold standard for treating BPH and involves removing prostate tissue that is obstructing the urethra. The procedure is performed under general or spinal anesthesia, and a resectoscope is inserted through the urethra. This allows the surgeon to remove small pieces of the prostate without the need for external incisions. TURP offers immediate relief from urinary symptoms and has a high success rate. However, some patients may experience side effects such as urinary incontinence or erectile dysfunction.
• HoLEP (Holmium Laser Enucleation of the Prostate)
  HoLEP is a more advanced technique that uses a laser to enucleate and remove obstructive prostate tissue. It is particularly effective for treating larger prostates and is associated with fewer complications compared to traditional TURP. During HoLEP, the surgeon uses a laser to cut and remove excess tissue, which is then suctioned out through the urethra. HoLEP has a shorter recovery time than TURP and a lower risk of postoperative bleeding, making it an attractive option for patients who need more extensive tissue removal.
• Radical Prostatectomy
  This procedure is primarily used to treat prostate cancer and involves the complete removal of the prostate gland. Depending on the patient’s condition and the size of the tumor, the surgery can be performed via an open procedure or a minimally invasive robotic approach. Radical prostatectomy offers a high chance of curing localized prostate cancer but may lead to side effects like incontinence or impotence.
• Simple Prostatectomy
  Simple prostatectomy, also known as an open prostatectomy, is used for men with significantly enlarged prostates that cannot be treated with less invasive techniques. During this procedure, the surgeon removes the part of the prostate causing obstruction but leaves the outer portion of the gland intact. This procedure is reserved for severe cases of BPH and may require a longer recovery time compared to TURP or HoLEP.

Which Procedure is Right for You?

The type of prostatectomy best suited for a patient depends on factors such as the size of the prostate, the severity of symptoms, and whether the surgery is being performed to treat cancer or BPH. Your urologist will help you decide which approach will offer the best outcomes based on your condition.

Surgery is typically recommended for men who experience significant symptoms due to an enlarged prostate or when prostate cancer has been diagnosed. Deciding to undergo prostatectomy is based on several factors, including symptom severity, cancer stage, and the patient’s overall health.

• Benign Prostatic Hyperplasia (BPH)
  BPH, or prostate enlargement, is one of the most common reasons for prostatectomy. When the prostate becomes enlarged, it can obstruct the flow of urine, leading to symptoms like difficulty urinating, frequent urination, and urinary retention. If medications fail to provide relief, surgical intervention may be necessary. TURP and HoLEP are the primary procedures used to treat BPH and restore normal urinary function.
• Prostate Cancer
  Men diagnosed with localized prostate cancer may require a prostatectomy to remove the prostate gland and prevent the spread of cancer. Radical prostatectomy is the procedure of choice for men whose cancer is confined to the prostate and who are in good health. Removing the prostate offers a chance for cure and can prevent the need for further treatments like radiation or hormone therapy in the future.
• Recurrent Urinary Tract Infections (UTIs)
  In some cases, an enlarged prostate can cause recurrent urinary tract infections due to incomplete bladder emptying. Men who experience frequent UTIs may benefit from prostatectomy to relieve the obstruction and reduce the risk of infections.
• Bladder Stones and Chronic Urinary Retention
  An enlarged prostate can lead to chronic urinary retention, which may cause the formation of bladder stones. For men suffering from bladder stones or chronic urinary retention that doesn’t respond to medication, prostatectomy is recommended to eliminate the obstruction and improve bladder function.

Signs You May Need Surgery

If you’re experiencing symptoms like weak urine flow, frequent urination, or incomplete bladder emptying, it may be time to discuss prostatectomy with your doctor. Surgery may be the best option if medications aren’t relieving your symptoms, or if you’re facing complications like recurrent infections or urinary retention.

Recovery after prostatectomy varies depending on the type of surgery performed. Minimally invasive procedures like HoLEP and TURP generally have shorter recovery times than more extensive surgeries like radical prostatectomy. However, all procedures require careful post-operative care to ensure a smooth recovery.

• Hospital Stay and Immediate Recovery
  Most patients undergoing TURP or HoLEP are discharged within 1-2 days after surgery. For more extensive procedures like radical prostatectomy, a hospital stay of 2-3 days may be required. During the first few days post-surgery, patients may experience mild pain, which can be managed with prescribed pain medications. A catheter is often inserted to help drain the bladder for a few days after surgery, and patients are advised to drink plenty of fluids to flush the bladder.
• Activity Restrictions
  Patients are typically advised to avoid strenuous activities, heavy lifting, and sexual intercourse for at least 4-6 weeks after surgery. Gentle walking is encouraged to promote blood circulation and prevent complications like blood clots. Most men can return to light activities and work within 2-4 weeks, depending on the procedure and their overall health.
• Follow-Up Appointments
  It’s important to attend all follow-up appointments to monitor your recovery and check for complications. These visits allow your urologist to ensure the surgery was successful and to assess any post-operative concerns, such as urinary incontinence or erectile dysfunction.
• Long-Term Care
  For men who undergo prostatectomy for cancer, long-term monitoring may include regular PSA tests to ensure cancer has not returned. Patients who have surgery for BPH will likely see a significant improvement in urinary function within a few weeks post-surgery. However, some men may experience temporary issues like urinary incontinence or erectile dysfunction, which often resolve with time and rehabilitation.

The cost of prostatectomy can vary significantly depending on factors such as the type of surgery, the surgeon’s expertise, and the hospital or clinic where the procedure is performed. Patients should understand these cost factors when planning for the procedure.

• Type of Surgery
  The cost of prostatectomy depends largely on the type of procedure being performed. Minimally invasive surgeries like TURP and HoLEP may be more affordable compared to radical prostatectomy, which involves more extensive surgery and recovery time. Robotic-assisted surgery, often used for radical prostatectomy, can also increase the cost of the procedure.
• Hospital vs. Outpatient Centers
  Where the surgery is performed can impact the overall cost. Procedures done in hospitals typically have higher fees than those performed in outpatient centers. However, the choice of facility should depend on the patient’s specific needs and the complexity of the surgery.
• Insurance Coverage
  Most health insurance plans cover prostatectomy when deemed medically necessary, especially for conditions like BPH or prostate cancer. Patients should contact their insurance provider to confirm their coverage and ask about out-of-pocket costs, such as co-pays or deductibles.
• Out-of-Pocket Expenses
  For patients without insurance, or those facing high deductibles, the cost of prostatectomy can be substantial. Some hospitals and outpatient centers offer payment plans or financing options to help make the procedure more affordable.