What Is an Open Prostatectomy?
Open prostatectomy is done when the prostate gland has to be removed completely or partially. It is done to treat prostate cancer and benign prostatic hyperplasia. In this procedure, a cut is made in the lower abdominal region to access the prostate gland and the nearby structures. The surgical tools are inserted to visualize the area, and the procedure is performed accordingly. Nowadays, open prostatectomy is rarely done because there are other minimally invasive procedures available. They have good results, and the patients experience minimal surgical trauma.
What Are the Common Problems of the Prostate Gland?
There are several problems that affect the working of the prostate gland. However, not all problems require prostatectomy and can be treated by minimally invasive procedures. The common problems of the prostate gland have been described below:
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Benign Prostatic Hyperplasia - As the person grows old, the prostate gland becomes enlarged, resulting in benign prostatic hyperplasia. Though the condition is not malignant, the symptoms are similar to prostate cancer. The patient experiences restricted urine flow, urinary incontinence (leakage of urine), and nocturia (a strong urge to urinate at night).
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Prostatitis - Prostatitis is characterized by inflammation and infection of the prostate gland. Fever, pain, and a burning sensation while urinating are some of the symptoms of prostatitis.
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Prostatism - In this condition, the urine does not flow freely as the prostate gland becomes enlarged and blocks the bladder neck.
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Prostatalgia - It is characterized by pain in the prostate gland due to prostatitis.
Why Is an Open Prostatectomy Done?
Open prostatectomy aims to eliminate prostate cancer and is done when the cancerous cells remain confined to the gland. The reasons for doing an open prostatectomy are listed below:
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Urinary retention, or the inability to empty the urinary bladder.
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Continuous bleeding from the prostate gland.
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Urinary tract infections occur repeatedly.
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Presence of stones in the urinary bladder due to urine retention.
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Restricted flow of urine due to bladder obstruction by the prostate gland.
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Hydronephrosis, or the swelling of the kidneys due to retention of the urine for a prolonged period.
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Hematuria, or the presence of blood in the urine due to the enlargement of the prostate gland.
What Are the Different Methods of Prostate Surgery?
Prostatectomy, or the removal of the prostate gland, can be done by different methods. The other methods of prostate surgery have been described in the table below:
What Are Some of the Different Types of Open Prostatectomy?
Prostatectomy can be done by making a large incision manually (open prostatectomy), with the help of a robot, or by a laparoscope. The different techniques of open prostatectomy have been described below:
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Open Suprapubic Prostatectomy - It is one of the most common approaches used by doctors to treat prostate cancer. Suprapubic prostatectomy is done when cancer spreads from the prostate gland to the nearby lymph nodes. The gland is removed along with the lymph nodes to treat cancer.
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Nerve-Sparing Prostatectomy - As the name suggests, this type of prostatectomy approach deals with the nerves. Cancer might spread to nearby nerves and damage them. If the nerve bundles of both sides are cut and removed surgically, the patient will be unable to have an erection. However, if the nerves of only one side are removed, the patient can carry out an erection. Therefore, the surgery aims to save the nerves to allow the body to function normally.
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Perineal Approach - It is a procedure in which the entire gland is removed surgically by making a small incision in the perineum (area between the scrotum and anus). However, this procedure is only used when the cancer is in the initial stages and has not reached the nearby lymph nodes or the nerves.
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Robot-Assisted Prostatectomy - The surgeon sits in front of the computer screen and handles the robotic arm. Hence, the surgery is performed by a robot guided by a surgeon.
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Laparoscopic Prostatectomy - In this procedure, three to four small incisions are made in the lower abdomen to insert a small instrument. This instrument is known as a laparoscope and consists of a camera to visualize the area that needs to be operated.
How Does the Patient Prepare for an Open Prostatectomy?
Open prostatectomy is done to treat the problems of the prostate gland. The following things need to be kept in mind before the procedure:
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The doctor explains the procedure in detail and the benefits, and the side effects associated with the procedure. If the patient is willing to undergo the procedure, the patient must sign a consent form before the procedure begins.
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The patient should also inform before undergoing the procedure about the medication or herbal supplements taken by him. One should let the doctor know in case of allergies or disorders. For example, the doctor might recommend the patient stop taking drugs like Aspirin and Ibuprofen before the surgery, as they can cause excessive bleeding and other complications.
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A physical examination might be done prior to the procedure to know whether the patient is fit for the procedure or not. The doctor might order a blood test for the patient to check the general health of the body.
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The patient should not eat eight hours or a night before the surgery and only take his prescribed medications before the procedure in the morning.
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One needs to quit smoking before the procedure as it interferes with the healing.
What Happens During the Procedure?
An open prostatectomy procedure can be done by retropubic or perineal approach. The general steps of the procedure have been described below:
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First, the patient needs to remove the ornaments, clothes, and other things that might hinder the surgical procedure.
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The patient is placed in a position, and his legs are placed in the stirrups.
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The vitals like blood pressure, pulse rate, and body temperature are checked before and during the procedure.
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An intravenous line is attached to the arm of the patient.
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The site to be operated upon is cleaned with the help of an antiseptic solution.
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General anesthesia is administered to make the patient unconscious, and a breathing tube is inserted into the lungs. The tube is attached to a ventilator to allow the patient to breathe.
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If a retropubic prostatectomy is performed, an incision is made below the belly button to reach the gland.
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The lymph nodes are dissected, taking care of the nerves present near the gland and the urethra. Next, the prostate gland is removed slowly, and the drainage is inserted.
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If a perineal prostatectomy is performed, the patient is placed in a position in which the knees and hips are bent, and the legs are far apart. The feet are placed in stirrups for support.
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A U-shaped incision is made in the area between the scrotum and the anus (perineum) to remove the prostate gland and the surrounding tissues damaged due to cancer.
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A pair of glands present in the male urinary system (seminal vesicles) might be removed if they are affected by cancer.
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Finally, the incisions are closed with the help of stitches, and a catheter is placed to facilitate the drainage of urine.
What Happens After the Procedure?
After the procedure is complete, the patient is taken to the recovery room to monitor the blood pressure, pulse, and respiratory rate until they become normal. Painkillers are given to the patient orally or parenterally. Once the effect of anesthesia wears off, the patient becomes conscious, and a liquid diet is started for a few days. It is because the patient is not in a condition to have solid food. The patient needs to urinate through the catheter for one to three weeks after the surgery. As time passes, the patient will be able to carry out his normal activities. However, the following things are to be kept in mind after the surgery:
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Drink a sufficient quantity of water daily.
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Do not lift heavy objects or weights.
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Avoid exercising or bike riding for four to six weeks.
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Have a healthy and fiber-rich diet to prevent constipation.
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The semen might leave the body while urinating (retrograde ejaculation), but that happens for a few days.
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The patient must not have intercourse for two to three weeks.
The patient needs to report to the doctor immediately if the following symptoms are noted:
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Fever.
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Swelling or bleeding from the incised area.
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Presence of a large amount of blood in the urine.
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Severe pain near the incision site.
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Difficulty in passing urine after the catheter is removed.
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Constipation, or inability to pass stools.
What Are the Complications of the Procedure?
There are certain risk factors associated with every surgical procedure. The complications of open prostatectomy have been listed below:
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Urinary incontinence or the leakage of urine is commonly seen in men above 70 years of age who have undergone this procedure. It improves over time or persists in some patients.
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The patient might suffer from erectile dysfunction for a year after the surgery. However, nerve-sparing surgery has reduced the possibility, but nerves damaged during the surgery increase the risk of erectile dysfunction.
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As the connection between the testes and the urethra is lost to prostatectomy, the semen flows into the urine instead of flowing through the urethra (retrograde ejaculation). The patient might not be able to become a father in the future (infertility).
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If the lymph nodes are obstructed or removed during the surgery, swelling occurs, resulting in lymphedema. The fluid accumulates in the tissues of the legs resulting in pain and swelling.
Conclusion:
Open prostatectomy is a surgical procedure in which the prostate gland is removed to treat cancer and benign prostatic hyperplasia. The biggest concern of the patient before undergoing surgery is infertility. The solution to this problem is nerve-sparing surgery in which the nerves are preserved to prevent erectile dysfunction. The medications like Sildenafil and Avanafil, vacuum devices, and penile implants also help to resolve the problem of infertility. Therefore, the patient must not worry about the problem of infertility and consult the doctor at the earliest to learn more about the procedure.