Prostatectomy: surgery for prostate cancer and bph

One of the prostate treatments, especially prostate cancer or benign prostate hyperplasia (BPH) is prostate prostatectomy surgery. This operation is performed to remove the problematic prostate gland. How does this work? Check out the following reviews.

Overview of prostate prostatectomy surgery

Prostatectomy is a surgical procedure to remove part or all of the prostate gland due to prostate cancer or BPH (benign prostate enlargement).

This operation can be done in various ways, depending on the patient's condition. For prostate cancer, a radical prostatectomy is usually performed, while for BPH a simple prostatectomy will be performed.

Radical prostatectomy

This operation is performed as a way of treating prostate cancer by removing the entire prostate gland, seminal vesicles, and some of the surrounding tissue, including lymph nodes.

Not limited to prostate cancer, this operation can also be performed on BPH patients if the prostate has grown too large and has started to cause damage to the bladder. Here are some of the techniques used in radical prostatectomy.

1. Open radical prostatectomy

Open radical prostatectomy is an operation performed by a surgeon by making an incision to reach the prostate gland. This operation is carried out through two approaches, namely the retropubic approach, the nerve sparing approach, and the perineal approach.

Retropubic approach

This type of open prostatectomy is the most commonly performed to treat prostate cancer. In this operation, the surgeon will make an incision in the lower abdomen, from the navel to the pubic bone.

If the cancer has spread to the lymph nodes, the surgeon will also remove some of these glands. After the procedure, a catheter (small tube) is placed to help drain the urine and it will last one to two weeks as it heals.

This operation has a lower risk of nerve damage, which can lead to bladder control and erection problems.

Perineal approach

An incision in this approach is made in the perineal area, which is the area between the anus and scrotum. Prostatectomy with the perineal approach is rare because it can cause erection problems.

It's just that, the perineal approach tends to be shorter and the recovery is also faster than others. This option may be appropriate if the cancer has not spread to the lymph nodes.

Neuro-sparing approach

A nerve-sparing approach will be used if cancer cells become entangled with nerves, so that part of the affected nerve structures must be cut to remove the cancerous tissue. The risk is, men may not be able to experience an erection again afterward.

2. Laparoscopic radical prostatectomy

This operation is performed by making several small incisions in the abdomen with the help of a laparoscope (used to make a small incision in the abdominal wall) which is inserted into one of the incisions. The removal of the prostate gland in this method is done by hand.

Laparoscopic radical prostatectomy has several advantages over open radical prostatectomy. These include less pain and blood loss, shorter hospital stays, and faster recovery times.

3. Robot-assisted radical prostatectomy

This is the same as a laparoscopy, but assisted by a robotic arm. The robot helps translate the surgeon's hand movements from the remote control device (remote) into a more refined and precise action. This operation is only performed by trained specialists.

Although radical prostatectomy can remove all cancer cells, be sure to get follow-up treatment. This is done as an early detection if the cancer recurs. There are several risks that may occur in patients, namely:

• bloody urine,
• injury to the rectum,
• lymphocele (a complication of damage to the lymphatic system),
• urinary tract infection (UTI),
• erectile dysfunction (impotence),
• the occurrence of narrowing of the urethra, and
• unable to control urination (urinary incontinence).

Simple prostatectomy

This surgical process differs from radical prostatectomy in that it does not remove the entire prostate, but facilitates obstructed urine flow. Simple prostatectomy is generally recommended for men with severe urinary symptoms and an enlarged prostate gland (BPH), but not prostate cancer.

In addition, there are several other symptoms that use simple presectomy surgery, namely:

• difficulty urinating,
• urinary tract infection,
• pee slows down,
• inability to urinate,
• more frequent urination at night, and
• frequent urges to urinate.

Mayo Clinic urologists recommend that treating the symptoms of an enlarged prostate can be done using advanced endoscopic techniques (visual examination using binoculars), without open, laparoscopic, or robotic prostatectomy.

There are several risks that can occur from this procedure, including:

• there is narrowing of the urethra,
• bloody urine,
• unable to control urination (urinary incontinence),
• dry orgasm, and
• the presence of injury to adjacent structures.

What should be prepared when performing surgery?

Before surgery, the doctor may order a cystoscopy to see the condition of the urethra and bladder. Then it is also necessary to do blood tests, prostate specific antigen (PSA) tests, digital rectal tests, and biopsy.

There are several things that need to be considered and must be consulted with the doctor, such as the use of over-the-counter drugs or supplements that the patient uses or the patient's allergies, especially to the use of certain drugs.

Prior to surgery, the patient must abstain from eating or drinking for a certain period of time and perform an enema procedure (insertion of fluid into the intestine through the anus to stimulate the patient to defecate so that the intestines become clean).

What patients need to pay attention to after surgery

The treatment and abstinence that a patient must undergo can vary depending on the type of surgery and the patient's own condition. However, patients will generally be told a number of things including:

• Patients can resume activities, but gradually over four to six weeks.
• The patient cannot drive for at least a few days. Do not drive until the patient's catheter is removed or use pain medication again.
• The patient needs to see the doctor several times for check upabout six weeks and resumed after a few months.
• Patients can resume sexual activity after recovering from surgery. In simple prostatectomy, the patient can still experience orgasm during sex.
• Patients should not do sports or activities that include lifting heavy weights for at least six weeks.

Prostate surgery other than prostatectomy

Apart from prostatectomy, there are also various surgeries that can be performed to treat BPH with less risk. These procedures are minimally invasive, so the scars won't be too severe.

The procedure is namedtransurethral which is done by inserting a small tube through the urethra into the prostate to destroy or take part of the prostate tissue and launch urination.

Some of the types are transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and laser therapy.

Whatever type you choose, of course, you must also consult your doctor to consider risk factors and adjust to your circumstances.