Prostate surgery is performed using several different techniques depending on whether the goal is to remove the entire gland (for cancer) or to trim away tissue that blocks urine flow (for an enlarged prostate). The most common approaches today are robotic-assisted surgery, transurethral resection, laser procedures, and open surgery. Each one enters the body differently and uses different tools, but they all target the same walnut-sized gland sitting just below the bladder.
Robotic-Assisted Prostatectomy
This is the most widely used method for removing the entire prostate gland, typically for cancer treatment. The surgeon sits at a console a few feet from the operating table and controls robotic arms that hold tiny instruments and a high-definition camera. Six small incisions (each roughly the width of a pencil) are made in the abdomen, positioned using the belly button, hip bones, and pubic bone as landmarks.
Once inside, the surgeon works through a specific sequence. The seminal vesicles and surrounding structures are isolated first, which is a critical step for preserving the nerve bundles that run along the sides of the prostate. These nerves control erections, so how aggressively the surgeon can spare them depends on where the cancer is located and how far it has spread. Nerve-sparing can range from maximum preservation, where dissection stays as close to the prostate capsule as possible, to no preservation at all if cancer has reached the outer edge of the gland.
After the prostate is freed from surrounding tissue, the surgeon cuts through the blood vessels at the top and the urethra at the bottom, fully detaching the gland. The final step is reconnecting the bladder directly to the remaining urethra using stitches placed through the robotic arms. This reconnection is one of the most delicate parts of the operation and directly affects how well urinary control recovers afterward.
Transurethral Resection (TURP)
TURP is the classic procedure for an enlarged prostate that’s squeezing the urethra and making it hard to urinate. Unlike robotic surgery, TURP doesn’t involve any external incisions. Instead, a combined visual and surgical instrument called a resectoscope is inserted through the tip of the penis and guided up through the urethra until it reaches the prostate.
At the end of the resectoscope is a small electrical loop. The surgeon uses this loop to shave away excess prostate tissue from the inside, one small piece at a time, widening the channel through which urine flows. As tissue is cut, the instrument releases fluid that carries the pieces back into the bladder. At the end of the procedure, all the tissue fragments are flushed out and collected. The entire prostate stays in place; only the obstructing inner tissue is removed.
Laser Procedures
Laser surgery treats an enlarged prostate in one of two ways: vaporization or enucleation. Both are performed through the urethra with no external cuts, similar to TURP, but they use focused light energy instead of an electrical loop.
Vaporization uses a high-powered laser to essentially evaporate obstructing tissue on contact. It’s effective for smaller prostates, but the tissue is destroyed rather than collected, so there’s nothing to send to a lab for analysis. For larger prostates, retreatment rates can be significant. One review found that vaporization had a retreatment rate of about 27%, and it’s generally considered less effective for high-volume glands.
Enucleation takes a different approach. A holmium laser is used to peel the inner core of the prostate away from its outer shell, almost like scooping the fruit out of an avocado. The removed tissue is then pushed into the bladder, broken into smaller pieces with a separate instrument, and suctioned out. This method produces durable results, with a reoperation rate of less than 1% over a patient’s lifetime. It also tends to produce better symptom scores, stronger urine flow, and fewer complications than vaporization. The tradeoff is that enucleation requires more specialized surgical skill and isn’t available at every hospital.
Open Surgery
Open prostatectomy involves a single larger incision in the lower abdomen. For cancer, this gives the surgeon direct access to remove the entire gland along with surrounding lymph nodes if needed. For a very large enlarged prostate, the surgeon can reach in and shell out the obstructing tissue by hand.
This approach has largely been replaced by robotic surgery at major medical centers. Compared to open surgery, robotic techniques result in less blood loss, less pain, a shorter hospital stay, and faster recovery. Open surgery is still performed when robotic equipment isn’t available, when the prostate is exceptionally large, or when a patient’s anatomy makes minimally invasive access difficult.
What Happens Before Surgery
In the weeks before your procedure, expect a series of tests to confirm you’re healthy enough for anesthesia and recovery. These typically include blood work to check kidney function and general health, an ECG to evaluate your heart, lung function tests, and possibly a chest X-ray. Some hospitals send a questionnaire in advance asking about your medical history and current medications. Certain blood thinners and supplements will need to be stopped ahead of time, and your surgical team will give you specific instructions on when to stop eating and drinking before the procedure.
Recovery After Prostate Surgery
For robotic or laparoscopic prostatectomy, most people go home one to two days after the operation. You’ll leave the hospital with a urinary catheter in place because the reconnection point between your bladder and urethra needs time to heal. The standard duration for this catheter is about seven days, though some surgeons remove it as early as three to four days after surgery if healing looks good on imaging. Expect the catheter to feel uncomfortable but manageable.
Full recovery to your normal routine generally takes about four to six weeks. The first two weeks typically involve limited activity, no heavy lifting, and gradually increasing the distance you walk each day. Recovery from TURP and laser procedures is faster since no external incisions are made, with most people returning to normal activities within two to three weeks.
Urinary Control and Sexual Function
These are the two side effects that concern most men, and the numbers are more encouraging than many people expect. After radical prostatectomy for cancer, more than 95% of patients regain urinary continence within a few months. Leaking is common in the first weeks after the catheter comes out, and pelvic floor exercises (Kegels) before and after surgery can speed recovery.
Erectile function takes longer to return and depends heavily on whether the nerves alongside the prostate were spared during surgery. Among men who had nerve-sparing procedures, about 40 to 50% return to their pre-surgery erectile function within one year, and 30 to 60% by two years. These ranges reflect the reality that age, pre-existing function, and the extent of nerve preservation all play a role. About 75% of men who undergo nerve-sparing surgery report achieving erections with the help of oral medications. Recovery of erections is a gradual process, and most specialists recommend starting medication early after surgery to promote blood flow and healing in the nerve tissue.
For TURP and laser procedures targeting an enlarged prostate, erectile dysfunction is much less common since the nerves aren’t typically disturbed. The more frequent side effect is retrograde ejaculation, where semen flows backward into the bladder during orgasm instead of exiting through the penis. This is harmless but permanent in most cases, and it’s worth understanding before you agree to the procedure.