A simple prostatectomy is a surgical procedure designed to alleviate urinary symptoms caused by an enlarged prostate gland. This operation involves the removal of only the inner portion of the prostate, which is responsible for obstructing the urethra. By carefully excising this overgrown tissue, the procedure aims to restore a more normal flow of urine and improve overall urinary function.
Conditions Treated by the Procedure
The primary medical condition that necessitates a simple prostatectomy is severe Benign Prostatic Hyperplasia (BPH). BPH describes a non-cancerous enlargement of the prostate gland, which commonly occurs as men age. This enlargement can compress the urethra, leading to various urinary symptoms.
Symptoms that may lead a doctor to recommend surgery over medication include difficulty urinating, a slow or interrupted urine stream, and the frequent sensation of needing to urinate, especially at night. More severe indicators for surgery can involve complete urinary retention or recurrent urinary tract infections. The procedure may also be considered for complications such as bladder stones or kidney problems.
The Surgical Process
During a simple prostatectomy, surgeons remove only the overgrown inner core of the prostate, similar to scooping out the pulp of an orange while leaving the peel intact. The outer capsule of the prostate gland remains in place. This approach helps to preserve the nerves responsible for erectile function and continence.
The procedure can be performed using several techniques. Open surgery involves a larger incision in the lower abdomen and is often used for very large prostates or in cases with other complications. Laparoscopic surgery uses several small incisions, through which a camera and specialized instruments are inserted. Robotic-assisted surgery is a laparoscopic approach where a surgeon controls robotic arms from a console, offering enhanced precision and visualization.
It is important to understand that a simple prostatectomy differs significantly from a radical prostatectomy. A simple prostatectomy treats benign conditions like BPH by removing only a part of the prostate. In contrast, a radical prostatectomy involves the removal of the entire prostate gland, seminal vesicles, and sometimes nearby lymph nodes, and is primarily performed as a treatment for prostate cancer.
The Recovery Period
Following a simple prostatectomy, patients typically stay in the hospital for one to two days. Walking is encouraged to help prevent blood clots and aid recovery. Pain medication is usually provided to manage any discomfort.
A urinary catheter is placed during surgery and remains in the bladder to drain urine, allowing the surgical area to heal. This catheter is usually kept in place for approximately 7 to 14 days. Patients typically return to the doctor’s office for catheter removal.
At home, physical activity restrictions are common for several weeks. Patients are advised to avoid strenuous activities and heavy lifting for at least one month. Driving can usually resume once the catheter is removed and the patient is no longer taking narcotic pain medication. Most individuals can return to work within two to four weeks, depending on the nature of their job and their recovery.
Potential Post-Surgical Changes
After a simple prostatectomy, patients may experience long-term changes. The most common outcome is retrograde ejaculation, also known as a dry orgasm. This occurs because the internal bladder neck, which normally closes during ejaculation to direct semen forward, may be altered by the surgery, causing semen to flow backward into the bladder. While not harmful, this condition affects fertility.
Less common, but possible, changes include stress incontinence, which is the involuntary leakage of urine during physical activities like coughing or laughing. This often improves over several weeks or months as the body heals. Shifts in erectile function can also occur, though many men who had normal erectile function before surgery will retain it. Full recovery of sexual function, if affected, can take several months to over a year after the procedure.