When your doctor tells you that you need to have surgery to remove your prostate gland because of cancer or another problem, it's normal to feel a little scared and anxious. "Is this a major operation?", "What will happen to me?", "What will my life be like after the surgery?" You may have many questions coming to mind. So today, let's talk about prostatectomy, or prostate removal surgery, in a very simple way that you can understand.
First, let's see, what is the prostate gland?
Simply put, the prostate is a small gland that is found only in men. It's about the size of a walnut, to be exact. It's located just below your bladder. The urethra, the tube that carries urine and semen out of your body, runs through the middle of this gland.
The main function of this gland is to add a fluid to the ejaculate. This fluid nourishes the sperm and helps them travel safely. So this is an important part of the male reproductive system.
What are the main types of prostatectomy surgery?
This surgery can be divided into two main types. The doctor will choose the most suitable method for you based on your medical condition.
1. Simple Prostatectomy
Think of it like an orange. The orange has a pulp inside and a peel outside. The prostate gland is a bit like that. It has an inner part and an outer covering (capsule). Normally, this inner part gets bigger as you get older.
In a simple prostatectomy, the surgeon removes only the inner part of the prostate gland, much like removing the core of an orange. The outer covering remains intact. This surgery is often performed for non-cancerous conditions, such as Benign Prostatic Hyperplasia (BPH), where the prostate gland becomes enlarged and obstructs urination.
2. Radical Prostatectomy
In this, as the name suggests, the entire prostate gland is removed. Some of the surrounding tissue, the seminal vesicles, and sometimes lymph nodes may also be removed. Then, the surgeon reconnects your urethra to your bladder. This surgery is most commonly used for prostate cancer .
The important thing is that both of these surgeries can now be performed as "Open Surgery" as well as the more modern, "Keyhole Surgery" (Laparoscopic/Robotic Surgery) .
| Surgical method | Description |
|---|---|
| Open Surgery | The surgery is performed by making a vertical incision several inches long in the lower abdomen. The doctor can see the gland and the surrounding area clearly. |
| Laparoscopic/Robotic Surgery | The surgery is performed by making several small incisions (like keyholes) in the abdomen, through one of which a camera (laparoscope) and fine instruments are inserted. When robotic technology is used, the doctor controls the robotic arm to perform the surgery with great precision and accuracy. The incisions are small, so there is less pain and less recovery time. |
How do you prepare before surgery?
After the surgery date is set, you will need to see the doctor. Your health will be checked.
- Tell your doctor about all the medications you are taking (prescription, over-the-counter, Ayurvedic, herbal). You may be asked to stop taking aspirin and blood thinners a few days before your surgery. Never stop taking any medication without first asking your doctor.
- Tell us about your allergies: Be sure to tell us about any allergies you have (medicines, iodine, plasters, foods).
- Fasting: You will be advised not to eat or drink anything after midnight the night before the surgery. If you must take medication, you may only be able to take it with a sip of water.
What happens after the surgery?
The surgery usually takes about two to four hours. After the surgery, you will be taken to a recovery room. You will feel a little sluggish after you regain consciousness.
- Pain: Robotic surgery is less painful than open surgery. However, you will be given painkillers to help manage the pain.
- Catheter: Almost everyone has a catheter inserted after surgery. This helps to drain urine until the bladder heals. This may be left in place for 2-3 days for a simple prostatectomy, and for 10-14 days for a radical prostatectomy.
- Food: Only liquid food is given for the first day or two. Then, gradually introduce regular food.
- Walking: You will be encouraged to get out of bed and walk around a bit from the day after surgery. Walking improves blood circulation and helps you heal faster.
- Hospital stay: A day or two for robotic surgery, three to four days for open surgery.
Risks of surgery and changes in life
As with any surgery, there are some risks. But remember, when it comes to something like prostate cancer, the benefits of surgery outweigh the risks of not having treatment.
| Possible risks of prostatectomy surgery | |
|---|---|
| General surgery risks | |
| |
| Risks specific to prostatectomy surgery | |
| Incontinence | Involuntary leakage of urine when coughing, sneezing, or exercising. For most people, this will return to normal within a few weeks or months. |
| Erectile dysfunction | Surgery can damage the nerves that control sexual arousal. This condition may gradually improve over a few months. There are treatments (e.g., PDE-5 inhibitor drugs - Viagra®, Cialis®) for this. |
| Dry Orgasm | After the prostate gland is removed, ejaculation does not occur during orgasm, but the ability to orgasm and sensation remain normal. |
These side effects may scare you. But remember, they don't happen to everyone. For most people, these conditions get better over time. And your doctor can talk to you about treatments and exercises that can help with these problems.
When should I see the doctor again?
You will be given follow-up clinic dates. Be sure to go to those dates. Also, if you experience the following symptoms , call your doctor immediately or go to the hospital's Emergency Treatment Unit (ETU).
- Excessive bleeding or discolored fluid oozing from the incision.
- A fever of 38 Celsius (100 Fahrenheit) or higher.
- Signs of infection around the incision (swelling, redness, severe pain, odor).
- Unbearable pain.
If the prostate gland was removed due to cancer, a blood test called PSA (Prostate-specific antigen) will need to be done periodically to see if the cancer has returned.
Take-Home Message
- Prostatectomy is a successful treatment for conditions such as prostate cancer and BPH.
- Surgeries performed with modern robotic technology result in less pain and shorter recovery time.
- Problems with urinary control and urination may occur after surgery, but most of them resolve with time or can be managed with treatment.
- If you have any questions, fears, or doubts about the surgery, feel free to discuss them with your doctor. He or she will explain everything to you.
- You are not alone. Doctors, nursing staff, and your family are with you to support you on this journey.
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