A prostatectomy is the surgical removal of the prostate gland found in all males. This procedure is usually performed by an urologist for a variety of reasons, most commonly due to the enlargement of the gland or the growth of a prostatic tumor. The procedure can be done a variety of ways such as the open technique, transurethral approach, or even with robotic assistance.
Open Prostatectomy
Open prostatectomy is the removal of part or all of the prostate gland via a classical surgical incision. Reasons for utilizing the open procedure include weight of the tissue removed exceeding 75 grams, or if associated medical issues such as an orthopedic condition (which can limit positioning for the other techniques), hernias, or urethral issues (which can also complicate the other procedures) are present. Advantages include lower re-treatment rates, and more complete removal of the tissue as it is directly visualized in the open procedure. Disadvantages include longer hospitalization plus recovery times, and increased risk for bleeding.
Transurethral Resection of the Prostate
Transurethral resection of the prostate (TURP) is the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), which is an enlargement of the prostate. It utilizes a scope that is passed from the urethra back into the prostate where the surrounding enlarged tissue is excised. Common indications include bladder outlet obstruction and irritability that influence the patient's quality of life. Advantages include decreased risk of bleeding, symptom relief that exceeded more invasive procedures, and decreased mortality. Disadvantages include TURP syndrome (characterized by decreased heart rate, confusion, vomiting, and visual disturbances), impotence, and urinary incontinence.
Robot Assisted Prostatectomy
Also known as laparoscopic prostatectomy, this technique utilizes robotic devices to allow the surgeon to operate, suture and dissect with the facility of a human wrist despite not being in direct contact with the patient. It also offers a unique three-dimensional view of the anatomy that is often a problem with traditional laparoscopic techniques. Advantages include minimal blood loss, early hospital discharge, and possible decreases in postoperative urinary incontinence and impotence (dependent on skill of the surgeon). Disadvantages include rectal injury, urinary retention, and occasional conversion to the open technique (rare once surgical experience is attained).
References
- "Campbell-Walsh Urology, 9th Edition"; Wein; 2007
- "Urology"; Laparoscopic radical prostatectomy: Preliminary results; Abou, CC et al. Volume 55, 2000
