Abdominal Prostatectomy (Removal of Prostate Gland)

What is an abdominal prostatectomy?

Abdominal prostatectomy is surgical removal of the prostate gland through a cut in the lower abdomen (belly). Other names for this procedure are simple suprapubic prostatectomy, simple retropubic prostatectomy, and radical retropubic prostatectomy.

The prostate gland is part of a man's reproductive system. It is normally a little bigger than a walnut. It is located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra. (The urethra carries urine from the bladder out through the penis.) The prostate makes the fluid that nourishes and carries sperm.

When is it used?

This surgery may be done to:

• Remove an enlarged prostate that is blocking the flow of urine.
• Treat recurrent prostate bleeding caused by an enlarged prostate.
• Treat prostate cancer.

A number of different procedures may be done to remove prostate tissue. Removal through a cut in the abdomen is usually done to treat prostate cancer because it allows total removal of the prostate gland, the ducts draining the gland, and the surrounding lymph nodes.

How do I prepare for an abdominal prostatectomy?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you take some medicines daily, ask your healthcare provider if you should take any of your medicines before surgery. If you take blood thinners, daily aspirin, or anti-inflammatories such as ibuprofen (for example, Motrin or Advil) or naproxen (Aleve), ask your provider if you need to stop them before surgery. If you do need to stop taking your medicines, ask your provider when you can start taking them again. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Antibiotics may be prescribed for a few days before and after surgery to help prevent infection.

Follow any other instructions your healthcare provider may give you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

Your provider may give you a laxative to take the night before the surgery or an enema the morning before the surgery.

What happens during the surgery?

You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and keeps you from feeling pain.

An IV will be put in your arm to give you fluids and medicine.

Once you are numb, your healthcare provider will make a cut in the lower abdomen. Your provider will then remove the prostate. He or she may also remove the ducts draining the gland and the surrounding lymph nodes if the surgery is treatment for prostate cancer. The cut in your abdomen will then be sewn closed.

The surgery usually takes 2 or 3 hours.

What happens after the procedure?

How long you will need to stay in the hospital will depend on many factors. Often the hospital stay is for 2 to 3 days after the operation. You will have a catheter (tube) in your bladder to drain urine and flush out any blood clots after surgery. You may go home with the catheter. Your healthcare provider will remove the catheter later, after the bleeding stops and when you are able to urinate on your own.

While recovering from surgery, you may have trouble controlling your bladder. You may notice blood in your urine or have trouble urinating. These symptoms usually go away as you heal. If they do not get better, call your healthcare provider.

Drink a lot of water and for 4 to 6 weeks avoid activities that put strain on your abdomen, such as straining to have a bowel movement or heavy lifting.

Ask your provider how to care for yourself, when you can go back to work, and when you should come back for a checkup.

What are the benefits of this procedure?

The benefits depend on the reason for the surgery.

• If you had an enlarged prostate, blockage and incomplete emptying of the bladder caused by the enlarged prostate will be relieved. You will have less discomfort and will be able to urinate more easily.
• It will stop prostate bleeding.
• The tissue that was removed can be checked for cancer.
• If you had cancer, the cancerous growth will be removed.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• Your bladder could be damaged or become infected. If this causes a lot of discomfort, you may not be able to pass urine.
• The muscle around your urethra may be permanently damaged. This could make it hard to control your urine.
• A scar may form around the urethra and make it narrow. In the future, you may need to have your urethra stretched to widen the passageway.
• Your ability to have an erection may be affected. Also, when you have an orgasm, semen may not come out of your penis. Instead it may flow backward into your bladder (retrograde ejaculation). This is a problem only in that it may lessen the sensation of orgasm and lessen the chance of pregnancy, if that is desired.
• You may become sterile (unable to father a child).

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

After surgery, follow your provider’s instructions for taking care of yourself. If you have not been given specific instructions about when to call your provider, here are some guidelines:

Call your provider right away if:

• You are bleeding a lot or passing blood clots.
• You have a fever of 100°F (37.8°C) or higher.
• You cannot use the catheter you were given.
• You have blood in your urine.
• You have a weak flow of urine or you are leaking urine.
• You are urinating more than usual.
• You have pain or burning when you urinate.
• You cannot pass urine.
• You have swelling in your scrotum or groin.
• You have abdominal pain.
• You have signs of infection around your surgical wound. These include:
  • The area around the wound is redder or more painful.
  • The wound area is very warm to touch.
  • You have blood, pus, or other fluid coming from the wound area.
  • You have chills, nausea, vomiting, or muscle aches.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.