Prostate surgery or prostatectomy is a surgical procedure to remove part or all of the prostate gland, which is a gland owned by men. Sometimes also done rapture network other around the prostate gland. This gland is located under the bladder in men, and functions to produce semen.
There are two main techniques in abdominal prostate surgery, namely:
- radical prostatectomy, is a procedure to remove the entire prostate gland tissue along with the tissue around the gland. Radical prostatectomy is generally performed to treat prostate cancer. This procedure can be performed openly through a wide incision in the skin, or assisted by a laparoscope (laparoscopic prostatectomy) through smaller incisions in the skin.
- simple prostatectomy, is a procedure to remove part of the prostate gland without removing the entire prostate tissue and surrounding tissue. A simple prostatectomy is generally performed to treat an enlarged prostate gland.
In addition to the stomach, prostate surgery can also be done through the hole and the urinary tract by cutting a small part of the prostate gland that blocks the urinary tract. This method is known as transurethral resection of the prostate (TURP) or transurethral incision of the prostate (TUIP). Both are done by cutting the part of the prostate gland that clogs the urinary tract, then the pieces will come out together with urine when the patient urinates.
Prostate Surgery Indications
Prostate surgery is performed as a treatment for prostate cancer, in addition to chemotherapy, radiotherapy, or hormone therapy. In addition, this procedure can also be done to treat the symptoms of an enlarged prostate (Benign prostatic hyperplasia/BPH). BPH can block the flow of urine and cause complications in sufferers.
Symptoms that indicate that a person may need treatment through prostate surgery are:
- Frequent urge to urinate (void).
- Feeling difficult at the beginning of urination.
- Urination with a long duration, and the flow of urine is slow or sluggish.
- Cannot urinate at all.
- Have a urinary tract infection.
- Increased frequency of urge to urinate at nightnocturia).
- Feeling of incomplete urination after completion.
Prostate Surgery Warning
Prostate surgery in general has no special conditions that prevent patients from having this surgery at all. However, especially for prostate cancer patients, patients are not recommended to undergo a simple prostatectomy. Patients with prostate cancer are required to undergo a biopsy examination first in order to determine the prostate surgery technique that will be undertaken. In addition, if the patient is taking blood thinning drugs, such as warfarin or clopidogrel, or if he has a blood clotting disorder, it is advisable to inform the doctor to prevent heavy bleeding during surgery.
Prostate Surgery Preparation
Before undergoing prostate surgery, the patient will first undergo a cystoscopy procedure. Cystoscopy is done to check the condition of the prostate gland and urinary tract visually. Patients may also undergo other tests, such as blood tests, urine flow tests, and prostate size checks. To prevent infection of the surgical wound, the patient will be given antibiotics by the doctor a few days before undergoing surgery.
Apart from that, some other things that are included in the preparation for prostate surgery are:
- The doctor will ask the patient about any medications he is currently taking, especially blood thinners and pain relievers, such as aspirin and ibuprofen. If you are taking one of the two types of drugs, the doctor will ask the patient to stop it before undergoing prostate surgery.
- The patient will be given laxatives to clear the digestive tract, and will be asked to fast for a few hours before undergoing surgery.
- Patients who have allergies to certain drugs, should notify the doctor.
- Patients are asked to leave jewelry, dentures, contact lenses, and glasses at home before undergoing the surgical procedure.
- Patients should be accompanied by their families before and after undergoing surgery, including for pick-up purposes. Generally, patients can go home immediately after the operation is finished and do not require hospitalization.
Prostate Surgery Procedure
Prostate surgery is usually performed while the patient is unconscious due to general anesthesia (general anaesthesia). In some cases, the patient is only given a half-body anesthetic so that he remains conscious during the operation, but does not feel anything. The patient will also be placed on a urinary catheter to drain urine from the bladder without going through the urinary tract, during surgery.
Patients undergoing open prostatectomy will begin by making a skin incision, either in the front of the prostate (retropubic) or at the back of the prostate (perineal). A skin incision in open retropubic prostatectomy is made from below the navel to near the pubic bone. While the skin incision in the perineal open prostatectomy is made from near the anus to the area near the scrotum. After the skin incision is opened, the urologist will remove the patient's prostate gland. If needed, along with surrounding tissue, such as lymph nodes. After the removal of the prostate gland is complete, the skin incision is closed again using stitches.
Meanwhile, laparoscopic prostatectomy is performed using incisions as big as a keyhole, but there are more than one. A skin incision in a laparoscopic prostatectomy is made in the abdominal area to insert a special surgical instrument (laparoscope) into the area near the prostate with the help of a camera at the end of the laparoscope. When the laparoscope reaches the prostate gland, the doctor then cuts and removes the prostate gland using the laparoscope. In hospitals that have implemented more sophisticated technology, laparoscopic prostatectomy can be assisted with robotic technology to facilitate the removal of the prostate gland.
To reduce blockage in the urinary tract, especially for patients with enlarged prostate (BPH), prostate surgery can be performed without going through an incision in the abdominal wall, but through the urethra and urinary tract. These operations include:
- prostate surgery with This procedure aims to cut an enlarged prostate gland using a laser. A laser device in the form of a long tube will be inserted through the urinary opening until it reaches the prostate gland. When it reaches the prostate gland area, the laser is then activated to cut the prostate gland. The cut prostate tissue will be excreted in the urine.
- TURP. Transurethral Resection of the Prostate (TURP) is performed using special sterile sutures.
- TUIP.TUIP or Transurethral Incision of the Prostate This is done using a special surgical instrument that cuts the prostate gland into several parts at the site of the narrowing of the urinary tract.
Patients who undergo prostate surgery with incisions in the skin, will be stitched back to close the incision wound. The suture area is then covered with a sterile bandage to prevent infection, and a catheter will remain in place to drain urine during the recovery period.
After Prostate Surgery
After undergoing prostate surgery, patients may experience the following:
- Pain in the surgical suture area.
- The appearance of blood in the urine.
- Difficulty holding urine at the time of urination.
- Pain when urinating.
Patients who have undergone prostate surgery will be given painkillers. Painkillers will first be given in the form of intravenous fluids, and will be changed to oral drugs in the following days. The patient will remain in the catheter to assist urination for several days, at least 5-10 days after surgery. The doctor will advise the patient to take light walks to help with postoperative recovery. If the condition is considered good enough, the patient will be allowed to go home. If not, the patient will undergo treatment for several days in the hospital.
Keep in mind that the patient must be picked up from the hospital by a family member after the operation. During the recovery period, the patient will be asked not to do strenuous physical activity, and to increase his physical activity gradually. The doctor will also schedule a repeat check-up during the recovery period and will tell the patient when they can return to normal sexual activity.
Prostate Surgery Risks
Regardless of the various prostate surgery techniques performed, the risks that can occur to the patient include:
- Allergic reaction to anesthetics.
- Surgical wound infection.
- Blood clots.
- Bleeding.
- Damage to organs near the prostate gland.
- Urinary tract infection.
- Urinary incontinence.
- Not reaching orgasm during sexual intercourse.
- Urethral stricture.
- Impotence.
- The formation of cysts in the lymph nodes near the prostate gland.
Patients undergoing prostate gland surgery are often unable to get an erection for several weeks after surgery. In some cases, prolonged impotence can be caused by damage to the nerves that regulate erections.