Patient education: Prostate removal surgery (The Basics)

What is prostate removal surgery? — Prostate removal surgery is a procedure to remove the prostate gland. It is also called "prostatectomy."

The prostate is a gland that surrounds the urethra (the tube that carries urine from the bladder out through the penis) (figure 1). Lymph nodes or tissue around the prostate might also be removed during this surgery.

The surgery can be done in different ways.

●Open surgery – During open surgery, the doctor makes a cut, or "incision," in the skin. This can be done on the lower belly or between the rectum and the scrotum. This allows the doctor to see directly inside the body when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery allows the doctor to make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

How do I prepare for prostate removal surgery? — The doctor or nurse will tell you if you need to do anything special to prepare.

After having your prostate removed, you will not be able to get a partner pregnant through sex. If you want the option of getting a partner pregnant in the future, talk to your doctor. They might suggest that you collect and store sperm before your surgery.

Before the surgery, your doctor will do an exam, including a "digital rectal exam." During a digital rectal exam, they put a gloved finger into your rectum to feel your prostate. They might send you to get tests, such as:

●Prostate-specific antigen ("PSA") and other blood tests

●Urine test

●Ultrasound – This is an imaging test. It uses sound waves to create pictures of your prostate.

●Special tests to check your bladder function

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during prostate removal surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will put a thin, flexible tube called a "catheter" into your bladder. This is to drain urine during the procedure.

●The doctor will remove all of your prostate. In some cases, they will also remove lymph nodes or other tissue.

●The doctor will close your incisions and cover them with clean bandages.

●The procedure takes about 3 to 4 hours.

What happens after prostate removal surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people stay in the hospital overnight, and others stay a bit longer.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The catheter will remain in your bladder to help drain urine. It is common for your urine to have a small amount of blood or blood clots in it. After a week or so, the doctor will remove the catheter.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of prostate removal surgery? — Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Infection – Urinary tract infection is the most common.

●Problems with ejaculation – When this happens, semen goes into the bladder instead of out through the urethra.

●Loss of fertility – "Fertility" means being able to get a partner pregnant. If you want to be able to get a partner pregnant in the future, talk to your doctor before your surgery. There are procedures that can help with this.

●Problem with urine control, which is rarely long-lasting

●Injury to the urethra, bladder, bowel, or nerves

●Need for another procedure – This could happen if symptoms do not get better or return as the prostate continues to get bigger.

●Trouble getting an erection

●Bleeding or small blood clots in urine

●Swelling in the genital area or legs (if lymph nodes were removed)

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Prostate removal surgery – Discharge instructions (The Basics)
Patient education: Benign prostatic hyperplasia (enlarged prostate) (The Basics)
Patient education: Surgery for benign prostatic hyperplasia (The Basics)
Patient education: Prostate biopsy (The Basics)
Patient education: Prostate cancer (The Basics)
Patient education: Prostate cancer screening (PSA tests) (The Basics)
Patient education: Choosing treatment for low-risk localized prostate cancer (The Basics)

Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
Patient education: Prostate cancer screening (Beyond the Basics)
Patient education: Treatment for advanced prostate cancer (Beyond the Basics)