Open prostatectomy

Open prostatectomy is usually done in men who have a greatly enlarged prostate gland, bladder damage or other complicating factors, such as bladder stones or urethral narrowings (strictures). It accounts for very few prostate operations for BPH in the United States, though it's performed more often in other countries.

It's called open because your surgeon makes an incision in your lower abdomen to reach the prostate rather than going up through your urethra. Only the inner part of your gland is removed. The outer portion is left intact, almost identical to TURP.

What to expect. The procedure is done under general or spinal anesthesia and requires a three- to five-day hospital stay. You'll need a catheter for at least three to seven days afterward. It may take a couple of weeks to several months to recover from surgery, depending on the exact surgical approach. Most men can return to sedentary work in two or three weeks and vigorous physical labor and sexual activity in about six weeks.

Who it works best for. Open prostatectomy is often the most effective surgery for men with extreme prostate enlargement.

Outcome. Nearly all men who have this procedure experience significant symptom relief. Symptom scores drop 14 to 20 points.

Side effects. Side effects are as common as those with TURP, or more so. Urinary incontinence, erection problems and retrograde ejaculation occur in some men.

Need for re-treatment. The need for future medical treatment is rare.