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By Mayo Clinic staffOpen prostatectomy usually takes an hour and a half to three hours.
Before surgery, your doctor will give you a general anesthetic, which means you'll be unconscious during the procedure. Or you may receive a spinal anesthetic, which means you'll be conscious during surgery but won't feel any pain.
Your doctor will also give you an antibiotic right before surgery, to prevent infection.
During the procedure
Once the anesthetic is working, your doctor may perform a cystoscopy. A long, flexible viewing scope (cytoscope) is inserted through the tip of your penis to see inside the urethra, bladder and prostate area.
Your doctor will then insert a tube (catheter) into the tip of your penis and extend it into your bladder. The tube drains urine during the procedure. After your surgery area has been shaved and sterilized, your doctor will make a cut (incision) below your navel. Depending on what technique your doctor uses, he or she may need to make an incision through the bladder to reach the prostate. In some cases, the procedure is done with robot assistance or laporascopically. Laparoscopic surgery requires a few smaller incisions rather than a single large incision.
If you also happen to have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it. Having mesh in place from a previous hernia repair may limit the ability to use robotic or laparoscopic techniques during prostatectomy.
Once your doctor has removed the part of your prostate causing symptoms, you may have one to two temporary drain tubes inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder (suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After the surgery, your doctor will close the inside and outside of the surgery site with stitches or staples.
After the procedure
After surgery you will be watched carefully for any signs of trouble.
- Your doctor may inflate a balloon inside the area where part of your prostate was removed. This puts pressure on the surgery area to stop bleeding. To keep blood clots from forming, your will have saline solution flowing through (irrigating) the bladder.
- You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the IV is removed.
- You'll have stockings and compression devices on your legs. These help prevent blood clots.
- Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.
- You'll likely go home a few days after surgery. When your doctor thinks it's safe for you to go home, the pelvic drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.
- You'll likely return home with a catheter in place. Most men need a urinary catheter for seven to 10 days after surgery.
- The suprapubic tube is generally removed after a few days. It may be taken out before you go home from the hospital. Or you may need to keep it in place and return to the hospital or doctor's office to have it removed.
- Most men can resume sexual activity 6 to 8 weeks after surgery. After prostatectomy, you can still have an orgasm during sex, but you'll ejaculate very little or no semen.
Make sure you understand the post-surgery steps you need to take, and any restrictions.
- You'll need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks.
- You won't be able to drive for at least a few days after going home. Don't drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it's OK.
- You'll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about six weeks and then again after a few months. If you have any problems, you may need to see your doctor sooner or more often.
- Guideline on the management of benign prostatic hyperplasia (BPH). Linthicum, Md.: American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph. Accessed Jan. 27, 2011.
- Han M. Retropubic and suprapubic open prostatectomy. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/128042617-3/0/1445/92.html?tocnode=54305512&fromURL=92.html. Accessed March 25, 2011.
- Thiel DD, et al. Electroresection and open surgery. Urologic Clinics of North America. 2009;36:461.
- Matlaga BR, et al. Surgery for benign prostatic hypertrophy. In: Graham SD, et al. Glenn's Urologic Surgery. 7th ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2010:166.
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