How is prostate surgery performed? Learn about the main procedures and potential risks
Prostate surgery is a procedure often necessary in cases such as prostate cancer or benign prostatic hyperplasia (BPH).
These conditions can affect the normal functioning of the gland, leading the physician to recommend surgical intervention. For those who receive this recommendation, it’s common to wonder: how is prostate surgery performed?
There are different techniques used for this type of procedure, varying according to the patient’s condition and case complexity. The main goal is to remove part or all of the prostate, depending on the diagnosis, with minimal impact on the patient’s health.
Keep reading and find out everything you need to know: how is prostate surgery performed, when it may be indicated, and the possible risks.
When is prostate surgery recommended?
Prostate surgery is advised in specific cases where medication or less invasive treatments are not enough to improve the patient’s quality of life.
The indication for the procedure depends on the type of prostate problem and the severity of the symptoms. When the condition progresses, or conventional treatments do not yield satisfactory results, surgery may be the best option.
The main cases in which prostate surgery is indicated are:
- Prostate cancer: when cancer is diagnosed at a stage where prostate removal may prevent the disease from spreading. Symptoms include difficulty urinating, blood in the urine (hematuria), and pelvic pain.
- Benign prostatic hyperplasia (BPH): the prostate enlarges in a noncancerous way, making urination difficult. Common symptoms include difficulty initiating urination, a weak urine flow, and feeling that the bladder is not fully empty.
- Recurrent infections (prostatitis): in cases of chronic or recurrent infections that do not improve with medication, surgery may be recommended. Symptoms include painful urination, urgent need to urinate, and pelvic discomfort.
- Severe urinary flow blockage: if the enlarged prostate completely blocks the flow of urine, causing urinary retention, surgery may be necessary to relieve the obstruction.
- Bladder tumors: when tumors affect the bladder and are close to the prostate, removal may be required as part of the treatment. Symptoms include painful urination, blood in the urine, and frequent need to urinate.
- Rectal tumors: in cases of rectal cancer that affect or press on the prostate, removal may be indicated to control the disease’s progression. Symptoms may include painful bowel movements and blood in the stool.
How is prostate surgery performed?
Different pelvic surgeries can be performed to treat prostate conditions, each with a specific purpose, depending on the patient’s diagnosis.
Techniques have evolved over the years, allowing less invasive interventions that may facilitate recovery in certain cases. Below, learn about the main types of prostate surgery for enlarged prostate and how each is performed.
1. Open prostatectomy
Open prostatectomy is one of the most traditional procedures, indicated for more severe cases of prostate cancer or significant enlargement. The surgery removes the gland along with the seminal vesicles, located above the prostate, between the bladder and the rectum.
Preparation
- Preoperative fasting;
- Blood and imaging tests;
- Guidance on anticoagulant medications;
How the surgery is performed
The prostate is removed through an abdominal or perineal incision. The surgeon directly accesses the gland and removes all or part of the prostate.
Benefits and distinguishing features
- Complete removal of the prostate in advanced cancer cases.
- Provides a direct and broad view for the surgeon.
Risks
- Longer recovery time.
- Higher risk of complications, such as infections and bleeding.
- Possibility of erectile dysfunction and urinary incontinence.
2. Robotic surgery
Robotic surgery is an advanced technique that uses a robotic system controlled by a surgeon, providing greater precision.
Preparation
- Preoperative fasting.
- Blood and imaging tests.
- Guidance on anticoagulant medications.
How the surgery is performed
Small incisions are made in the abdomen to insert instruments controlled by the robot. The surgeon operates remotely with the help of a console, precisely removing the prostate.
Benefits and distinguishing features
- Less blood loss.
- Faster recovery.
- Less pain and smaller scars.
Risks
- Requires advanced technology, available only in specialized centers.
- Possibility of erectile dysfunction and urinary incontinence, though less common.
3. Laser surgery
Laser therapy is mainly indicated for the treatment of benign prostatic hyperplasia (BPH). This procedure is considered one of the least invasive.
Preparation
- Preoperative fasting.
- Imaging and urine tests.
- Medication guidance.
- How the surgery is performed
A laser is inserted through the urethra and used to remove prostate tissue blocking the urinary flow.
Benefits and distinguishing features
- Shorter recovery time.
- Lower risk of bleeding.
- Procedure performed without incisions.
Risks
- Temporary discomfort when urinating.
- Possible need for another procedure in the future.
4. Laparoscopic surgery
Laparoscopic surgery uses small incisions and thin instruments to remove the prostate.
Preparation
- Preoperative fasting.
- Imaging and blood tests.
- Guidance on anticoagulant medications.
How the surgery is performed
Small incisions are made in the abdomen through which instruments are inserted to remove the prostate.
Benefits and distinguishing features
- Shorter hospital stay.
- Faster recovery than open prostatectomy.
- Fewer scars.
Risks
- Risk of infection and bleeding.
- Possibility of erectile dysfunction and urinary incontinence.
5. Transurethral resection of the prostate (TURP)
TURP is one of the most common techniques to treat benign enlargement of the prostate (BPH). It is an endoscopic surgery specifically aimed at removing prostate tissue.
Preparation
- Preoperative fasting.
- Imaging and urine tests.
- Discontinuation of certain medications.
How the surgery is performed
An instrument is inserted through the urethra to remove excess prostate tissue that blocks urinary flow.
Benefits/Distinguishing features
- No external incisions.
- Quick recovery.
Risks
- Temporary urinary infections.
- Urinary retention in the postoperative period.
- Possible retrograde ejaculation.
6. Stent placement
Stents are small tubes used to keep urinary flow unobstructed when the prostate blockage cannot be surgically removed.
Preparation
- Imaging tests to assess the extent of the blockage.
- Guidance on stent insertion.
How the surgery is performed
The stent is inserted into the urethra, expanding the area narrowed by the enlarged prostate.
Benefits and distinguishing features
- Minimally invasive procedure.
- Quick solution for symptom relief.
Risks
- Temporary discomfort.
- Possible infection or stent displacement.
7. Endoscopic surgery
Endoscopic surgery is used to treat various prostate conditions, being a minimally invasive approach.
Preparation
- Preoperative fasting.
- Imaging and urine tests.
- Medication guidance.
How the surgery is performed
An endoscope is inserted through the urethra to remove or treat prostate tissue.
Benefits and distinguishing features
- Quick and effective procedure.
- Shorter recovery time.
- No external scars.
Risks
- Possible urinary infection.
- Risk of urethral damage.
Care for men with a penile prosthesis
Men who already have a penile implant, whether malleable or inflatable, require a different set of care. However, it is possible to perform radical prostatectomy surgery.
Preoperative
The surgeon must always be informed about the presence of the prosthesis. This allows strategies that protect the prosthesis while targeting the prostate.
Intraoperative
The main concern is with the inflatable prosthesis, which has a reservoir next to the bladder, close to the gland. The surgeon should inflate the prosthesis so that the reservoir decreases in size during surgery, preventing it from hindering the surgeon’s work during open, robotic, or laparoscopic procedures.
In the case of transurethral surgery in men with a penile prosthesis, a different access route, such as the perineum, may be considered so the instrument can reach the gland and unblock the channel.
Postoperative
The use of catheters, common in prostate surgeries, may cause erosion of the prosthesis. Proper catheter positioning is crucial so the patient does not risk losing the implant.
For the inflatable prosthesis, the mechanism should not be activated for some time.
Post-prostate surgery care
After prostate surgery, it is essential to follow a series of care measures to ensure good recovery and prevent complications. The postoperative period may vary according to the type of surgery performed, but some universal measures help the patient recover more quickly and efficiently.
Rest
Rest is crucial in the first days after surgery. In cases of cancer, removal may be vital to saving lives, and while side effects can be challenging, they can be managed as needed.
Avoid physical exertion, such as lifting weights or making sudden movements, allowing the body to heal properly. However, walking moderately at home is recommended to prevent circulatory problems like thrombosis.
Hydration and diet
Drinking plenty of water is important for the proper functioning of the urinary system and for preventing infections. Keeping the urine fluid helps reduce the risk of urinary tract infections.
Also, choosing a light and balanced diet facilitates recovery. Foods rich in fiber are recommended to prevent constipation, which can cause postoperative discomfort.
Catheter care
In some cases, the patient may leave surgery with a catheter to help drain urine. It is essential to follow medical guidelines on cleaning and maintaining the catheter to avoid infections. Keep the area clean and dry, and watch for unexpected bleeding or leakage.
Medication use
Strictly follow the medical prescription regarding medications. Analgesics, antibiotics, or other drugs prescribed by the doctor should be taken at the correct times to prevent complications such as infections and pain.
Attention to signs of infection
Redness, fever, intense pain, or abnormal discharge may indicate an infection. If any of these symptoms occur, contact the doctor immediately to assess the need for interventions.
Gradual return to activities
Return to physical activities and daily routines should be gradual and always with the doctor’s approval. Light activities, such as walking, may be resumed after a few weeks, while more intense exercises and weight lifting should be avoided for a longer period. Sexual activities should also be resumed according to medical recommendations.
Medical follow-up
Follow-up consultations are essential to evaluate prostate health recovery. During these consultations, the physician may adjust the treatment, remove the catheter (if still present), and conduct tests to ensure that the recovery is progressing well.
Is it necessary to replace the penile prosthesis after prostatectomy?
It is not usually necessary to replace the penile implant after prostate surgery. In most cases, the surgeon can treat the prostate without interfering with the prosthesis’s function or causing complications.
However, the patient should observe, after prostatectomy, whether there is any loss of penile rigidity. This may indicate damage to the implant during or due to the operation. In this case, replacement may be recommended by the urologist.
Common postoperative complications after prostate surgery
Prostatectomy can cause complications that affect a man’s sexual life, such as:
- Infections
- Urethral injury
- Urethral erosion, exposing the prosthesis
- Redness
- Discharge
- Dry orgasm
- Retrograde ejaculation
- Climacturia (urine loss during orgasm)
- Urinary incontinence
- Erectile dysfunction
Are prostate surgeries dangerous?
Prostate surgeries, like any surgical procedure, involve some risks, although they are generally safe and successful. However, two of the most common side effects that concern patients are erectile dysfunction and urinary incontinence, both related to the prostate’s delicate anatomy and surrounding structures.
Erectile dysfunction can occur after surgery, especially in more invasive procedures like radical prostatectomy. This happens because the nerves responsible for erection are very close to the prostate, and even in the most careful surgeries, there may be temporary or permanent damage.
Urinary incontinence is also a concern, as the prostate is located near the bladder and the urinary sphincter, which controls urine flow. During surgery, these structures may be affected, leading to difficulties controlling urination in the first months after the procedure.
Considering these possibilities, prostate surgery can be seen as potentially risky. However, it is important to remember that the decision to proceed with surgery is based on a careful evaluation of the benefits versus the risks.
Advances in techniques have helped reduce these complications and may facilitate recovery for some patients.
What happens to a man after the prostate is removed?
After prostate removal, a man may experience various physical and emotional changes. In the short term, the body needs time to recover from surgery, and it is common for the patient to feel tired and require rest. During this period, the focus is on healing and avoiding excessive strain.
In the long term, two of the main effects a man may face are urinary incontinence and erectile dysfunction. Despite these possible changes, many men report an improved quality of life after recovery, with individualized treatments and medical support.
It is important to remember that, in cancer cases, removal can be vital for saving lives, and while side effects can be challenging, they can be addressed individually.
Prostate cancer is the second most common type of the disease among men in Brazil. Early detection and regular medical follow-up can make all the difference in treatment and patient quality of life. Being attentive to signs and seeking proper guidance helps prevent complications and maintain overall well-being.
If you are seeking the best treatment for your health, contact Dr. Paulo Egydio, MD, PhD in Urology and a specialist in restoring men’s sexual health and self-esteem.
Schedule an appointment now and discover how it is possible to regain your quality of life with the care of one of the best specialists in the field.
Thank you!
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