Open prostatectomy for benign prostatic hyperplasia
Open prostatectomy is the surgical removal of an enlarged (noncancerous) prostate. It is done under a general or spinal anesthetic. Usually, an incision is made through the lower abdomen, although sometimes the incision is made between the rectum and the base of the penis. A catheter may be placed in the bladder through the lower abdominal skin to help flush the bladder (postoperative bladder irrigation) and another catheter comes out of the penis to drain the urine. The procedure requires a slightly longer hospital stay and recovery period than transurethral resection of the prostate (TURP).
Open prostatectomies may be needed only for men with very enlarged prostate glands (it may be more effective than TURP in relieving the blockage of urine flow), for men with bladder diverticula (pockets) or stones, and if TURP is not possible. A prostatectomy also reduces the possibility that another surgery will be needed, which is a potential problem when TURP is used. But if you have been treated for prostate cancer, an open prostatectomy cannot be done.
What To Expect After Surgery
Open prostatectomy requires several days in the hospital.1 A catheter is left in place for 3 to 5 days. You may go home with a urinary catheter in place. Your doctor will give you instructions about how to care for your catheter at home.
Why It Is Done
Open prostatectomy usually is used for men who want surgery to treat their benign prostatic hyperplasia (BPH) symptoms and who have very enlarged prostates.
How Well It Works
Open prostatectomy almost always improves symptoms. Men generally notice about a 10-point improvement in their American Urological Association (AUA) symptom index scores after surgery.2 For example, if your symptom score is 25 (indicating severe symptoms), this surgery might reduce it to about 15 (indicating moderate symptoms).
The risks of open prostatectomy include:
- The possible need for a blood transfusion. Slightly more men require a blood transfusion after open prostatectomy than after TURP.
- An inability to have sexual intercourse because of erection problems. This occurs in less than 5% of men and is more frequent in older men than younger men.1
- Complete or partial inability to hold back urine (incontinence).
- Ejaculation of semen into the bladder instead of out through the penis (retrograde ejaculation). Although this is not harmful, it may cause fertility problems.
What To Think About
Surgery usually is not required to treat BPH, although some men may choose it. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectation of the results, the severity of your symptoms, and the possibility of developing complications.
Men who have severe symptoms before surgery often have great improvement in their quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve their quality of life. They may want to think carefully before deciding to have surgery to treat BPH.
- Han M, Partin AW (2007). Retropubic and suprapubic open prostatectomy. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2845–2853. Philadelphia: Saunders Elsevier.
- AUA Practice Guidelines Committee (2003). AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 3: Results of the treatment outcomes analyses. Available online: http://www.auanet.org/guidelines/bph.cfm.
Last Updated: March 24, 2008