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Prostatectomy

 
 

What is it?

The prostate gland is a thick ring of muscle and gristle which lies between the outlet of the bladder and the penis. It is rather like the bung in the outlet of a homemade wine bottle, holding the outflow tube in place. It lies deeply behind the bone in the front of the pelvis (which is the lower part of your abdomen). It makes the fluid that carries sperm. Sometimes the centre of the prostate ring becomes narrow because of overgrowth or scarring. This causes difficulty in passing urine, and back-pressure effects on the bladder and kidneys.

The Operation

The centre of the prostate ring is widened by coring out the tissue using an instrument passed up the penis. The removed tissue is send to the laboratory for examination. Sometimes the tissue is taken out by opening up the bladder through a cut just below the tummy button. Most patients have a general anaesthetic, so that they are asleep during the operation. It is quite common however, for patients to be numbed from the waist down with an injection in the back. If this is the case you will be awake during the operation, but feel no pain. The operation takes about 40 to 60 minutes.

Any Alternatives

If you just have a little slowness of the stream of urine and are getting up at night once or twice, simply waiting and seeing if you have more trouble is a reasonable idea.

If you find your life is being upset by the prostate, then treatment is sensible. Drug treatment may be helpful in the short term, but there may be side-effects. A complete blockage definitely needs treatment, at first with a drainage tube (catheter) through the penis or through the lower tummy wall, followed usually with a coring out through the penis. Keeping the way through the prostate clear using short indwelling tubes is experimental. An open operation through the tummy is needed in about 10% of cases. The main indication for this is a very large prostate (more than 60 to 80g) which is very difficult to take it out by passing the instrument through the penis because this can take a very long time and is associated with an increased risk of complications after the operation. Two other much less common indications for removing your prostate with an open operation are a bladder condition such as large bladder stones or a blowout on the bladder wall. Sometimes a permanent catheter with a collecting bag for urine strapped to the leg is the best plan if an operation would be very risky.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

There will be a catheter in your penis connected to a urine bag. Usually the catheter has a continuous stream of salt solution running through to keep it from blocking. The urine will be bloodstained for the first two or three days. If you have had the operation on your tummy, there will be a fine, plastic drainage tube coming out near the wound. This is to drain any residual blood or other fluid from the area of the operation. This usually comes out two to three days after the operation. It is uncomfortable having a catheter in the penis. It can give a strong feeling of wanting to pass urine. This passes off. The tummy wound is not very painful, but you can have injections or tablets to control any pain and discomfort. Ask for more painkillers if the pain is not well controlled or if it gets worse. When the urine has cleared, the catheter will be taken out. You should then pass urine freely. If you have the open operation, stitches or clips in the wound will be taken out after 7 to 10 days. Sometimes the catheter has to be flushed through by the nurses or doctors to free any blood clot. This is not painful. Most hospitals arrange a check-up about one month after you leave hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.

After - At Home

At first discomfort in the wound will prevent you from harming yourself by lifting things that are too heavy. After a tummy operation you should be able to return to a light job after about four weeks and a heavy one after about eight weeks. After a coring operation - halve these times. You may restart sexual relations within a week or two, when the wound is comfortable enough. You may find that at intercourse no liquid comes, and that afterwards you notice milky fluid in the urine. This can happen in up to 80% of cases and is because the widened prostate ring allows the sperm to pass up into the bladder instead of down into the penis. You may be sterile. Some men (5-10%) find that they cannot have sex as well after the operation as before it. At the follow-up appointment you will be given the results of examination of the prostate under the microscope. Sometimes further treatment with tablets is needed. This will be discussed with you.

Possible Complications

If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

If you have an anaesthetic injection in the back, there is a very small chance of blood clot forming on top of your spine which can cause a feeling of numbness or pins and needles in your legs. The clot usually dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.

In the first 48 hours, bleeding in the urine may be a problem. The medical and nursing staff will deal with this. There is a 5% chance that you may require a blood transfusion because of the blood loss. Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing chest infections. When the catheter is first removed you may notice that you want to pass urine every few minutes. This is normal and passes off in a day or two. Sometimes after removal of the catheter, there may be difficulty passing any urine at all. It may mean replacing the catheter for three days or more. Sometimes after removal of the catheter there is some dribbling or moistness from the penis after passing urine. This improves with time and the improvement can continue gradually for up to three months. However, there is about a 1% chance that you may experience mild to moderate urine incontinence in the long term. Ask the surgeon for advice if it is troublesome.

Infection of the urine can give a burning feeling and a need to pass urine every hour or so. This can be tested and treated by the surgical team. Sometimes blood stains the urine again 7 to 10 days after the operation. You should seek medical advice, but the condition usually settles down. There is a 10-15% chance that the prostate ring becomes narrow again over months or years. Seek medical advice in this case and most likely you will need another operation to fix the problem.

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