An open prostatectomy is a surgical procedure done on adult males to remove a prostate gland that has become enlarged. The prostate gland is one of the male reproductive organs and it produces the nourishing fluid found in semen. It is located just beneath the bladder and it surrounds the urethra, the tube that carries urine from the bladder.
Patients who have difficulty urinating may be suffering from a non-cancerous disorder of the prostate, known as benign prostate hyperplasia (BPH). As men age, routine screening for BPH and prostate cancer should be done by a physician. This includes a digital rectal exam (DRE) and a blood test for prostate specific antigen (PSA). During the DRE, the physician can feel the prostate and determine if it is enlarged. If PSA levels in the blood are normal, the physician may diagnose the patient with BPH.
When BPH develops, the prostate gland becomes enlarged and can constrict the urethra. Many patients may qualify for a less invasive laparoscopic prostatectomy to remove an enlarged prostate. In the case that the prostate is quite enlarged or if the patient is experiencing complications involving the bladder, the surgeon may choose to perform an open prostatectomy to remove the prostate.
The open prostatectomy is done as an inpatient surgery while the patient is under either general anesthesia or regional anesthesia given in the lower spine. Patients should expect to stay three to five days in the hospital. The surgeon can remove the prostate of the patient in what is called a suprapubic prostatectomy or a retropubic prostatectomy.
Suprapubic refers to a procedure done by going above the pubic bone. The surgeon makes an incision in the lower abdomen and opens the bladder. Removal of the interior portion of the enlarged prostate gland can be done while the bladder and urethra are examined at the same time. Once the prostate is removed, the bladder and urethra are closed and the incision in the skin is sutured.
To perform the retropubic open prostatectomy, the surgeon makes an incision in the lower abdomen but removes the inner portion of the prostate from behind the pubic bone. The bladder and urethra are left intact. This procedure is less invasive and would be done if the surgeon does not suspect any bladder disease.
Following the open prostatectomy, the patient may have a catheter in place to drain the bladder. There may also be a drainage tube in the abdomen. Both of these should be removed within a week after surgery. The patient should be able to make a complete recovery within four to six weeks.