Open Prostatectomy for Benign Prostatic Hyperplasia
Open prostatectomy is the surgical removal of
an enlarged (noncancerous)
prostate. It is done under a
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
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
- 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.
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.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
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
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/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Christopher G. Wood, MD, FACS - Urology, Oncology|
|Last Revised||March 23, 2010|