Surgical Procedure
Surgeons may choose from a number of opera-
tions to remove the prostate gland. The choice
depends on the reason for the operation, the size
of the prostate gland, and the man’s overall health
status. There are six commonly performed prosta-
tectomy operations: transurethral retrograde
prostatectomy (TURP), transurethral incision of
the prostate (TUIP), three open prostatectomy
operations (suprapubic, retropubic, and perineal),
and radical open prostatectomy.
Transurethral retrograde prostatectomy (TURP)
TURP has long been the standard, and remains the
most common, surgical operation to remove
obstructive prostate gland tissue due to BPH (non-
cancerous prostate gland enlargement) when the
prostate gland remains relatively small. The sur-
geon uses an endoscopic instrument called a resect-
ing cystoscope or resectoscope, inserted through
the PENISand urethra to the prostate gland.
The surgeon passes a cutting tool through the
resectoscope to make an incision through the ure-
thra and remove part or all of the prostate gland
by shaving away layers of tissue. After removing
the prostate gland the surgeon sutures the urethra
back to the neck of the bladder. The removed
shreds of tissue collect in the bladder and pass out
with the URINEover the first few days after sur-
gery. TURP generally requires three days in the
hospital and two to four weeks recovery time until
full return to normal activities. A man who has
had a TURP usually retains erectile function
though has RETROGRADE EJACULATION(ejaculation
into the bladder).
Transurethral incision of the prostate (TUIP)
TUIP is a cystoscopic procedure in which the sur-
geon makes a series of small incisions through the
urethra into the prostate gland. The incisions
relieve the pressure the enlarged prostate gland is
exerting against the urethra, without removing
prostate tissue, restoring the free flow of urine.
TUIP is treatment only for noncancerous prostate
enlargement, such as BPH, and is used only in
limited circumstances that depend on the size and
structure of the prostate gland. TUIP is often an
AMBULATORY SURGERYprocedure (a same-day sur-
gery) with full return to normal activities in three
to five days. Erectile and ejaculatory functions
nearly always remain normal.
Open prostatectomy The three operations of
open prostatectomy, sometimes called simple
prostatectomy, involve making an incision
through the surface of the SKIN to reach the
prostate gland. The incision for suprapubic or
retropubic prostatectomy extends from the navel
(belly button). In the suprapubic approach the
surgeon reaches the prostate gland through the
bladder. In the retropubic approach the surgeon
reaches the prostate gland without entering the
bladder. The incision for perineal prostatectomy is
between the SCROTUMand the ANUS. Open prosta-
tectomy removes the prostate gland and seminal
vesicles intact. The surgeon may also remove
nearby LY M P H nodes (lymphadenectomy) when
the operation is to treat prostate cancer.
Open prostatectomy is major surgery that
requires a stay of up to eight days in the hospital
and six to eight weeks recovery (sometimes
longer) before return to regular daily activities.
There is moderate risk for significant complica-
tions such as bleeding, URINARY INCONTINENCE, and
damage to the nerves that supply the penis result-
ing in ERECTILE DYSFUNCTION.
Radical prostatectomy Radical prostatectomy is
a treatment for prostate cancer in which the sur-
geon removes the prostate gland, seminal vesicles,
and surrounding tissue (fat, MUSCLE, and connec-
tive tissue) during an operation that can take five
hours or longer. Often the surgeon removes adja-
cent lymph nodes as well. Radical prostatectomy is
major surgery that requires about 10 days in the
hospital and up to four months for recovery. Radi-
cal prostatectomy is treatment for prostate cancer
and has a high risk for complications such as uri-
nary incontinence and erectile dysfunction,
though these complications may improve over
time.
In some circumstances the surgeon may opt to
perform radical prostatectomy laparoscopically,
inserting a laparoscope and surgical instruments
through several small incisions in the abdomen.
The laparoscopic approach significantly lessens the
risk for complications and shortens recovery time,
though the operation is nonetheless major sur-
gery. Sometimes the surgeon may use laparoscopic
surgery to remove pelvic lymph nodes while using
the open perineal approach to remove the
prostate gland.332 The Reproductive System