Open prostatectomy for benign prostatic hyperplasia

Surgery Overview

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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), those 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

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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 health professional will give you instructions about how to care for your catheter at home.

Why It Is Done

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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

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Open prostatectomy almost always improves symptoms. Men generally notice about an 80% 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 5 (indicating mild symptoms).

Risks

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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

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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.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Han M, et al. (2002). Retropubic and suprapubic open prostatectomy. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 2, pp. 1423–1434. Philadelphia: W.B. Saunders.

2. Agency for Healthcare Research and Quality (1994). Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guidelines No. 8 (AHCPR Publication No. 94-0582). Rockville, MD: Agency for Healthcare Policy Research.

Credits

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Author	Ralph Poore
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Terrina Vail
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	Christopher G. Wood, MD, FACS - Urology/Oncology
Last Updated	March 31, 2006