Open removal of the prostate for benign disease

What is this?

Removal of the obstructing portion of the prostate gland through an abdominal incision when the prostate gland is too big to remove with the telescopic method

What alternatives are there?

Drugs to shrink or open the prostate, long-term catheter drainage, telescopic removal of prostate obstruction.

What to expect before procedure

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. The procedure, on average, takes 45-60 minutes. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The operation is performed through an incision in the lower part of your abdomen and is usually preceded by telescopic examination of your bladder. The outer shell of the prostate gland is opened and the central part of the prostate removed. A bladder catheter and a wound drain are normally inserted at the end of the procedure.

After the procedure

There is normally some bleeding from the prostate area after the operation. The urine is usually clear of blood after 48 hours, although some patients lose more blood for longer. If the loss is moderate, you may require a blood transfusion to prevent you from becoming anaemic. You will be able to eat and drink the morning after the operation although this may be allowed earlier after a spinal anaesthetic. The wound drain is usually removed when drainage ceases after 2-4 days. The catheter is generally removed after 4-6 days, following which urine can be passed in the normal way. At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by tablets or injections and the frequency usually improves within a few days. It is not unusual for your urine to turn bloody again for the first 24-48 hours after catheter removal. A few patients are unable to pass urine at all after the operation. If this should happen, we normally pass a catheter again to allow the bladder to regain its function before trying again without the catheter. The average hospital stay is 7 days for a routine admission and 10 days following emergency admission.

Potential side effects