Prostate surgery or prostatectomy is a surgical procedure to remove part or all of the prostate gland, which is a gland that is owned by men. Sometimes also carried out other tissue removal around the prostate gland. This gland is located under the bladder of men, and serves to produce semen.
There are two main techniques in prostate surgery through the stomach, namely:
- Radical prostatectomy, the procedure of removing all prostate gland tissue along with the tissue around the gland. Radical prostatectomy is generally done to treat prostate cancer. This procedure can be done openly through a wide incision on the skin, or assisted with a laparoscope (laparoscopic prostatectomy) through a smaller incision on the skin.
- Simple prostatectomy, is the procedure of removing a portion of the prostate gland without removing all prostate tissue and surrounding tissue. Simple prostatectomy is generally done to treat enlarged prostate glands.
Apart from the abdomen, prostate surgery can also be done through the opening and urethra by cutting a small portion of the prostate gland that is blocking the urethra. This method is known as transurethral resection of the prostate (TURP) or transurethral incision of the prostate (TUIP). Both are done by cutting the prostate gland that clogs the urinary tract, then the piece will come out along with urine when the patient urinates.
Indications for Prostate Surgery
Prostate surgery is performed as a treatment for prostate cancer, other than through chemotherapy, radiotherapy or hormone therapy. In addition, this procedure can also be performed to treat symptoms of enlarged prostate (benign prostatic hyperplasia / BPH). BPH can inhibit urine flow and cause complications in sufferers.
Symptoms that indicate that a person may need treatment through prostate surgery are:
- There is often a desire to urinate (urinate).
- Feeling difficult at the beginning of urination.
- Urination with a long duration, and a slow or faltering urine flow.
- Can not urinate at all.
- Having a urinary tract infection.
- Increased frequency of wanting to urinate at night (nocturia).
- Feeling urination is not complete when finished.
Prostate Operation Warning
Prostate surgery in general does not have a special condition that causes patients not to undergo this surgery at all. However, specifically for prostate cancer patients, patients are not recommended to undergo a simple prostatectomy. Patients with prostate cancer are required to undergo a biopsy beforehand so that prostate surgery techniques can be determined. In addition, if the patient is taking blood-thinning medications, such as warfarin or clopidogrel, or if you have a blood clotting disorder, it is recommended to inform your doctor to prevent heavy bleeding during surgery.
Preparation for Prostate Surgery
Before undergoing prostate surgery, the patient will first undergo a cystoscopic procedure. Cystoscopy is performed to visually check the condition of the prostate gland and urethra. Patients can also undergo other tests, such as blood tests, urine flow tests, and prostate size checks. To prevent surgical site infections, patients will be given antibiotics by doctors a few days before undergoing surgery.
In addition, several other things that are included in the preparation for prostate surgery are:
- The doctor will ask the patient about medications that are being consumed, especially blood thinners and pain relievers, such as aspirin and ibuprofen. If you are taking one of the two drugs, the doctor will ask the patient to stop it before undergoing prostate surgery.
- The patient will be given a laxative to clear the digestive tract, and will be asked to fast several hours before undergoing surgery.
- Patients who have allergies to certain drugs, should tell the doctor.
- The patient is asked to leave jewelry, dentures, contact lenses, and glasses at home before undergoing the surgical procedure.
- Patients should be accompanied by their family before and after undergoing surgery, including for pickup purposes. Generally, patients can go home a few hours after surgery is complete and does not require hospitalization.
Procedure for Prostate Operation
Prostate surgery is usually done in a patient unconscious state due to the influence of general anesthesia (general anesthesia). In some cases, patients are only given half body anesthesia so that they remain awake during the operation, but do not feel anything. The patient will also be placed in a urine catheter to drain urine from the bladder without passing through the urethra, during surgery.
Patients who undergo open prostatectomy will begin by making a skin incision, either on the front of the prostate (retropubic) or on the back of the prostate (perineal). Skin slices in retropubic open prostatectomy are made from under the navel to approach the pubic bone. While the skin incision in perineal open prostatectomy is made from near the anus to reach the area near the scrotum. After the skin incision is opened, the urologist removes the patient's prostate gland. If needed, along with the surrounding tissue, such as lymph nodes. After removal of the prostate gland is complete, the incision is closed again using stitches.
While laparoscopic prostatectomy is performed using slices the size of a keyhole, but more than one. Slices of the skin in a laparoscopic prostatectomy are made in the abdominal area to insert a special surgical instrument (laparoscope) into the area near the prostate with the help of a camera at the end of the laparoscope. When the laparoscope reaches the prostate gland, the doctor then cuts and removes the prostate gland using the laparoscope. In hospitals that have implemented more sophisticated technology, laparoscopic prostatectomy can be assisted with robotic technology to facilitate removal of the prostate gland.
To reduce the blockage in the urinary tract, especially for patients who have prostate enlargement (BPH), can undergo prostate surgery without going through an incision in the abdominal wall, but through the ureter and urinary tract. These operations include:
- Prostate surgery with this procedure aims to cut the enlarged prostate gland using a laser. A laser device in the form of a long hose will be inserted through the urinary hole until it reaches the prostate gland. When it reaches the prostate gland area, the laser is then activated to cut the prostate gland. Cut prostate tissue will be removed through urine.
- TURP. Transurethral Resection of the Prostate (TURP) is performed using special sterile threads.
- TUIP. TUIP or Transurethral Incision of the Prostate is carried out using a special surgical instrument that cuts the prostate gland into sections at the site of narrowing of the urinary tract.
Patients who undergo prostate surgery with an incision in the skin, will be sewn back to close the wound. The suture area is then covered with a sterile dressing to prevent infection, and the catheter will remain attached to drain urine during the recovery period.
After Prostate Surgery
After undergoing prostate surgery, the patient can feel the following:
- Pain in the area of the stitches used for surgery.
- The appearance of blood in the urine.
- Difficulty holding urine when urinating.
- Pain when urinating.
Patients who have undergone prostate surgery will be given painkillers. Painkillers will first be given in the form of intravenous fluids, and will be replaced with oral medication in the following days. The patient will still be fitted with a catheter to help urinate for several days, at least 5-10 days after surgery. The doctor will advise the patient to take a light walk to help with postoperative recovery. If the condition is good enough, the patient will be allowed to go home. If not, the patient will undergo treatment for several days at the hospital.
Keep in mind that the patient must be picked up from the hospital by a family member after completing the operation. During the recovery period, the patient will be asked not to engage in heavy physical activity, and to gradually increase his physical activity. The doctor will also arrange a re-control schedule during the recovery period and will tell the patient when sexual activity can return to normal.
Risk of Prostate Surgery
Apart from the various prostate surgery techniques performed, the risks that can occur in patients include:
- An allergic reaction to the anesthetic.
- Surgical wound infection.
- Blood clots.
- Bleeding.
- Organ damage near the prostate gland.
- Urinary tract infection.
- Urinary incontinence.
- Do not reach orgasm during intercourse.
- Urethral stricture.
- Impotence
- Cyst formation in the lymph nodes near the prostate gland.
Patients who undergo prostate gland surgery often cannot experience an erection for several weeks after surgery. In some cases, prolonged impotence can be caused by nerve damage that regulates erection.
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