Prostatectomy (from the Greek προστάτης prostátēs, 'prostate' and ἐκτομή ektomē, 'excision') is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention as well as for prostate cancer and for other cancers of the pelvis. There are two main types of prostatectomy. A simple prostatectomy (also known as a subtotal prostatectomy) involves the removal of only part of the prostate. Surgeons typically carry out simple prostatectomies only for benign conditions. A radical prostatectomy, the removal of the entire prostate gland, the seminal vesicles and the vas deferens and pelvic lymph nodes, is performed for cancer. There are several ways the operation can be done for benign prostatic hyperplasia (BPH): with open surgery (via a large incision through the lower abdomen), laparoscopically with the help of a robot (a type of minimally invasive surgery), through the urethra or through the perineum. Laser prostatectomy or holmium laser enucleation of the prostate (HoLEP) is a minimally invasive surgery to treat BPH. The holmium laser is used to enucleate and remove excess prostate tissue that is blocking the urethra into urinary bladder. A morcellator is then used to cut the prostate tissue into smaller pieces before extracting it from the body. HoLEP can be an option for men who have a severely enlarged prostate. Due to the decreased risk of bleeding and recurrence of obstruction, HoLEP has started to replace transurethral resection of the prostate (TURP) operations, even for patients who have a smaller prostate. The procedure started to become extremely popular in Western countries and has recently gained popularity in the Middle East, including Jordan, Egypt, and Saudi Arabia. Other terms that can be used to describe a radical prostatectomy include:
Nerve-sparing: the blood vessels and nerves that promote penile erections are left behind in the body and not taken out with the prostate. Limited pelvic lymph node dissection: the lymph nodes surrounding and close to the prostate are taken out (typically the area defined by external iliac vein anteriorly, the obturator nerve posteriorly, the origin of the internal iliac artery proximally, Cooper's ligament distally, the bladder medially and the pelvic side wall laterally). Extended pelvic lymph node dissection (PLND): lymph nodes farther away from the prostate are taken out also (typically the area defined in a limited PLND with the posterior boundary as the floor of the pelvis).
Medical uses
Benign Indications for removal of the prostate in a benign setting include acute urinary retention, recurrent urinary tract infections, uncontrollable hematuria, bladder stones secondary to bladder outlet obstruction, significant symptoms from bladder outlet obstruction that are refractory to medical or minimally invasive therapy, and chronic kidney disease secondary to chronic bladder outlet obstruction.
Malignant A radical prostatectomy is performed for malignant cancer. For prostate cancer, the best treatment often depends on the level of risk presented by the disease. For most prostate cancers classified as very low risk and low risk, radical prostatectomy is one of several treatment options; others include radiation, watchful waiting and active surveillance. For intermediate and high-risk prostate cancers, radical prostatectomy is often recommended in addition to other treatments. Radical prostatectomy is not recommended in the case of known metastases, when the cancer has spread through the prostate to the lymph nodes or other parts of the body. Before a decision is made on the best treatment for higher-risk cancers, imaging studies such as CT, MRI or bone scans are done to see whether the cancer has spread outside of the prostate.
Contraindications These would be same as the contraindications for any other surgery.
Simple prostatectomy Simple prostatectomy for benign prostatic hyperplasia (BPH) is a surgical enucleation of the adenomatous transition zone, reserved for selected patients with large prostates and severe symptoms refractory to less invasive options. It can be performed via open, laparoscopic, or robotic-assisted approaches, with comparable functional outcomes but differing perioperative profiles.
Definition and historical background Simple prostatectomy refers to removal of the prostatic adenoma while leaving the peripheral zone and prostatic capsule in situ, in contrast to radical prostatectomy where the entire prostate and seminal vesicles are excised for cancer. Historically, open simple prostatectomy (OSP) via transvesical (Freyer) or retropubic (Millin) approaches represented the standard operation for very large BPH before the diffusion of modern transurethral and laser techniques. With the development of minimally invasive surgery, laparoscopic and robotic-assisted simple prostatectomy (RASP) have been introduced as alternatives to OSP.
Indications Simple prostatectomy is indicated for men with benign prostatic enlargement and lower urinary tract symptoms (LUTS) attributable to bladder outlet obstruction who have failed or are unsuitable for medical therapy and less invasive surgical modalities. It is generally reserved for large prostates, typically over 80–100 ml, especially when transurethral resection or laser enucleation is not available, not feasible, or not preferred. Additional indications include the presence of complications of BPH such as recurrent urinary retention, refractory gross hematuria from BPH, recurrent urinary tract infections, bladder stones, or significant bladder diverticula in the setting of large adenomas.
Guideline recommendations Major urological guidelines categorize simple prostatectomy as a treatment option for surgically managing LUTS/BPH, alongside transurethral procedures and minimally invasive surgical therapies. The American Urological Association (AUA) guideline on BPH/LUTS states that simple prostatectomy (open, laparoscopic, or robotic-assisted) can be considered when prostate size and patient characteristics preclude a safe or effective transurethral approach. The European Association of Urology (EAU) guidelines on non‑neurogenic male LUTS recommend open prostatectomy for men with moderate-to-severe LUTS and prostate volume greater than 80 ml when size-independent endoscopic enucleation techniques such as bipolar transurethral enucleation or holmium laser enucleation (HoLEP) are not available.
… excerpt ends here. Continue reading the full article.
