Prostate Surgery: What to Expect on the Day of Surgery

Transurethral Resection of the Prostate for BPH

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Prostate surgery is performed to treat prostate cancer and the urinary symptoms or complications of benign prostatic hyperplasia (BPH). There are different types of prostate surgeries. Choosing the right surgery depends on the underlying condition (cancer versus enlargement) and other factors like the size of the prostate gland and surgeon experience. For the vast majority of prostate surgeries, patients can expect to stay in the hospital for one to three nights.

Before the Surgery

On the day of your prostate surgery, you will arrive at the hospital or surgical center, check-in, and sign an anesthesia and surgery consent form. After that, you will go to a pre-operative room where you can expect the following:

  • You will change into a hospital gown.
  • A nurse will record your vitals (heart rate, blood pressure, etc.) and place an intravenous (IV) line into a vein in your arm for administering fluids and medications.
  • Your urologist and anesthesiologist will come to say hello and briefly review the surgery with you.
  • When the surgical team is ready, you will be wheeled into the operating room on a gurney where the anesthesia process will start.

There are two types of anesthesia used for prostate surgery:

  • General anesthesia: An anesthesiologist will give you inhaled or intravenous medication that will put you to sleep. Since you are temporarily unconscious, you will not remember anything during the surgery or experience any pain. After you are asleep, the anesthesiologist will insert a breathing tube (called an endotracheal tube) and deliver oxygen.
  • Regional anesthesia: An anesthesiologist will inject a numbing medication into a part of your body, usually your lower back (called a spinal or epidural block). You will be conscious, but you will not feel any pain or other sensations in the numbed part of your body. In order to fall into a light sleep, you will also be given a sedative through your IV.

During the Surgery

The type of prostate surgery depends on the condition being treated—prostate cancer versus BPH.

Prostate Cancer

The most common type of surgery to treat prostate cancer is a radical prostatectomy. This surgery involves removing the entire prostate gland along with nearby tissues, such as the seminal vesicles.

A radical prostatectomy can be performed in three different ways:

  • Open radical prostatectomy: The surgeon accesses the prostate gland by making a large incision over the lower abdomen. Less commonly, the prostate is accessed through an incision made between the anus and scrotum (the perineum).
  • Laparoscopic radical prostatectomy: This minimally invasive approach involves accessing the prostate gland by inserting long, thin instruments through several keyhole-sized incisions made in the lower abdomen.
  • Robotic-assisted laparoscopic prostatectomy: With this approach, the surgeon sits at a computer console and manipulates mini robotic arms/instruments (inserted through several keyhole-sized incisions) to remove the prostate gland.

A radical prostatectomy generally proceeds in the following fashion:

  • After anesthesia and an antibiotic is given, a member of the surgical team cleans the skin over the lower abdomen using an antiseptic solution to kill any bacteria.
  • With an open operation, the surgeon makes a large incision from the belly button down to the pubic bone. With a laparoscopic approach, several small incisions are made in the abdomen.
  • The surgeon then removes the entire prostate gland along with nearby tissues, including the seminal vesicles, and sometimes, surrounding lymph nodes. If the laparoscopic approach is used, long-thin instruments are inserted through the small incisions to remove the gland and tissues.
  • After the prostate gland is removed, the bladder is reconnected to the urethra. A catheter is then placed in the penis to help drain urine from the bladder.
  • Anesthesia is then stopped, the breathing tube is removed (if undergoing general anesthesia), and the patient is taken to a recovery room.

Benign Prostatic Hyperplasia (BPH)

Surgery may be needed to treat symptoms of BPH that are refractory to medication, such as hesitancy, straining to void, or experiencing a urine flow that starts and stops. Surgery for BPH may also be indicated if complications like recurrent urinary tract infections or bladder stones develop.

The vast majority of BPH surgeries are performed using a transurethral technique. With this technique, a tube-like instrument called a resectoscope reaches the prostate gland via the urethra.

Some of these techniques include the following:

  • Transurethral resection of the prostate (TURP): An electrified wire loop is used to remove prostate tissue.
  • Transurethral electrovaporization of the prostate (TUVP): Electrical energy applied through an electrode is used to heat and vaporize an area of enlarged prostate tissue.
  • Transurethral incision of the prostate (TUIP): No prostate tissue is removed, but two deep cuts are made starting in the bladder neck (where the urethra and bladder join). The purpose of these cuts is to widen the urethra in order to improve urine flow.
  • Photoselective vaporization of the prostate (PVP or laser TURP): Laser energy is used to vaporize prostate tissue.
  • Laser enucleation of the prostate: Holium or thulium laser is used to remove excess prostate tissue that is blocking urine flow.
  • Transurethral microwave therapy (TUMT): A specialized urinary catheter with a small microwave antenna is used to heat and destroy prostate tissue.

As an example, a TURP (the most common surgery used to treat BPH) proceeds with the following steps:

  • After anesthesia is given, the penis and surrounding skin are cleaned with a solution to sterilize the skin as much as possible.
  • A resectoscope that contains an electric wire loop is then inserted into the urethra via the penis until the prostate gland is reached.
  • The surgeon uses the electric wire loop to cut away pieces of prostate tissue that are blocking the urethra. During the procedure, the surgery site is frequently flushed with an irrigation solution, which will push any removed pieces of the prostate into the bladder.
  • When the surgery is completed, the instruments are removed and a urinary catheter is inserted into the bladder. The pieces of the prostate that are in the bladder are then flushed from the body with urine, into the foley catheter collection bag.
  • Anesthesia is stopped, the breathing tube is removed (if applicable), and the patient is taken to a recovery room.

Less commonly (and often reserved for large prostate glands), a simple prostatectomy may be performed to treat BPH. This surgery consists of removing the core of the prostate gland while leaving its capsule or shell intact.

Choosing a Surgery

Deciding on a prostate surgery for BPH requires a detailed discussion with your surgeon. Factors that may affect the decision include:

  • Size and shape of the prostate gland
  • Risk for bleeding
  • Surgeon preference and experience
  • Patient's concerns towards potential sexual side effects (most notably, erectile dysfunction).

After the Surgery

In the recovery room after prostate surgery, you will wake up from the anesthesia or sedating medication. A nurse will monitor your vital signs (e.g., blood pressure and heart rate) and manage any post-operative symptoms like pain. Once you are awake and ready, you will be taken to a hospital room where you can expect to stay for one to three days.

During your hospital stay, the following will occur:

  • The catheter placed during surgery will remain. You may notice mild blood in your urine and experience bladder spasms.
  • You will be transitioned from IV pain medication to oral pain medication.
  • You will begin drinking liquids and advance to solids as tolerated.
  • You will begin walking around and increase your activity level as tolerated.

As you recover at home, you will have various post-operative instructions to follow, such as:

  • When showering, clean any incision site(s) with mild soap and use a washcloth to gently pat skin dry.
  • Avoid heavy lifting for up to six weeks after surgery and sexual intercourse for up to four weeks.
  • Avoid driving until you are off all pain medications and your catheter has been removed (around one to two weeks)
  • Eat small, frequent meals and limit high-fiber foods for the first few days or so after surgery in order to minimize constipation.
  • Follow up with your surgeon as instructed for removal of the catheter.

A Word From Verywell

When undergoing prostate surgery, it's important to select a highly skilled surgeon. The more skilled the surgeon, preferably with extensive experience performing hundreds or even thousands of procedures just like yours, the less likely you are to experience complications and sexual side effects (most notably erectile dysfunction due to nerve damage).

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Article Sources
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  3. Cleveland Clinic. Benign Prostate Hyperplasia. Reviewed December 2020.

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  5. Johns Hopkins Medicine. Transurethral Resection of the Prostate (TURP).

  6. University of Wisconsin Health. Frequently Asked Questions About Robotic Prostatectomy. 2021.