Open Prostatectomy

Who Needs Open Prostatectomy?

Open radical prostatectomy is recommended for men with prostate cancer confined to the gland who are in good overall health with a life expectancy of more than 10 years. Open simple prostatectomy is for men with very large prostate glands causing severe obstruction that cannot be treated endoscopically. Age, fitness, and cancer staging guide the decision.

Diagnosis

Pre-operative evaluation for open prostatectomy includes:

• PSA blood test to assess cancer risk and monitor levels
• Digital rectal examination to evaluate prostate size and consistency
• Transrectal ultrasound-guided biopsy to confirm cancer diagnosis
• MRI pelvis to assess local tumor extent and staging
• CT scan of abdomen and pelvis for lymph node assessment
• Bone scan to rule out metastasis in high-risk patients
• Urodynamic studies for BPH functional assessment

Surgical Procedure

Open prostatectomy is performed under general or spinal anesthesia. The surgeon makes a lower abdominal incision, carefully dissects and removes the prostate while preserving the urethral sphincter and neurovascular bundles when possible. A urinary catheter is placed and left for 1 to 2 weeks after the procedure. Surgery typically takes 2 to 4 hours.

Open Prostatectomy Steps

The open prostatectomy procedure involves:

• Administration of general or spinal anesthesia
• Making a lower midline abdominal incision
• Dissecting the space between the pubic bone and bladder to expose the prostate
• Identifying and preserving neurovascular bundles when nerve-sparing is indicated
• Dividing the urethra at the apex of the prostate and the bladder neck
• Removing the entire prostate along with the seminal vesicles
• Performing pelvic lymph node dissection if required for staging
• Reconnecting the urethra to the bladder neck (anastomosis)
• Placing a urinary catheter and closing the incision in layers

After the Surgery

Recovery after open prostatectomy takes 4 to 8 weeks. Hospital stay is typically 5 to 7 days. A urinary catheter is kept for 1 to 2 weeks. Pelvic floor exercises are started early to help restore urinary control. Physical activity is restricted for 6 weeks. Follow-up PSA testing is done every 3 to 6 months to monitor for cancer recurrence.

Complications of Open Prostatectomy

Potential complications of open prostatectomy include:

• Urinary incontinence that may be temporary or rarely permanent
• Erectile dysfunction especially without nerve-sparing technique
• Anastomotic leak at the urethral-bladder connection
• Deep vein thrombosis or pulmonary embolism
• Wound infection or incisional hernia
• Lymphedema if pelvic lymph node dissection was performed
• Urethral stricture causing difficulty urinating later