Prostate surgery

Benign prostate enlargement occurs in many men over the age of 60. The older they get, the more likely it is that they will suffer from prostate cancer. However, not every benign enlargement of the prostate requires surgery. Surgery is often not even required for prostate cancer as it often occurs in old age and only grows slowly.

Benign prostate enlargement is treated surgically when it becomes too difficult to urinate as a result of narrowing in the urethra. An operation is indicated for prostate cancer if the cancer is aggressive and threatens to grow into the surrounding tissue or metastasise.

What preparations are carried out before the procedure?

Different examinations are carried out to identify the cause of the prostate enlargement. They include a rectal examination with the finger, an ultrasound examination, a blood test to determine the PSA value (prostate-specific antigens), a tissue biopsy and also an MRI examination.

All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. Prostate surgery is performed either under general anaesthetic or with spinal anaesthesia. The choice of anaesthesia depends on each patient’s individual situation.  Patients must have an empty stomach for the procedure.

How is the operation carried out?

Radical prostatectomy

The entire prostate is removed (radical prostatectomy) in the event of cancer of the prostate.

The open surgical method with an abdominal incision has been increasingly displaced by the minimally invasive laparoscopic method in the last few years. The cutting-edge Da Vinci surgical system is now used in laparoscopic prostatectomies in many centres. 

Several small skin incisions are made with the help of the Da Vinci surgical system to insert the laparoscope with camera and the surgical instruments of the robot for the laparoscopic method. With help of the Da Vinci technology, the surgical area can be depicted three-dimensionally and magnified up to ten times on the screen. The small surgical instruments of the Da Vinci robot are controlled and used by surgeons with pinpoint accuracy via a console. With this method, the nerves in the area of the prostate gland can be optimally protected when they are not affected by tumours. The prostate gland, including the seminal vesicles, is removed completely. Depending on the stage of the tumour, the neighbouring lymph nodes are also removed.

The entire operation takes between two and four hours.

Transurethral prostatectomy

Transurethral prostatectomy is usually carried out under spinal anaesthesia.

This surgical technique involves removing the prostate through the urethra with an endoscope. The method is suitable for treating the symptoms of benign prostate enlargement in particular.  The endoscope with a camera and an electrical loop is inserted via the urethra to remove the prostate. During this surgical procedure, only the inner part of the prostate is removed. The outer part and the prostate capsule are retained. The prostate is continuously irrigated with an irrigation solution while it is being removed. This irrigation is also continued via a catheter for 24 hours after the surgery.

What is the success rate of this procedure?

The prognosis for cancer of the prostate depends on the stage of the disease. If the tumours have not metastasised, the prospects of recovery with prostate removal are high.

A transurethral prostate removal can usually remedy the symptoms of benign prostate enlargement well. The urine flow becomes stronger again and the urge to urinate frequently subsides.

What are the possible complications and risks of this procedure?

As with all surgery, the operation may occasionally lead to post-operative bleeding, nerve damage or infections. 

The risk of nerve injuries with subsequent impotence or incontinence is much lower after a transurethral prostate removal than after a radical prostatectomy. However, such complications are now also occurring far less frequently after a radical prostate removal thanks to the careful surgical technique. In very rare cases, transurethral prostate removal can cause circulatory difficulties in the patient in question if irrigation fluid enters the blood stream. In such a situation, medication must be administered to quickly stabilise the circulation.

What happens after the operation?

After the operation, you will be monitored in the recovery room for a few hours. If a drainage tube has been inserted, it is usually removed in 24 hours. Urine is excreted via a bladder catheter in the first few days after the surgery. The catheter is removed before discharge from hospital.  Patients who undergo this operation must usually stay in hospital for five to seven days. You should do regular pelvic floor exercises after the operation to strengthen your pelvic floor muscles in order to prevent bladder incontinence.

You should not play sport or undertake any physically demanding activities for four to six weeks after the surgery.  Burning during urination and blood in the urine may occur for a few days after the surgery. Please make sure that you drink enough fluid.

Follow-up treatment for prostate cancer will be based on the stage of the cancer.

Only a section of the prostate is removed in the case of benign prostate enlargement. Accordingly, prostate cancer can still develop at a later date and the patient should continue to undergo regular cancer screenings.