Prostatectomy (PTT)
Prostatectomy (PTT): Overview, Types, Procedure, Risks, and Recovery
What is Prostatectomy (PTT)?
Prostatectomy (PTT) is a surgical procedure to remove all or part of the prostate gland. It is commonly performed to treat prostate cancer or benign prostatic hyperplasia (BPH) causing urinary obstruction. The extent of removal depends on the condition being treated.
Types of Prostatectomy
- Simple Prostatectomy
- Removes only the part of the prostate blocking urine flow, usually for BPH.
- Does not remove the entire prostate gland.
- Radical Prostatectomy
- Complete removal of the prostate gland, its capsule, seminal vesicles, and sometimes nearby lymph nodes.
- Primarily used to treat localized prostate cancer.
Approaches to Radical Prostatectomy
- Open Prostatectomy
- Retropubic approach: Incision in the lower abdomen from the belly button to the pubic bone. Allows removal of prostate and lymph nodes.
- Perineal approach: Incision between the anus and scrotum; less common due to limited lymph node access and higher risk of erectile dysfunction.
- Minimally Invasive Prostatectomy
- Laparoscopic prostatectomy: Several small incisions in the abdomen; surgeon manipulates instruments directly.
- Robotic-assisted laparoscopic prostatectomy: Surgeon controls robotic arms via a console; offers greater precision, less blood loss, shorter hospital stay, and potentially better preservation of urinary and sexual function.
Procedure Details
- Under general or regional anesthesia, the prostate and surrounding tissues are carefully dissected and removed.
- A catheter is placed in the urethra to drain urine during healing, typically left in place for 1–2 weeks.
- Pelvic lymph node dissection may be performed if cancer spread is suspected.
- Surgery duration and recovery depend on the approach and patient factors.
Risks and Complications
- Urinary incontinence (loss of bladder control)
- Erectile dysfunction (impotence)
- Bleeding and infection
- Injury to surrounding organs or nerves
- Lymphocele or lymphatic leakage after lymph node removal
Recovery
- Hospital stay ranges from 1 to several days depending on surgery type.
- Catheter remains for 1–2 weeks post-op.
- Physical activity is gradually increased over weeks.
- Follow-up includes monitoring urinary function, sexual health, and cancer markers (PSA).
- Pelvic floor exercises may help improve continence.
Summary Table
| Type | Approach | Indications | Advantages | Disadvantages |
|---|---|---|---|---|
| Simple Prostatectomy | Open | BPH | Less extensive | Not for cancer |
| Radical Prostatectomy (Open) | Retropubic or perineal incision | Localized prostate cancer | Direct access, lymph node removal | Larger incision, longer recovery |
| Laparoscopic Radical Prostatectomy | Multiple small abdominal incisions | Localized prostate cancer | Minimally invasive, less pain | Requires surgical expertise |
| Robotic-assisted Prostatectomy | Robotic arms controlled by surgeon | Localized prostate cancer | Precision, less blood loss, better functional outcomes | Higher cost, limited availability |
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References
- Title: European Association of Urology Guidelines on Prostate Cancer: 2023 Update
DOI: 10.1016/j.eururo.2023.07.001
Summary: These updated guidelines from the European Association of Urology provide recommendations for the diagnosis, treatment, and follow-up of prostate cancer. They cover various aspects of prostatectomy, including surgical techniques, patient selection, and management of complications. - Title: Simple Prostatectomy for Benign Prostatic Hyperplasia: A Contemporary Review
DOI: 10.1007/s11934-021-01034-7
Summary: This review discusses simple prostatectomy as a surgical option for benign prostatic hyperplasia (BPH). It covers different techniques, including open, laparoscopic, and robotic approaches, and assesses their effectiveness in relieving urinary obstruction while minimizing complications.
Prostatectomy, especially radical prostatectomy, is a cornerstone treatment for localized prostate cancer. Minimally invasive techniques, particularly robotic-assisted surgery, have improved surgical precision and recovery outcomes, though risks like urinary incontinence and erectile dysfunction remain important considerations.
