Purpose: Prostate surgery may be recommended in the following cases:

• Prostate cancer, to prevent cancer from spreading outside the prostate gland
• Benign prostatic hyperplasia (BPH)

Symptoms: The following are the symptoms of prostate cancer, which may indicate the need for prostate surgery:

• Frequent urination
• Painful urination
• Burning sensation during urination
• Difficulty in urinating
• Increased urination at night
• Blood in urine
• Painful ejaculation
• Difficulty in having an ejaculation
• Blood in semen
• Pain in the pelvic area (area below the stomach) and legs
• Bone pain

Diagnosis:

1. Physical examination: The doctor evaluates the physical health status of the patient. The symptoms and medical history of the patient are also noted.
2. Cystoscopy: A visual scope is used to look inside the bladder and urethra (the tube that allows urine to be expelled from the body). It helps the doctor to check the size of the prostate and examine the urinary system.
3. Digital rectal exam: The doctor inserts his/her gloved, lubricated finger into the rectum to examine the prostate. If the doctor finds any abnormalities, further tests may be required.
4. Prostate-specific antigen (PSA) test: It is a type of blood test done to check the level of PSA in blood. A high level may indicate prostate infection, enlargement, inflammation, or cancer.
5. Ultrasound: This is an imaging test performed to obtain a clear image of the prostate gland.
6. MRI scan: This is also an imaging test done to obtain clear pictures of the prostate gland and its surrounding structures.
7. Biopsy: The doctor may collect a sample of cells from the prostate gland and send it to the laboratory for evaluation and check for the presence of cancer cells.
8. Blood and urine tests: These are routine tests performed before surgery to check for any underlying infections.
9. Chest x-ray: It helps in evaluating the condition of the heart and lungs of the patient.
10. Electrocardiogram (ECG): It helps in recording the electrical activity of the heart and checking for any heart problems.

Prostate surgery is primarily of two types:

• Open approach Radical Prostatectomy- open prostatectomy refers to the traditional form of surgery wherein the prostate is removed by making a single long incision (cut) in the skin. Open prostatectomy can be done in two different ways.

1. Radical retropubic prostatectomy- this type of surgery involves making an incision from the lower belly to the pubic bone. The prostate is removed to through this incision. This type of surgery also gives the surgeon access to nearby tissue and lymph nodes which might be affected.
2. Radical perineal prostatectomy- here, the incision is made between the anus and the scrotum (perineum). This type of surgery is performed when a retropubic surgery may pose complications. It lasts for a shorter duration than a retropubic surgery and recovery may be faster and less painful.

• Laparoscopic approach to radical prostatectomy- this procedure is comparatively less invasive and is carried out by making several small incisions to remove the prostate with the help of special tools.

1. Laparoscopic radical prostatectomy- multiple small surgical instruments along with a small tube, with a camera on one end, are inserted through small cuts to remove the prostate.
2. Robotic-assisted laparoscopic radical prostatectomy- uses a robotic interface which is connected to the instruments and camera. The robotic arms are controlled and monitored by the surgeon sitting in the operating room.

• Endoscopic surgery:

1. This procedure also does not involve making any incisions.
2. A long, flexible tube with a light and camera on one end goes through the tip of the penis to remove the parts of the prostate gland.

• Widening the urethra: This can be done in the following ways:

1. Transurethral resection of the prostate (TURP): This is the standard procedure for BPH. The urologist cuts pieces of the enlarged prostate tissue using a wire loop. The tissue pieces go into the bladder and flush out after the completion of the procedure.
2. Transurethral incision of the prostate (TUIP): This procedure involves making small cuts in the prostate and bladder neck for widening the urethra.

The following complications are associated with prostate surgery:

• Bleeding
• Infection
• Blood clot formation
• Allergic reaction to anesthesia
• Damage to the nearby organs
• Painful urination
• Difficulty in urinating
• Urinary incontinence (involuntary urine leakage)
• Erectile dysfunction
• Loss of libido
• Loss in fertility
• Lymphedema (accumulation of fluid in the lymph nodes in the legs or genital area)
• Groin hernia (a condition in which the soft tissues bulge through a weak point in the muscles of the abdomen)

• The patient will stay in the hospital for two to five days after the surgery, depending on the type of procedure performed.
• The doctor will prescribe pain-relieving medications to relieve the pain and discomfort of the patient after the procedure.
• Antibiotics will be prescribed to reduce the chances of infection.
• Take adequate rest after surgery.
• It is normal to have some blood in urine, urinary irritation, urinary tract infections, difficulty in holding urine, and prostate inflammation for a few days after the procedure.
• A drain tube comes out of the abdomen. This drain tube is generally removed a day or two after the surgery.
• A catheter (small tube) is fitted to the penis to drain the urine into an attached bag or bottle. This catheter is removed one to three weeks after the surgery. The patient is instructed on how to care for the catheter at home.
• The patient is instructed on how to keep the surgical wound clean.
• Driving should be avoided for one week after the procedure.
• Avoid strenuous activities and heavy lifting for six weeks after the procedure.
• Avoid soaking in bathtubs, hot tubs, and swimming pools.
• Avoid sitting in one position for a long time.
• Avoid sexual activities till the doctor permits the same.
• Drink plenty of fluids, exercise regularly, and eat a fiber-rich diet to prevent constipation after the procedure.
• The patient may be given laxatives if there are no bowel movements within a day or two of the surgery.
• If there is swelling in the scrotum after the surgery, a rolled towel may be placed under the scrotum while the patient is sitting or lying down. The ends of the rolled towel are looped over the legs to provide support. The doctor should be contacted if the swelling does not reduce after a week.