What is Open Prostatectomy Surgery and How is it Performed?

Open prostatectomy is a surgical procedure in which all or part of the prostate gland is removed. It is generally preferred for the treatment of large benign prostatic hyperplasia (BPH) or prostate cancer. Open prostatectomy is a more traditional technique compared to laparoscopic or robotic methods and provides an effective and safe solution, especially when the prostate is very large.

What is Open Prostatectomy Surgery?

Open prostatectomy is the surgical removal of the prostate gland. The term "open" means that the surgery is performed through a large incision in the lower abdomen. Through this incision, the prostate gland is accessed directly, and the surgeon carefully separates the tissues surrounding the gland to remove the prostate.

This surgery, usually performed under general anesthesia, allows for the direct visual removal of the prostate. Although it is a more traditional surgical technique compared to laparoscopic and robotic methods today, it is still one of the most effective methods, especially in cases where the prostate is very large. The patient's age, general health status, and prostate size play a significant role in deciding whether to perform this surgery.

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In what situations is open prostate surgery performed?

Open prostatectomy is commonly performed to treat benign prostatic hyperplasia and prostate cancer. It is a surgical method that is preferred, especially when other treatment methods have been insufficient or unsuitable. The main situations in which this surgery is preferred are as follows:

• Very large prostate gland: Normally, minimally invasive surgery (such as TUR-P) is preferred for prostate enlargement. However, if the prostate volume exceeds 100-120 grams, it may not be possible to remove all the tissue using a minimally invasive technique. Therefore, open surgery is preferred to open the urinary tract and completely resolve the symptoms.
• Symptoms associated with advanced prostate enlargement: This procedure can be performed in cases of persistent difficulty urinating, a feeling of incomplete bladder emptying, recurrent urinary tract infections, bladder stones, or the inability to urinate at all.
• Prostate cancer: In stages where prostate cancer is confined to the prostate gland and has not spread to surrounding organs, complete removal of the prostate is necessary. The open method is used especially in patients who are not suitable for laparoscopic or robotic surgery.
• Situations where minimally invasive surgical techniques are unsuitable: Some patients' anatomical structures may not be suitable for minimally invasive surgery. Comorbidities or previous surgeries can also make the closed method more difficult.

How is open prostatectomy surgery performed?

Open prostatectomy surgery is performed under general anesthesia. Before surgery, the patient's blood tests, imaging results, and overall health status are thoroughly evaluated. The surgery is usually performed from below the navel towards the pubic bone. In this method, the bladder is not opened; the prostate is accessed directly. When cancerous tissue is removed, the surrounding lymph nodes may also be removed.

There is another method performed via the bladder, but this method is more often preferred for benign growths. The incision is still made in the lower abdomen, but this method involves opening the bladder to access the prostate tissue. A Foley catheter (urinary catheter) is inserted after the surgery and usually remains in place for 3-5 days. Hospital stay can last up to 7 days. 

What precautions should be taken after open prostate surgery?

The post-operative period following open prostate surgery is crucial for the success of the treatment. Because it is open surgery, the recovery period is longer compared to laparoscopic surgery. Therefore, paying attention to lifestyle, hygiene, and the doctor's recommendations during this process will both speed up the recovery process and prevent complications. Here are some important points to consider after surgery:

• During the catheterization process, care must be taken to maintain the hygiene of the bag, it should be emptied regularly, and it should not touch the ground.
• Plenty of fluids should be consumed.
• Heavy lifting, sudden movements, and prolonged sitting should be avoided for the first 4-6 weeks; short walks should be used to support recovery.
• Constipation should be prevented, fiber-rich foods should be consumed, and alcohol and smoking should be avoided.
• For urinary incontinence that may occur in the first few months, regular Kegel exercises should be performed.
• Sexual intercourse can usually be resumed after 2-3 weeks, the timeframe being determined by the doctor based on the patient's condition. Erectile dysfunction should be reported to a doctor.
• If redness, discharge, or swelling occurs in the surgical area, the doctor should be consulted immediately.
• Doctor appointments should not be missed, and regular follow-ups are especially important for those who have undergone surgery for prostate cancer.
• Medications prescribed by the doctor should be taken regularly, and no other medication should be used without the doctor's knowledge. 

Frequently Asked Questions About Open Prostatectomy Surgery

Are Open Prostate Surgeries Dangerous?

Like any surgery, it carries risks (bleeding, infection, urinary incontinence, erectile dysfunction). However, it is generally safe in expert hands.

How long does recovery take after open prostate surgery?

Patients usually return to daily life in 4-6 weeks. Full recovery may take several months.

What is the difference between open and laparoscopic prostate surgery?

Open surgery is performed through a large incision, and the recovery period is long. If performed closed (laparoscopic or robotic), it is done through small incisions, allowing for faster recovery.

How long does open prostate surgery take?

It takes an average of 2-4 hours.

How long does urinary incontinence last after open prostate surgery?

It can occur frequently in the first few months. It may take longer for some. This time period varies from person to person. 

Does Open Prostate Surgery Affect Sexuality?

Yes, erection and ejaculation problems can occur. A decrease in sexual desire may also occur. This varies from person to person and can be largely managed with treatment.