What to Expect During Prostate Surgery: Step-by-Step Overview

Prostate surgery, whether for prostate cancer or benign prostatic hyperplasia (BPH), is a major medical procedure that involves removing part or all of the prostate gland. Understanding the steps involved in the surgery can help ease anxiety and prepare you for what to expect. This guide provides a step-by-step overview of the process, from preoperative preparation to postoperative recovery.

1. Preoperative Preparation

1.1 Initial Consultation with the Surgeon

What Happens: Before surgery, you will meet with your urologist or surgeon to discuss the details of the procedure, review your medical history, and determine the best surgical approach based on your condition (e.g., prostate cancer or BPH).
Key Considerations: The surgeon will evaluate your overall health, imaging tests, and blood work, such as prostate-specific antigen (PSA) levels. They will also explain the different surgical options available (e.g., open surgery, robotic-assisted surgery, or minimally invasive procedures) and the expected outcomes.

1.2 Pre-Surgical Tests

What Happens: Before surgery, you will undergo a series of tests to ensure you are in good health and ready for the procedure. These tests may include blood work, an electrocardiogram (EKG) to check heart function, and a chest X-ray.
Purpose: These tests help the medical team identify any potential risks and prepare for a safe surgery.

1.3 Instructions for the Day Before Surgery

Fasting: You will likely be instructed not to eat or drink anything after midnight the night before your surgery.
Medications: Your doctor will provide specific instructions regarding which medications to take or avoid before surgery, especially if you are on blood thinners or medications for other conditions.

2. Admission and Anesthesia on the Day of Surgery

2.1 Hospital Admission

What Happens: On the day of surgery, you will check into the hospital or surgical center several hours before the procedure. You will meet the surgical team, including the anesthesiologist, nurses, and your surgeon.
Preparation: A nurse will prepare you for surgery by checking your vital signs, starting an intravenous (IV) line, and reviewing your medical history once more.

2.2 Meeting the Anesthesiologist

What Happens: The anesthesiologist will explain the type of anesthesia you will receive and address any concerns. Prostate surgeries are typically performed under general anesthesia, meaning you will be asleep throughout the procedure.
Purpose: General anesthesia ensures that you remain unconscious and feel no pain during surgery.

3. The Surgical Procedure

3.1 Positioning and Incision

What Happens: Once the anesthesia takes effect, the surgical team will position you appropriately based on the type of surgery. If you are undergoing an open prostatectomy, the surgeon will make a large incision in your lower abdomen or perineum. In robotic-assisted or laparoscopic surgery, the surgeon will make several small incisions to insert surgical instruments and a camera.

3.2 Removal of the Prostate or Tissue

Radical Prostatectomy (Prostate Cancer): In cases of prostate cancer, the surgeon will remove the entire prostate gland along with surrounding tissues and possibly some lymph nodes to ensure all cancerous cells are removed.
Transurethral Resection of the Prostate (TURP) for BPH: For BPH treatment, the surgeon uses a resectoscope inserted through the urethra to remove the obstructive prostate tissue, clearing the pathway for urine to flow more easily.
Holmium Laser Enucleation of the Prostate (HoLEP): In this procedure, a laser is used to remove enlarged prostate tissue for patients with BPH.

3.3 Nerve-Sparing Techniques (for Prostate Cancer Surgery)

What Happens: During radical prostatectomy, the surgeon may use nerve-sparing techniques to avoid damaging the nerves responsible for erectile function and urinary control. This depends on the location and extent of the cancer.
Purpose: Nerve-sparing techniques aim to preserve sexual and urinary function post-surgery.

4. Completion of the Surgery

4.1 Final Inspection and Closure

What Happens: Once the prostate gland or tissue is removed, the surgeon will inspect the area to ensure there are no complications, such as bleeding or damage to surrounding tissues.
Closure: For open surgery, the incision is closed with sutures or staples. In robotic or laparoscopic surgery, the small incisions are closed with sutures or adhesive strips.

4.2 Catheter Placement

What Happens: After the prostate is removed, a urinary catheter (Foley catheter) will be placed in your bladder to help drain urine while your body heals. The catheter is typically left in place for 1-2 weeks post-surgery.
Purpose: The catheter allows urine to flow freely from your bladder while your urethra and surrounding tissues heal.

5. Postoperative Care and Recovery

5.1 In the Recovery Room

What Happens: After surgery, you will be taken to the recovery room, where the medical team will monitor your vital signs and ensure that you are waking up from anesthesia without complications. You may feel groggy, and pain medication will be administered as needed.
Pain Management: The surgical team will provide medication to manage any pain or discomfort, especially around the incision site.

5.2 Hospital Stay

Duration: The length of your hospital stay depends on the type of surgery. For minimally invasive procedures like robotic-assisted surgery, you may be discharged within 1-2 days. For open surgery, the hospital stay may be 3-5 days.
Monitoring: During your hospital stay, your healthcare team will monitor your urine output, catheter function, and incision site to ensure that you are healing properly.

5.3 Mobility

Early Movement: You will be encouraged to get out of bed and start walking as soon as possible after surgery to promote circulation and prevent blood clots. Walking also helps prevent complications like pneumonia.

6. Recovery at Home

6.1 Catheter Care

What Happens: You will go home with the urinary catheter still in place. Your healthcare team will provide instructions on how to care for the catheter and keep the area clean to avoid infection.
Catheter Removal: The catheter is typically removed 1-2 weeks after surgery during a follow-up visit.

6.2 Managing Pain and Discomfort

Medication: You will be prescribed pain medications to manage any discomfort during recovery. Over-the-counter pain relievers, such as ibuprofen, may also be recommended.
Discomfort: It's normal to experience some discomfort or soreness around the incision site, and you may feel tired for a few weeks.

6.3 Activity Restrictions

Lifting Restrictions: Avoid lifting heavy objects (more than 10-15 pounds) for several weeks after surgery to prevent strain on the incision site.
Exercise: Gentle walking is encouraged, but avoid strenuous exercise or activities like running, cycling, or heavy lifting until your doctor gives clearance.
Driving: Do not drive until you are no longer taking prescription pain medication and feel comfortable behind the wheel.

6.4 Follow-Up Appointments

When: You will have follow-up appointments with your surgeon within a week or two after surgery. These visits are crucial for monitoring your recovery, checking for complications, and removing the catheter.
Additional Tests: For prostate cancer patients, follow-up appointments may include PSA tests to monitor for any signs of cancer recurrence.

7. Long-Term Recovery and Outcomes

7.1 Returning to Normal Activities

Timeline: Most patients can return to normal activities, including work, within 4-6 weeks for minimally invasive procedures and 6-8 weeks for open surgery. It may take several months for full recovery.
Sexual Function: If nerve-sparing techniques were used, it may take several months to a year for erectile function to return. Medications or devices may be prescribed to assist with recovery.

7.2 Urinary Function

Short-Term Incontinence: Temporary urinary incontinence is common after prostate surgery, especially after radical prostatectomy. Many patients regain urinary control within a few weeks to a few months, though some may require longer rehabilitation.
Pelvic Floor Exercises: Your doctor may recommend Kegel exercises to strengthen the pelvic floor muscles and improve urinary control.

Prostate surgery is a major medical procedure that can effectively treat conditions such as prostate cancer and BPH. Understanding the step-by-step process—from preoperative preparation to recovery at home—can help you prepare for the surgery and ensure a smoother recovery. While the type of surgery and recovery time may vary based on the approach (open or robotic-assisted), most patients can expect improved urinary function and, in the case of cancer, a good chance of eliminating the disease.

Frequently Asked Questions (FAQ)

1. How long does prostate surgery typically take?

Prostate surgery can take 2-4 hours, depending on the type of surgery (open or robotic-assisted) and the complexity of the case.

2. How long do I need to stay in the hospital after prostate surgery?

For minimally invasive surgeries like robotic-assisted prostatectomy, patients typically stay 1-2 days. Open surgery may require a 3-5 day hospital stay.

3. Will I have a catheter after prostate surgery?

Yes, a urinary catheter is typically placed after prostate surgery to help drain urine during the healing process. It is usually removed 1-2 weeks after surgery.

4. How long does it take to recover from prostate surgery?

Recovery time varies, but most patients can resume normal activities within 4-6 weeks after minimally invasive surgery and 6-8 weeks after open surgery.

5. Will I experience erectile dysfunction after prostate surgery?

Erectile dysfunction is a possible side effect of prostate surgery, particularly after radical prostatectomy. Nerve-sparing techniques can help preserve erectile function, but recovery may take several months to a year.