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Open Prostatectomy for Benign Prostatic Hyperplasia
Open prostatectomy is the surgical removal of the prostate gland. It is done under a general or spinal anesthetic. Usually, an incision is made through the lower abdomen, although sometimes the incision is made between the rectum and the base of the penis. A catheter may be placed in the bladder through the lower abdominal skin to help flush the bladder (postoperative bladder irrigation) and another catheter comes out of the penis to drain the urine. The procedure requires a slightly longer hospital stay and recovery period than transurethral resection of the prostate (TURP).
Open prostatectomy is not done very often for benign enlargement of the prostate. It may be recommended if:
- You have a very large prostate.
- You have bladder diverticula (pouches in the wall of the bladder) or bladder stones.
- TURP is not possible for another reason.
A prostatectomy also reduces the chances that another surgery will be needed, which is a potential problem when TURP is used.
If you have been treated for prostate cancer, an open prostatectomy cannot be done.
What To Expect
Open prostatectomy requires several days in the hospital. A catheter is left in place for 3 to 5 days. You may go home with a urinary catheter in place. Your doctor will give you instructions about how to care for your catheter at home.
Why It Is Done
Open prostatectomy usually is used for men who want surgery to treat their benign prostatic hyperplasia (BPH) symptoms and who have very enlarged prostates.
How Well It Works
Open prostatectomy almost always improves symptoms.footnote 1
The risks of open prostatectomy include:
- The possible need for a blood transfusion. Slightly more men require a blood transfusion after open prostatectomy than after TURP.
- An inability to have sexual intercourse because of erection problems. This occurs in less than 5 out of 100 men and is more frequent in older men than in younger men.footnote 2
- A strong urge to urinate (overactive bladder), which can also cause leaking of urine (urge incontinence). This usually gets better within weeks or months.
- Complete or partial inability to hold back urine (incontinence).
- Ejaculation of semen into the bladder instead of out through the penis (retrograde ejaculation). This happens in 80 to 90 out of 100 men who have open prostatectomy. Although this is not harmful, it may cause fertility problems.
What To Think About
Surgery usually is not needed to treat BPH, but some men may choose it. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to think about include your expectation of the results, the severity of your symptoms, and the possibility of having complications.
Men who have severe symptoms before surgery often have great improvement in their quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve their quality of life. They may want to think carefully before deciding to have surgery to treat BPH.
- AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 3: Results of the treatment outcomes analyses. Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
- Han M, Partin AW (2012). Retropubic and suprapubic open prostatectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2695–2703. Philadelphia: Saunders.
Current as of: February 11, 2020
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