The types of surgery on the prostate

An operation to treat the prostate is called a prostatectomy. There are several types. If you decide with your surgeon that an operation is the best option, the choice of surgery should be explained to you beforehand. It is not always possible to tell which operation will be most suitable for you until you are anaesthetized, and the prostate and bladder can be examined more closely.

T.U.R.P. (Transurethral Resection of the Prostate)
This is the most common type of operation, used in 95 per cent of prostatectomies.
A special narrow telescope is used (called a resectoscope). After you are anaesthetized this is carefully inserted up the penis. It allows the surgeon to see the prostate and up into the bladder. It uses heat from an electric current to cut away pieces of the prostate which are then washed out through the penis and sent away for further examination. Only the obstructing part of the prostate is removed. Because the operation takes place through the penis there is no visible scar or wound. Nevertheless, you have been cut inside and you need to allow time for healing to take place afterwards. This operation takes about 40 minutes.

The surgeon can connect the resectoscope to a TV monitor to carry out the operation.

[DIAGRAMS]

Open prostatectomy
When the prostate is too large to perform the ‘TURP’, it must be removed by means of an incision in the lower abdomen. The recovery period is longer because the wound needs to heal.

Bladder neck incision (BNI)
When the prostate is not enlarged, a cut may be made into the neck of the bladder to improve the flow of urine. No prostate tissue need be removed.

New surgical treatments
Laser and microwave devices are now being used to remove excess prostate tissue while avoiding bleeding and other side-effects. You may have heard about these new techniques but you should understand that latest is not necessarily best. If you are interested, ask your surgeon if they are available in your hospital and are suitable for you. Do not be surprised if you are invited to take part in a clinical trial of one of these methods.

What about the anaesthetic?
The anaesthetic is one of the main concerns of patients. Modern anaesthetics are very safe, and serious complications uncommon.

Prostatectomy is performed under a general, epidural or spinal anaesthetic. The anaesthetist will decide which is best in your particular case. The spinal and the epidural anaesthetic makes you numb from the waist down so that you feel nothing during the operation, though you remain conscious. If you wish it, with these methods the anaesthetist can also sedate you so you would sleep through the operation. Alternatively, it is possible to stay awake during the operation and even get the opportunity to watch it on a TV monitor as it happens.

How long will I be in hospital?
Recovery is usually rapid. Most patients can go home about 4 days after the operation, but must take things easy for about 4 weeks after discharge. Time away form work may be longer if your work involves a lot of heavy lifting or digging (see the section on ‘recovery’).

What should I know about prostate cancer?
Most enlarged prostates are not cancerous. However, the symptoms caused by enlargement of the normal prostate can be the same as those of a cancer. In its earlies stages, there may be no symptoms with prostate cancer. The doctor can sometimes identify a cancerous prostate though the rectal examination. To be absolutely sure a test is done on the tissue removed from every patient during the operation. Sometimes the results of this ‘pathology’ test are available prior to the patient leaving hospital. In most cases hospitals give this news at the time of the next outpatient clinic visit, which may be some time later.

If you are particularly anxious about this, ask your surgeon for the result to be given to you as soon as it is available.

What treatments are available for prostate cancer?
Many older men who are found to have this will reach the end of their natural lives before the cancer poses a problem for them. So where the cancer is very small it may be felt best just to wait and watch for any change in the condition through regular checkups. This may be advisable because of the pateint’s age and if he suffers from other health problems which could be aggravated by treatment side-effects.

For very small cancers which are confined to the prostate, one treatment is to remove the whole organ (a ‘radical prostatectomy’). However, due to risk of side-effects this usually offered to younger fit men only, and there is disagreement over its effectiveness beyond this group.

For some tumours in some men, radiation treatment is believed to be the best available option. This will be decided by the surgeon and radiotherapist (who may work from a different hospital). There is a planned course of radiotherapy for each patient. Once completed, your surgeon or radiotherapist will inform you of progress made.

Where the cancer has spread beyond the prostate other treatments are needed. Drugs administered by tablet or injection may be used to reduce the male hormone (testosterone) on which the cancer depends. In serious cases testosterone supply can be halted by removing the testicles. Where drug therapy is given, the ‘TURP’ prostatectomy may also be required to reduce obstruction of the urethra by the enlarging organ.