Open prostatectomy for Benign Prostate Hypertrophy

Open Prostatectomy (OP) is a surgical procedure used to treat Benign Prostate Hypertrophy (BPH), a condition in which the prostate becomes enlarged and can cause urinary problems. This guide will give you a complete overview of the OP procedure, including its purposes, pre-operative preparation, surgical process, post-operative period and associated risks.

Purpose of Open Prostatectomy (OP)

OP is primarily used to relieve symptoms associated with benign prostatic hypertrophy, including:

Reduced urinary flow: an enlarged prostate can compress the urethra, reducing urinary flow and causing difficulty urinating;
Frequent, urgent urination: BPH can cause increased urinary frequency and a sudden urge to urinate;
Urinary retention: in some cases, an enlarged prostate can lead to a complete inability to urinate, causing a condition known as urinary retention.

Pre-operative preparation

Before OP, the patient will undergo a series of diagnostic tests and preparations, which may include:

Physical exams and laboratory tests: these may include blood tests, including PSA, urinalysis, and evaluations of kidney function.
Urological evaluation: the patient will undergo a complete urological examination, which may include a digital rectal examination (DRE) and, in some cases, a prostate ultrasound.
Discontinuation of anticoagulant drugs: if the patient is taking anticoagulant or antiplatelet drugs, it may be necessary to discontinue or adjust the dose under the doctor's supervision.

Surgery steps

The OP procedure is performed by making a transverse incision in the lower portion of the abdomen, two fingers above the pubis:

Anesthesia: OP can be performed using general anesthesia or spinal anesthesia, depending on patient and surgeon preference;
Lower abdominal incision, suprapubic, transverse (Pfannestiel incision): this is the incision that allows access to the anterior wall of the bladder;
Removal of the prostate tissue: once the anterior wall of the bladder is incised, a circular incision is made in the bladder neck, and the enlarged part of the prostate is enucleated and extracted, leaving the normal prostate in its place;
Bladder catheter: before closing the bladder, a bladder catheter is inserted to control bleeding and achieve correct drainage of the bladder in the postoperative period;
Skin sutures: self-absorbable stitches or metal clips can be used, which must be removed after a week:

Post-operative period

After the OP, the patient will be monitored by medical personnel and receive appropriate post-operative care. This can include:

Monitoring: the patient will be monitored closely to check for any post-operative complications, such as bleeding;
Pain management: the patient may receive pain medications, if necessary, to relieve any discomfort after the procedure;
Catheter: it is common for the patient to be left with a urinary catheter for 5-6 days after the procedure to allow urine to drain, control bleeding, and promote healing; after removal of the bladder catheter, the patient is monitored for 24 hours to check for the resumption of spontaneous urination;
Discharge and follow-up: upon discharge, a post-operative visit will be scheduled to check the wound, discuss the histological examination of the removed prostatic tissue, and verify the correct bladder emptying.

Risks associated with OP

Although OP is considered safe and effective, there are some associated risks and complications, including:

Bleeding: bleeding during or after the procedure may require blood transfusions or additional interventions to control it;
Infection: there is a risk of infection of the urinary tract or the prostate itself after OP;
Retrograde ejaculation: after OP, some men may experience retrograde ejaculation, where semen enters the bladder instead of being expelled through the urethra during orgasm; this side effect does not entail any danger;
Erectile dysfunction: although rare, OP can cause erectile dysfunction in some patients.

Risks associated with not doing the OP

Not performing OP when it is indicated may pose several risks and complications associated with untreated benign prostatic hypertrophy (BPH). Here are some of the main risks:

Worsening of urinary symptoms: without treatment, the symptoms associated with benign prostatic hypertrophy tend to worsen over time. These symptoms, as already mentioned on this website, include difficulty in starting urination, weak urinary flow, frequent and urgent urination, sensation of incomplete emptying of the bladder, and frequent awakenings at night to urinate. Worsening symptoms can significantly reduce quality of life and lead to problems such as acute urinary retention;
Acute urinary retention: without treatment, enlargement of the prostate can progress to cause a complete inability to urinate, known as acute urinary retention. This condition requires emergency medical intervention and can lead to serious complications, such as kidney damage, severe urinary infections, and other bladder-related complications;
Urinary tract infections: accumulation of urine in the bladder due to reduced urine flow increases the risk of developing urinary tract infections. These infections, as is known, can cause painful and unpleasant symptoms, such as burning during urination, urinary urgency, frequent urination, and sometimes fever and pelvic pain;
Kidney damage: accumulation of urine in the bladder due to untreated prostatic hypertrophy can increase pressure on the upper urinary tract, including the kidneys. Over time, this can lead to kidney damage, kidney failure, and other serious kidney complications;
Sexual complications: untreated benign prostatic hypertrophy can negatively affect sexual function. It can cause problems such as erectile dysfunction, painful ejaculation, and reduced libido.

Conclusions:

OP is an effective surgical procedure to treat the symptoms of benign prostatic hypertrophy and improve the quality of life of patients suffering from this condition. However, as with any surgery, patients need to understand the risks and benefits of the procedure and discuss their options with their doctor before making an informed decision.

Not treating BPH with OP or other treatment options can lead to a variety of urinary and general problems that can have a significant impact on the patient's quality of life and overall health. It is essential to consult a doctor to evaluate your treatment options and determine the best plan to manage the condition effectively.