Prostate Surgery

Definition of Prostate Surgery

Prostate surgery is a surgical procedure aimed at removing all or part of the prostate gland, either because of its large size or because it is affected by a malignant tumor.

There are various types of prostate surgery. For example, prostate surgery for an adenoma (prostate enlargement) is different from prostate cancer surgery; we will describe both.

Who is prostate surgery indicated for?

Surgical indications for prostate enlargement

Benign prostatic hyperplasia (BPH), also called benign prostatic adenoma (BPA), coincides with an increase in prostate volume, often due to aging. This benign growth occurs in the transition zone of the prostate, compressing the prostatic urethra and preventing urine evacuation. This is a very common pathology in men: it affects 5-10% of men after age 40 and more than 80% after age 70 and 80, but only produces symptoms in half of the subjects. This hypertrophy should not cause excessive concern, as it is a benign and reversible disease, in which there is no tumor formation or tissue infiltration. Scientific studies have not established a correlation between prostatic hyperplasia and carcinoma, although these pathologies can coexist.

Prostate surgery in this case is indicated for people whose prostate has a volume greater than 60 cm3, who have urinary symptoms of urinary retention and/or nocturia (nocturnal urination), which seriously affects their quality of life.

Surgical indications for prostate cancer

Regarding prostate cancer, surgery is performed in cases where there are no metastases, that is, in cases where the cancer is located only in the prostate. The decision to proceed with surgery has a curative purpose: the objective is indeed to eliminate the entire tumor.

The operation is called radical prostatectomy and consists of the removal of the prostate, seminal vesicles, and lymph nodes present in the regions around the prostate and in the pelvis. Lymph nodes are small glands whose function is to filter fluids and proteins (and possibly cancer cells) present in the lymphatic vessels. Lymph node removal is performed in order to achieve complete tumor removal and more precise staging of the disease.

Why is prostate surgery performed?

Prostate surgery, in the case of a prostate adenoma, is performed to prevent obstruction at the level of the urethra that prevents the exit of urine, and that the urine accumulates at the level of the bladder, forcing the patient to wear a catheter permanently.

In the case of non-disseminated prostate cancer, the removal of the prostate, if there are no metastases, is performed because it improves the prognosis of the disease and, combined with chemotherapy or radiotherapy, can be curative.

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Risks of prostate surgery

Possible complications associated with prostate surgery include:

• Retrograde ejaculation: This is the condition in which the emission of sperm is reversed, not outwards but into the bladder. It does not alter the sensation of pleasure, but can interfere with the ability to have children;
• Urinary incontinence;
• Urethral stricture: This is the narrowing of the urethra; it affects about 4% of people undergoing prostate surgery;
• Persistent and profuse bleeding: They are very rare;
• Urinary tract infections: In the most unfortunate cases, they can also be a recurring problem;
• Urinary retention: Due to damage to the bladder muscles, this consists of the inability to completely empty the bladder during urination;
• Impotence (or erectile dysfunction): This is the difficulty in achieving or maintaining an erection;

Preparation for prostate surgery

Preparation for prostate surgery involves a blood test with coagulation and urine, an electrocardiogram and a chest X-ray as well as a visit to the anesthesiologist.

How does convalescence after prostate surgery proceed?

After prostate surgery, recovery will be gradual. It is normal to stay in the hospital for one day if it is a transurethral resection of the prostate, or up to five days if it is a radical resection for prostate cancer.

After the operation, the patient wears a bladder catheter through which it is normal for hematuric (bloody) urine to flow, which gradually clears to become clear in about fifteen days. The catheter will remain in place for about a week. The patient's return to normal life is generally one month after the procedure.

Results of prostate surgery

Prostate surgery gives satisfactory results when it is surgery for prostate adenoma, since it produces an improvement in the patient's quality of life, who will not have to wear a catheter, nor get up continuously to urinate.

The results of prostate cancer surgery are a little more complex. Although the removal of the prostate reduces the possibility of disease progression, there may be sequelae such as impotence and/or urinary incontinence, which may persist over time.

How to prevent prostate cancer?

Prostate cancer involves a number of unpredictable factors, such as heredity. Men whose first-degree relatives have had prostate cancer are more likely to develop it than those who do not have it in their family. It has not been shown that the use of medications or vitamins can prevent prostate cancer.

Studies have not proven the existence of a clear link between diet and overweight, on the one hand, and cancer, on the other, although it seems that eating well and exercising can make the appearance of cancer more difficult.

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