Open Prostatectomy: The Latest BPH Procedure
Open prostatectomy is one of the surgical methods to treat Benign Prostatic Hyperplasia (BPH), which is enlargement of the prostate, a common condition among men over 45 years of age. The degree to which the prostate grows varies from man to man as they age and may constrict the urethra and cause difficulty with urination. Left untreated, BPH may lead to urinary tract infections, bladder or kidney damage, bladder stones or incontinence.
Open Prostatectomy
An open prostatectomy is the operation of choice when the prostate is very large — e.g., >80 grams (since transurethral surgery cannot be performed safely in these men). However, it carries a greater risk of life-threatening complications in men with serious cardiovascular disease, because the surgery is more extensive than TURP or TUIP.
In the past, open prostatectomies for BPH were carried out either through the perineum — the area between the scrotum and the rectum (the procedure is called perineal prostatectomy) — or through a lower abdominal incision. Perineal prostatectomy has largely been abandoned as a treatment for BPH due to the higher risk of injury to surrounding organs, but it is still used for prostate cancer. Two types of open prostatectomy for BPH — suprapubic and retropubic — employ an incision extending from below the umbilicus (navel) to the pubis. A suprapubic prostatectomy involves opening the bladder and removing the enlarged prostatic nodules through the bladder. In a retropubic prostatectomy, the bladder is pushed upward and the prostate tissue is removed without entering the bladder. In both types of operation, one catheter is placed in the bladder through the urethra, and another through an opening made in the lower abdominal wall. The catheters remain in place for three to seven days after surgery. The most common immediate postoperative complications are excessive bleeding and wound infection (usually superficial). Potential complications that are more serious include heart attack, pneumonia and pulmonary embolus (blood clot in the lungs). Breathing exercises, leg movements in bed and early ambulation are aimed at preventing these complications. The recovery period and hospital stay are longer than for transurethral prostate surgery.
Other types of surgery
Current surgical options include monopolar and bipolar transurethral resection of the prostate (TURP), robotic simple prostatectomy (retropubic, suprapubic and laparoscopic), transurethral incision of the prostate, bipolar transurethral vaporization of the prostate (TUVP), photoselective vaporization of the prostate (PVP), prostatic urethral lift (PUL), thermal ablation using transurethral microwave therapy (TUMT), water vapor thermal therapy, transurethral needle ablation (TUNA) of the prostate and enucleation using holmium (HoLEP) or thulium (ThuLEP) laser.
