Prostatectomy

The prostate is a gland located below the bladder and in front of the anus (between the bladder and the penis). This gland secretes a fluid that contains sperm in the male reproductive system, which may be due to prostate cancer, urinary tract disease, enlargement and swollen prostate, or benign prostatic hyperplasia (BPH), requires prostate surgery for removal of all or part of it.

Surgical method

There are different types of prostate surgery, but all types of prostate surgery mentioned below can be performed under both general and spinal anesthesia, depending on the patient’s physical condition and the discretion of the surgeon and anesthesiologist, one of these two methods is used.

1. Open prostatectomy (open prostate surgery): An incision is made in the skin and the surgeon removes the prostate and extra tissue in it. There are two treatments for open surgery:

• • A. Radical retropubic prostatectomy: The surgeon makes an incision from the abdomen to the penis. In most cases, the surgeon only removes the prostate itself.
  • B. Radical perineal: The surgeon makes an incision between the anus and the scrotum. This method is usually chosen when due to certain conditions and diseases, radical retropubic surgery is not possible in the patient. In this case, the surgeon cannot remove the lymph nodes. This surgery takes less time than the previous method but may lead to erection problems in the patient.

2. Laparoscopy: This treatment is the least invasive and incisional treatment for the treatment of swollen prostate or prostate cancer in men. Laparoscopic radical prostatectomy (LRP) is a surgical procedure that requires making several small incisions of about two centimeters in the body so that the surgeon can insert small and special medical devices into the patient’s body. The surgeon uses a thin incision tool with a camera to see inside the body. The benefits of this method include reducing bleeding, reducing pain, reducing the length of hospital stay, and shorter recovery times.
3. Laser prostate surgery: In this type of laser surgery, benign prostate enlargement in men can be treated without the need for incisions on the skin. The surgeon inserts a small fiber-optic rod into the body through the penis and directs it to the urethra. The surgeon then removes tissue from the prostate that blocks the flow of urine.
4. Endoscopic surgery: Like laser prostate surgery, endoscopic surgery does not require making an incision in the patient’s body, and the surgeon uses a long, narrow tube with the help of light and a lens to remove extra parts of the prostate gland. This tube is inserted through the penis and is less invasive than the previous method.
5. Urethral dilation:

• • A. TURP: This surgery is a resection (removal of all or part of a tissue or organ in the body) of the urethra for enlarged prostate in men, which is one of the standard methods for benign and large swollen prostate disease. In this procedure, the surgeon separates the extra parts of the patient’s enlarged prostate with the help of a wire loop. These pieces enter the patient’s bladder and then are evacuated at the end of this treatment. One of the advantages of this surgical method is that the patient is not hospitalized for more than 2 to 3 days and urinary incontinence, which is one of the most common concerns of patients, is minimized.
  • B. TUIP: The method of urinary incision is for the prostate. In this procedure, the surgeon makes several small incisions in the prostate and the body of the bladder to dilate the urethra. The doctor will decide after performing the diagnostic process and related tests that which of these methods is right for you. Proportionate to the amount of prostate swelling and the patient’s condition and the patient’s medical record and general health, the treating physician determines which surgical procedure is most appropriate for the patient. It should be noted that all these surgical procedures mentioned above are performed in Mortaz Hospital by the most professional Iranian physicians who are medical professors in Yazd Medical Universities.