Types of Prostate Surgery In Detail

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Prostate Surgery: An Overview

Prostate Gland Image, Prostate Gland, Prostate, Prostrate,
The Prostate Gland. Image: © ADAM

Prostate surgery is commonly performed for two reasons: prostate cancer and benign prostatic hypertrophy (BPH). Treatment may be life-saving, or it may be done to relieve problems urinating that did not respond to medication.

Deciding on a prostate procedure can be difficult as there are multiple types available for the treatment of prostate issues. Each surgery has unique benefits and risks. Some of the less invasive procedures have a quicker recovery time, but they are not appropriate for the treatment of cancer. The more invasive procedures can cause long term complications, but those issues must be weighed against the risk of leaving prostate cancer untreated.

Your choice of surgeon may be the most important decision you make, even more so than the type of procedure. The more skilled the surgeon, preferably with extensive experience performing hundreds or even thousands of procedures just like yours, the less likely you are to experience erectile dysfunction due to nerve damage.

In addition to selecting a highly skilled surgeon, it is important to work with your surgeon to select the best procedure for your unique needs. Some procedures are used to shrink prostate tissue, others remove a portion or all of the prostate and may be used to treat cancer.

All surgeries have an element of risk, prostate surgery has some specific risks in addition to the more general risks of a surgical procedure.

2
Robotic Prostate Surgery

Prostate Gland Image, Prostate Gland, Prostate, Prostrate,
The Prostate Gland. Image: © ADAM

The robotic-assisted laparoscopic prostatectomy is an inpatient surgery performed to treat prostate cancer with the assistance of a robot. When performed without a robot it is referred to as a laparoscopic prostatectomy, but is otherwise the same procedure.

It is important to keep in mind that the skill of the surgeon is the most important factor in determining the final outcome from your surgery. A robot in the hands of an excellent surgeon should result in an excellent outcome, however, a robotic surgery performed by a less skilled surgeon will be less likely to have a great outcome.

Both the laparoscopic prostatectomy and the robotic procedure are minimally invasive procedures, done using keyhole incisions rather than the older traditional surgery which used a large incision from pubic bone to umbilicus.

The procedure is performed under general anesthesia and begins with five small incisions spaced between the pubic bone and the umbilicus. Through these incisions small instruments are inserted, including a video camera, assisting instruments and cutting tools. In the robotic procedure, the surgeon is controlling the cutting instruments by controlling the robot. In the non-robotic procedure, the hands of the surgeon are directly controlling the instruments.

The prostate is removed through an incision after being cut away with a scalpel or similar instrument. Once the tissue has been removed, the area is irrigated with sterile solution, a foley catheter is inserted and the incisions are closed.

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Transurethral Resection of the Prostate (TURP)

Transurethral resection of the prostate, also known as a TURP procedure, is one of the most common prostate surgeries used to treat cancer. This procedure is done in two ways, the “standard” procedure which uses a scalpel to remove prostate tissue, or the using electro-resection, which uses an electrified wire loop to remove tissue.

This procedure is minimally invasive, and there are no visible incisions requiring wound care after the procedure. It is an inpatientprocedure, with the patient staying overnight in the hospital at the minimum.

The TURP procedure begins with the administration of anesthesia. The penis and surrounding skin is cleaned with a solution to sterilize the skin as much as possible. The pubic area may also be shaved.

The surgeon begins by introducing a cytoscope or a resectoscope into the urethra. The instrument has a light and a camera, which allow to surgeon to visualize the procedure. The instruments use are typically half an inch in diameter and at least 12 inches long.

The tube-like instrument is advanced through the urethra until the prostate is reached. When it is in place, the surgeon removes sections of the prostate or the entire gland. This may be done with a cutting instrument or a wire that is electrified.

The surgery site is frequently flushed with irrigation solution, which will push any pieces of the prostate up into the bladder. This solution may have additives that prevent infection or minimize swelling.

When the surgery is completed, the instruments are removed and a foley catheter is inserted into the bladder. The pieces of the prostate that are in the bladder are then flushed from the body with urine, into the foley catheter collection bag.

There may be some blood in the urine in the days immediately following surgery, and the pieces of the prostate from the bladder may also be noted.

4
Transurethral Microwave Thermotherapy (TUMT)

Prostate Gland Image, Prostate Gland, Prostate, Prostrate,
The Prostate Gland. Image: © ADAM

Transurethral microwave thermotherapy (TUMT) is an outpatient surgical treatment for benign prostatic hypertrophy (BPH). The process is meant to help men who have difficulty urinating due to prostate size and is not used to treat prostate cancer. The procedure is typically repeated several times to obtain the desired effect.

Under sedation, a special urinary catheter is inserted in through the urethra and into the bladder. Once the surgeon has the catheter in place, a small microwave antenna is inserted into the prostate gland.

Once in place, the antenna is heated to at least 113 degrees Fahrenheit (45 degrees Celcius). Temperatures below 113 degrees do not provide necessary heat for reliable tissue death, however, higher temperatures can cause pain and require a cooling component during the procedure.

The procedure can result in prostate edema (swelling) so the urinary catheter is typically left in place for 5 to 7 days. For most patients, TUMT is repeated several times for optimum results.

5
Minimally Invasive Prostate Surgery (TUEVAP)

Transurethral Electro-Vaporization of the Prostate, or TUEVAP, is a minimally invasive variation on the TURP procedure that uses electro cautery to remove prostate tissue.

The procedure is essentially the same except instead of using an electrified wire to remove prostate tissue, an electrified roller ball is used. The ball is applied to the prostate, vaporizing the unwanted tissue. The ball can also be used to cauterize small blood vessels to control bleeding.

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Sources

Sources:

Incontinence After Prostate Surgery. Global Robotics Institute at Florida Hospital. https://www.globalroboticsinstitute.com/en/urology-robotic-prostatectomy/incontinence-after-prostate-surgery

Laparoscopic Robotic Assisted Prostatectomy. University of Michigan Health System. Accessed May 2010. http://www.med.umich.edu/1libr/urology/lapRP.htm

Transurethral Electro-Resection of the Prostate. Cedars-Sinai. Accessed May 2010. http://www.csmc.edu/Patients/Programs-and-Services/Minimally-Invasive-Urology-Program/Treatment/Transurethral-Electro-Resection-of-the-Prostate-TURP.aspx

Transurethral Microwave Technology. Cedars-Sinai. Accessed May 1010. http://www.csmc.edu/Patients/Programs-and-Services/Minimally-Invasive-Urology-Program/Treatment/Transurethral-Microwave-Technology-TUMT.aspx

Transurethral Resection of the Prostate. National Institute of Health. Accessed May 2010. http://www.nlm.nih.gov/medlineplus/ency/article/002996.htm

Urinary Incontinence Following Prostate Cancer Treatment: Incidence and Clinical Presentation. From the Service d'Urologie at the Hôpital Charles Nicolle, Rouen, France (PG), and the Genitourinary Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida. Medscape Today.

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