Prostatectomy
Encyclopedia
A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine
along the urethra
.
There are several forms of the operation:
(BPH) and outcomes are excellent for a high percentage of these patients (80-90%).
irrigation and eliminates the need for an ESU grounding pad thus preventing TUR syndrome and reducing other complications. As a result bipolar Turp is also not subject to the same surgical time constraints of conventional TURP.
-Nd:YAG high powered "red" or potassium titanyl phosphate (KTP) to vaporize the adenoma
. More recently the KTP laser has been supplanted by a higher power laser source based on a lithium triborate crystal, though it is still commonly referred to as a "Greenlight" or KTP procedure. The specific advantages of utilizing laser energy rather than a traditional electrosurgical TURP is a decrease in the relative bloodloss, elimination of the risk of TUR syndrome, the ability to treat larger glands, as well as treating patients who are actively being treated with anti-coagulation therapy for unrelated diagnoses.
, and the prostate is removed, by going behind the pubic bone (retropubic).
, midway between the rectum
and scrotum
through which the prostate is removed. This procedure has become less common due to limited access to lymph nodes and difficulty in avoiding nerves.
. Nerve-sparing surgery reduces the risk that patients will experience erectile dysfunction. However, the experience and the skill of the nerve-sparing surgeon, as well as any surgeon are critical determinants of the likelihood of positive erectile function of the patient.
Remedies to the problem of post-operative sexual dysfunction include:
prostate surgeon based at The Prostate Centre
in London
. Professor Roger Kirby has performed over 2000 radical prostatectomy operations during his career and is internationally recognised as one of the UK's most experienced prostate surgeons.
However, Daily Mail reported in November 2011, the Top Ten Urologists for Surgical Treatment of Prostate cancer. The findings were based upon Urologist themselves asking the question "Who do the experts trust to treat prostate cancer?".
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
along the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
.
There are several forms of the operation:
Transurethral resection of the prostate (TURP)
A cystoscope [a resectoscope which has a 30 degree viewing angle, along with resectoscopy sheath & working element] is passed up the urethra to the prostate, where the surrounding prostate tissue is excised. This is a common operation for benign prostatic hyperplasiaBenign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH) and outcomes are excellent for a high percentage of these patients (80-90%).
Conventional (monopolar) TURP
The conventional TURP method in tissue removal utilizes a wire loop with electrical current flowing in one direction (thus monopolar) through the resectoscope to cut the tissue. A grounding ESU pad and irrigation by a nonconducting fluid is required to prevent this current from disturbing surrounding tissues. This fluid (usually glycine) can cause damage to surrounding tissue after prolonged exposure, resulting in TUR syndrome, so surgery time is limited.Bipolar TURP
Bipolar TURP is a newer technique that uses bipolar current to remove the tissue. Bipolar TURP allows salineSaline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
irrigation and eliminates the need for an ESU grounding pad thus preventing TUR syndrome and reducing other complications. As a result bipolar Turp is also not subject to the same surgical time constraints of conventional TURP.
Laser prostate surgery
Another surgical method utilizes laser energy to remove tissue. With laser prostate surgery a fiber optic cable pushed through the urethra is used to transmit lasers such as holmiumHolmium
Holmium is a chemical element with the symbol Ho and atomic number 67. Part of the lanthanide series, holmium is a rare earth element. Its oxide was first isolated from rare earth ores in 1878 and the element was named after the city of Stockholm....
-Nd:YAG high powered "red" or potassium titanyl phosphate (KTP) to vaporize the adenoma
Adenoma
An adenoma is a benign tumor of glandular origin. Adenomas can grow from many organs including the colon, adrenal glands, pituitary gland, thyroid, prostate, etc. Although these growths are benign, over time they may progress to become malignant, at which point they are called adenocarcinomas...
. More recently the KTP laser has been supplanted by a higher power laser source based on a lithium triborate crystal, though it is still commonly referred to as a "Greenlight" or KTP procedure. The specific advantages of utilizing laser energy rather than a traditional electrosurgical TURP is a decrease in the relative bloodloss, elimination of the risk of TUR syndrome, the ability to treat larger glands, as well as treating patients who are actively being treated with anti-coagulation therapy for unrelated diagnoses.
Open prostatectomy
In an open prostatectomy the prostate is accessed through an incision that allows manual manipulation and open visualization through the incision. The most common types of open prostatectomy are radical retropubic prostatectomy (RRP) and radical perineal prostatectomy (RPP).Radical retropubic prostatectomy
With RRP, an incision is made in the lower abdomenAbdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
, and the prostate is removed, by going behind the pubic bone (retropubic).
Radical perineal prostatectomy
In RPP an incision is made in the perineumPerineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
, midway between the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
through which the prostate is removed. This procedure has become less common due to limited access to lymph nodes and difficulty in avoiding nerves.
Suprapubic transvesical prostatectomy
Another type of open prostatectomy is suprapubic transvesical prostatectomy (SPP) where an incision is made in the bladder. SPP remains a common surgical treatment for BPH in Africa but has largely been supplanted by TURP in the West for this application. SPP may be indicated for use with large patients and prostates because of the surgical time constraints associated with conventional TURP.Laparoscopic radical prostatectomy
This is a laparoscopic procedure involving four small incisions made in the abdomen used to remove the entire prostate for treatment of prostate cancer.Computer-assisted laparoscopic radical prostatectomy (CALP)
Computer-assisted instruments are inserted through several small abdominal incisions and controlled by a surgeon. Some use the term 'robotic' for short, in place of the term 'computer-assisted'. However, procedures performed with a computer-assisted device are performed by a surgeon, not a robot. The computer-assisted device gives the surgeon more dexterity and better vision, but no tactile feedback compared to conventional laparoscopy. When performed by a surgeon who is specifically trained and well experienced in CALP, there can be similar advantages over open prostatectomy, including smaller incisions, less pain, less bleeding, less risk of infection, faster healing time, and shorter hospital stay. The cost of this procedure is higher, whereas long-term functional and oncological superiority has yet to be established.Sexual effects of prostatectomy
Surgical removal of the prostate risks an increased likelihood that patients will experience erectile dysfunctionErectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
. Nerve-sparing surgery reduces the risk that patients will experience erectile dysfunction. However, the experience and the skill of the nerve-sparing surgeon, as well as any surgeon are critical determinants of the likelihood of positive erectile function of the patient.
Remedies to post-operative sexual dysfunction
Very few surgeons will claim that patients return to the erectile experience they had prior to surgery. The rates of erectile recovery that surgeons often cite are qualified by the addition of Viagra to the recovery regimen.Remedies to the problem of post-operative sexual dysfunction include:
- Medications
- Intraurethral suppositories
- Penile injections
- Vacuum devices
- Penile implants
Notable surgeons
Professor Roger Kirby is a BritishUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
prostate surgeon based at The Prostate Centre
The Prostate Centre
The Prostate Centre is a private men’s health clinic based in London’s Harley Street medical community. It is among the UK’s top centres for prostate care and treatment due to its team of specialist prostate surgeons, oncologists, physicians, radiologists and lifestyle therapists...
in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
. Professor Roger Kirby has performed over 2000 radical prostatectomy operations during his career and is internationally recognised as one of the UK's most experienced prostate surgeons.
However, Daily Mail reported in November 2011, the Top Ten Urologists for Surgical Treatment of Prostate cancer. The findings were based upon Urologist themselves asking the question "Who do the experts trust to treat prostate cancer?".
External links
- The Basics of the Prostatectomy Procedure Explained
- National Prostate Cancer Coalition
- Prostatectomy Procedure Video
- Prostatectomy - slideshow by The New York TimesThe New York TimesThe New York Times is an American daily newspaper founded and continuously published in New York City since 1851. The New York Times has won 106 Pulitzer Prizes, the most of any news organization...