All You Need to Know about Prostate Surgery

Prostate surgery, formally called “prostatectomy”, is a medical procedure performed on men to either remove or modify the prostate gland, to address complications in the prostate gland, which often arise as men age. This surgery is typically conducted to treat conditions such as an enlarged prostate (BPH) or prostate cancer. There are various types of prostate surgery, and the choice depends on the specific condition and the patient's overall health. The primary objective is to alleviate symptoms and enhance their well-being.

Types of Prostate Surgery

Common types of prostate surgery include:

Radical Prostatectomy Surgery

Radical Prostatectomy surgical procedure is a primary treatment for prostate cancer. It entails the complete removal of the prostate gland and adjacent tissues, and can be performed using various techniques, including open surgery and minimally-invasive approaches.

Transurethral Resection of the Prostate (TURP)

Transurethral Resection of the Prostate (TURP) is one of the most prevalent surgical interventions for BPH. It involves the removal of excess prostate tissue that obstructs the urethra. During this procedure, a slender tube equipped with a cutting instrument is inserted through the urethra to trim or eliminate the overgrown tissue.

Laser Prostate Surgery

Laser Prostate Surgery utilise concentrated laser energy to vaporise or remove prostate tissue. These techniques include Holmium Laser Enucleation of the Prostate (HoLEP) and Photoselective Vaporisation of the Prostate (PVP).

Open Prostatectomy

In cases of severely enlarged prostates or when alternative treatment methods prove inadequate, an open prostatectomy can be necessary. The surgery entails making an incision in the lower abdomen to excise the enlarged portion of the prostate.

Minimally-invasive Procedures

Various minimally invasive techniques are available to address prostate issues, including Transurethral Microwave Therapy (TUMT), Transurethral Needle Ablation (TUNA), and Prostatic Artery Embolization (PAE). These procedures aim to reduce or shrink prostate tissue using diverse methods, often without the need for incisions.

Robotic-assisted Prostatectomy

Robotic surgery for prostate cancer employs state-of-the-art robotic systems to enhance the precision of prostate removal. While commonly used for treating prostate cancer, this method can also be adapted for certain benign conditions.

Who Needs Prostate Surgery?

While medications can offer relief to many men dealing with an enlarged prostate {Benign Prostatic Hyperplasia (BPH)}, they may not always effectively alleviate the associated symptoms. In some cases, patients continue to experience persistent and troublesome symptoms that significantly affect their quality of life. When this occurs, the next step in the treatment of an enlarged prostate involves considering minimally invasive and surgical procedures.

Surgical procedures for BPH become the preferred option when diagnostic tests indicate a significant impact on urinary function and when complications related to BPH arise. These complications may include:

• Urinary Retention: This condition refers to the inability to urinate, causing significant discomfort and distress.
• Failure to respond to medical or minimally invasive treatments: In cases where previous treatments have not yielded positive results and the symptoms remain severe and unmanageable.
• Persistent blood in the urine: When the presence of blood in the urine does not improve, indicating a more serious issue.
• Formation of gallbladder stones: In some instances, BPH can lead to the development of gallstones, which can further complicate the condition.
• Frequent urinary tract infections: Increased susceptibility to urinary tract infections, which can lead to recurring health issues.
• Kidney damage: In severe cases, BPH-related complications can result in kidney damage, a serious and potentially life-threatening condition.

Preparation Before Prostate Surgery

Preparation for prostate surgery is a crucial step to ensure a safe and successful procedure. Here are some essential steps to follow:

• Health Assessment: A comprehensive evaluation is conducted to assess the patient’s overall health. This may include blood tests, electrocardiograms (ECGs), and other essential tests to determine fitness for surgery.
• Medication Review: The doctor should be informed about all medications, including prescription drugs, over-the-counter medications, and supplements. Guidance will be provided regarding the continuation or temporary discontinuation of certain medications.
• Fasting: Typically, patients are asked to abstain from eating or drinking for a specified period before the surgery to reduce the risk of anaesthesia-related complications. 
• Bowel Preparation: In certain cases, bowel preparation may be necessary, with instructions provided by the doctor. This may involve taking laxatives or using enemas.
• Smoking and Alcohol: If applicable, reducing or quitting smoking in the weeks leading up to surgery is advisable. Alcohol consumption should also be limited to promote optimal healing.
• Blood Clot Prevention: To reduce the risk of blood clots during and after surgery, the doctor may recommend blood-thinning medications or compression stockings.
• Consent: Patients are required to sign a consent form, acknowledging an understanding of the risks and benefits of the surgery. Carefully read this document and address any questions or concerns.
• Hygiene: On the day of the surgery, patients should take a shower and follow any specific hygiene instructions provided by their doctor.
• Essential Packing: Necessary personal items, identification, insurance information, and comfortable clothing should be packed for the hospital stay.

At-home Care Following Prostate Surgery

After prostate surgery, proper at-home care is essential for a smooth recovery. Here are some general post-operative care guidelines:

• Wound Care: Keep the surgical incision site clean and dry. Follow the doctor's instructions for wound care, including changing dressings and caring for any drainage tubes. Be vigilant for signs of infection, such as increased redness, swelling, or discharge.
• Pain Management: Take prescribed pain medications as directed. These medications can help manage discomfort and pain after surgery. Inform the doctor of any concerns regarding pain or medication side effects.
• Hydration: Stay well-hydrated to support the healing process. Drink plenty of water, but be mindful of any dietary restrictions advised by the doctor.
• Diet: Follow the dietary recommendations provided by the doctor, which may include sticking to a soft diet initially and gradually introducing solid foods. It is also important to focus on a balanced diet to support healing.
• Bowel Movements: Constipation can be a common issue following surgery. Use over-the-counter laxatives or stool softeners if recommended by the doctor. Ensure regular bowel movements to prevent discomfort and straining.
• Activity and Rest: Initially, rest is crucial for recovery. As strength is regained, engage in light walking to promote circulation. Avoid heavy lifting and strenuous activities, following the doctor's guidance regarding when it's safe to resume them.
• Urinary Care: After prostate surgery, you may experience urinary incontinence or changes in urinary function. Follow the guidance provided by the doctor, which may include pelvic floor exercises. Consider using incontinence pads or garments if needed.
• Pain Monitoring: Be aware of any persistent or increasing pain, fever, or signs of infection. Contact the doctor immediately if experiencing these symptoms.
• Wound and Drainage Tube Removal: The doctor will determine when it's appropriate to remove wound dressings and drainage tubes. This should be done by a healthcare professional.
• Sexual Activity: Discuss with the doctor when it's safe to resume sexual activity, as this varies depending on the type of surgery and individual recovery.
• Transportation: Avoid driving until being cleared to do so by the doctor. Arrange for transportation to medical appointments and other necessary outings.
• Follow-up Appointments: Attend all follow-up appointments with the doctor. These appointments are essential for monitoring progress and addressing any concerns or complications.

Risk and Complications of Prostate Surgery

Prostate surgery, like any medical procedure, carries certain inherent risks and potential complications. These include:

• Infection: There is always a risk of infection, either at the surgical site or in the urinary tract, with any surgical procedure.
• Bleeding: Surgical interventions involving the prostate can lead to bleeding, which may require medical attention.
• Urinary Retention: Some patients may face difficulties fully emptying their bladders, which can be a more serious issue.
• Erectile Dysfunction: Prostate surgery can affect a man's ability to achieve and maintain an erection, which may be a significant concern for some patients.
• Scarring (Strictures): The development of scar tissue in the urinary tract can result in blockages and urinary problems.

Side-effects of Prostate Surgery 

Side effects encompass a wider range of outcomes, which may be less severe or temporary in nature. These include:

• Urinary Incontinence: Some patients may experience involuntary urine leakage, which can vary in severity and duration.
• Blood in Urine (Hematuria): It's common to observe blood in the urine after surgery, but this typically resolves over time.
• Pain and Discomfort: Patients may experience temporary pain or discomfort in the pelvic area.
• Short-Term Changes in Bowel and Bladder Habits: Temporary alterations in bowel and bladder habits might occur.
• Bowel Issues: Prostate surgery can occasionally lead to temporary bowel changes, such as diarrhoea or constipation.
• Anaesthesia-Related Side Effects: The anaesthesia used during surgery can result in side effects like postoperative nausea or grogginess.
• Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): It's important to note that any major surgery, including prostate surgery, carries a risk of blood clot formation, leading to conditions like deep vein thrombosis or pulmonary embolism.

Why Choose Max Hospital for Prostate Surgery?

When it comes to prostate surgery, choosing Max means prioritising one's well-being. Max's renowned expert, Dr. Debashish Chaudhary, recommends prompt treatment decisions, ideally within six months, ensuring timely care delivery.

Patients at Max are encouraged to explore treatment options, comprehend potential side effects, and benefit from the extensive experience of Max's surgical and radiological team. Choosing Max for prostate surgery means choosing a healthcare provider that values the patient's health and offers expert guidance for their well-being.

Questions to Ask Your Doctor

Many seniors often face the question of when to undergo surgery for an enlarged prostate. As they explore their options, it's essential for them to ask their doctors the following five questions:

• Is there a reasonable likelihood that my condition will improve?
• To what extent can I expect improvement?
• What are the potential side effects associated with the chosen treatment?
• How long will the treatment's effects endure?
• Will this treatment require repetition in the future?