Prostate Removal Surgery in Delhi, India

Prostate removal surgery, or prostatectomy, is a procedure to remove the prostate, a small gland that sits below the bladder and surrounds the urethra, the tube that carries urine out of the body. It is required when conditions such as prostate cancer or benign prostatic hyperplasia (BPH) cause significant symptoms or complications that cannot be effectively managed with medication or less invasive treatments. The surgery can be done through minimally invasive methods, sometimes with robotic assistance, or through open surgery, which requires a larger incision.

There are two main types of prostate removal surgery. The preferred method is determined based on the patient’s condition and overall health.

Simple Prostatectomy

The prostate has two parts: an inner section that grows as men age and an outer layer that surrounds it like a capsule. In a simple prostatectomy, only the enlarged inner section is removed, while the outer layer remains intact.

There are different ways to perform this surgery:

Open surgery: A vertical incision (cut) is made in the lower abdomen to remove the inner portion.

Robotic surgery: The surgeon makes small cuts in the abdomen and inserts a thin tube with a camera (laparoscope) to guide the procedure. Surgical tools are used to remove the inner section through these small openings. This avoids the complications of surgery through penis and provides a very effective relief of symptoms.

TURP procedure (Transurethral Resection of the Prostate): 

This is a common method for treating an enlarged prostate. Unlike traditional surgery, it does not require external cuts. Instead, a thin instrument is inserted through the urethra to trim excess prostate tissue, helping relieve urinary symptoms.

Laser procedure for prostate conditions: In some cases, a minimally invasive laser treatment is used to remove or shrink excess prostate tissue. This method generally results in less bleeding and faster recovery compared to traditional surgery.

Radical Prostatectomy

A radical prostatectomy removes the entire prostate gland, along with nearby tissues like seminal vesicles and lymph nodes. The urethra is then reattached to the bladder with stitches.

This procedure can be performed in different ways:

Open surgery: The surgeon makes a vertical cut from the belly button to the pubic bone to remove the prostate.

Laparoscopic surgery: Small cuts are made to insert a laparoscope and surgical tools for the removal.

Robotic-assisted surgery: A robotic system allows the surgeon to operate with greater accuracy, especially in difficult-to-reach areas.

Prostate removal surgery is recommended when other treatments, such as medication or lifestyle changes, do not provide relief. This procedure is usually performed in the following cases:

• Prostate Cancer: If cancer is found within the prostate, a radical prostatectomy can help eliminate cancer and prevent its spread. This procedure is generally considered for healthy men under 75 years old.
• Enlarged Prostate (BPH): The prostate can grow larger with age and press on the bladder, making it hard to urinate. If medicines do not help, surgery can remove part of the prostate to improve urine flow and reduce symptoms.
• Trouble Urinating (Urinary Retention): If a person cannot urinate even with a catheter, surgery may be needed to clear the blockage.
• Repeated Infections (Urinary Tract Infections - UTI): If the prostate stops the bladder from emptying properly, infections may keep recurring. Surgery can help resolve this issue.
• Bladder Stones or Kidney Problems: If urine cannot flow out properly, it may cause stones in the bladder or kidney issues. Removing part of the prostate may alleviate these conditions.

A doctor will determine if surgery is the best option based on a patient’s overall health, symptoms, and medical history.

Before undergoing a prostate removal operation, several steps are taken to ensure the patient is prepared.

• Medical Evaluation: Before surgery, a doctor assesses overall health by reviewing medical history and conducting a physical examination. It is important to mention any existing health conditions, allergies, or medications that are being taken.
• Diagnostic Tests: Blood tests and imaging scans, such as X-rays or MRI, may be done to assess the prostate and surrounding areas.
• Pre-Surgery Instructions: Some medications, such as blood thinners or anti-inflammatory drugs, may need to be stopped before surgery to reduce the risk of bleeding. Patients are usually advised to avoid food and drinks after midnight before the procedure. Doctors will explain the type of prostatectomy planned, along with details about the procedure, recovery, and potential risks.
• Understanding the Procedure: A doctor is likely to explain the type of prostatectomy being planned, along with what might happen during and after surgery. Information about the procedure and recovery process is provided to ensure patients are well-prepared.

The prostate removal procedure is performed under general anaesthesia, ensuring that the patient remains unconscious and feels no pain.

Anaesthesia

Before the surgery, the patient is given general anaesthesia so they stay unconscious and do not feel any pain. A small tube (catheter) may be used to drain urine during and after the procedure.

Procedure

The type of surgery may vary depending on the patient’s condition and the doctor’s recommendation.

Open Surgery: A cut is made in the lower abdomen, usually between the belly button and the pubic bone. This allows the surgeon to remove the prostate gland. Once done, the incision is closed with stitches or staples. A small surgical drain may be placed to help remove excess fluid during recovery.

Robotic-Assisted Surgery: In robotic prostate removal, small cuts are made in the abdomen, and a laparoscope (a thin tube with a camera) is inserted to guide the procedure. Special robotic instruments allow for greater precision while preserving nearby tissues. The urethra is reattached to the bladder, and a surgical drain may be placed to aid healing.

The choice of surgery depends on the patient’s health, condition, and the doctor’s advice.

Recovery after prostate removal requires patience and proper post-surgical care. Following medical advice, avoiding strain, and gradually returning to activities can help the body heal and improve overall well-being.

Hospital Stay & Immediate Care

After the surgery, bandages or skin glue may be used to protect the incision sites. The effects of anaesthesia may take time to wear off, so the patient may feel drowsy at first. Pain medication may be provided if necessary. A urinary catheter is usually in place for a few days to help drain urine while the body heals.

Activity Restrictions & Healing

For the first couple of days, a liquid diet may be advised before slowly reintroducing solid foods. Doctors may recommend walking soon after surgery, as it can support blood flow, aid healing, and potentially reduce the risk of complications. It is important to avoid heavy lifting and strenuous activities for a few weeks to allow proper healing.

Rehabilitation & Follow-Up

Most patients leave the hospital within a day or two, depending on their condition. However, prostate removal recovery time varies from person to person. While some may resume light activities within a few weeks, full recovery can take several months. Follow-up appointments help ensure a smooth recovery and address any concerns along the way. Medications such as painkillers, antibiotics, and blood thinners are sometimes prescribed as part of post-surgery care.

Prostate removal surgery is generally safe and effective in reducing symptoms. However, like any surgery, it carries certain risks. Some prostate operation side effects may include:

• Infection: There is a chance of infection at the surgical site or in the urinary tract. In most cases, this can be managed with medication, but in some instances, further treatment might be required.
• Bleeding: Some patients may experience bleeding during or after surgery. While minor bleeding is common, significant blood loss might need medical attention.
• Urinary Retention: Some patients may find it harder to empty their bladder completely after surgery, but this is often temporary.
• Erectile Function Changes: The procedure may impact erectile function, making it harder to achieve or maintain an erection in some cases. If this occurs, various treatment options may help manage the issue.
• Scar Tissue Formation: Scar tissue may develop in the urinary tract, which could lead to blockages or difficulty urinating. If necessary, further procedures might help address this.
• Other Possible Risks: As with any surgery, there may be effects related to anaesthesia, swelling, blood clot formation, or fluid buildup at the surgical site. These issues are typically monitored, and doctors may offer guidance on managing them.

Every patient’s recovery is different, and doctors can guide patients on reducing risks and supporting the healing process.

1. How does prostate removal surgery affect urinary control?

Some men may experience temporary urinary incontinence after surgery. This is because the prostate surrounds the urethra and helps control urine flow. Most patients regain bladder control within a few weeks to months with the help of pelvic floor exercises.

2. Will I need a catheter after prostate removal surgery?

Yes, a urinary catheter is typically placed during surgery to help drain urine while the body heals. It is usually removed within one to two weeks, depending on the recovery progress.

3. Can prostate removal surgery affect sexual function?

Since the nerves responsible for erections are close to the prostate, there is a chance of erectile dysfunction after surgery. The impact varies based on the type of procedure and individual health. Some men recover their function over time, and treatments such as medications or therapy may help.

4. What is nerve-sparing prostatectomy, and who is eligible for it?

A nerve-sparing prostatectomy is a surgical approach that aims to preserve the nerves responsible for erectile function. It is usually considered for patients with localised prostate cancer that has not spread beyond the gland. The doctor will determine if this technique is suitable based on the patient's condition.

5. Will I experience changes in ejaculation after prostate removal?

Yes, after a radical prostatectomy, ejaculation no longer occurs because the prostate and seminal vesicles, which produce semen, are removed. However, the ability to experience orgasm remains intact in many cases.

6. How soon can I return to work after prostate removal surgery?

The recovery period depends on the type of surgery and individual health. Most patients can resume light activities within two to three weeks and return to work within four to six weeks. Jobs that require heavy lifting may require a longer recovery time.

7. Does prostate removal surgery affect testosterone levels?

No, prostate removal surgery does not directly impact testosterone levels since the prostate is not responsible for hormone production. However, hormone therapy, which is sometimes used for advanced prostate cancer, can lower testosterone levels.

8. Can prostate cancer return after prostate removal?

If the cancer was confined to the prostate and completely removed, the chances of recurrence are low. However, in some cases, microscopic cancer cells may remain and cause a recurrence. Regular follow-ups and PSA tests help monitor for any signs of cancer returning.

9. What is PSA, and why is it tested after surgery?

PSA (Prostate-Specific Antigen) is a protein produced by the prostate. After prostate removal, PSA levels should drop to nearly undetectable levels. Regular PSA tests help monitor for any potential recurrence of cancer.

10. Can prostate removal surgery cause bowel problems?

Bowel issues are uncommon after prostate surgery, but some patients may experience temporary constipation due to anaesthesia, medications, or reduced activity. Staying hydrated and eating fibre-rich foods can help prevent constipation during recovery.

11. Are there any long-term lifestyle changes needed after prostate removal?

Most men can return to their normal routines after recovery. However, maintaining a healthy diet, staying active, and performing pelvic floor exercises can help improve bladder control and overall well-being.

12. Can prostate removal surgery affect fertility?

Yes, prostate removal results in infertility since the seminal vesicles and part of the reproductive system are removed. Men who wish to have children after surgery may consider sperm banking before the procedure.

13. How does robotic-assisted prostatectomy compare to traditional surgery?

Robotic-assisted prostatectomy offers more precision, smaller incisions, and a quicker recovery compared to open surgery. It also reduces the risk of complications such as excessive bleeding and prolonged incontinence. However, the best approach depends on individual medical needs.

14. Is prostate removal surgery painful?

Patients receive general anaesthesia during the procedure, so they do not feel pain. After surgery, some discomfort or soreness is expected, but pain medication is provided to manage it. Most patients find the pain to be manageable and temporary.

15. What should I eat after prostate removal surgery?

A balanced diet rich in fibre, lean protein, and fluids is recommended to aid healing and prevent constipation. Spicy, acidic, or caffeine-rich foods should be avoided initially as they may irritate the bladder.

16. Can I exercise after prostate removal?

Light walking is encouraged soon after surgery to promote circulation and healing. However, strenuous exercises, heavy lifting, and high-impact activities should be avoided for at least six weeks or until the doctor gives clearance.

17. What follow-up care is needed after prostate removal?

Regular follow-up visits include PSA tests to monitor for recurrence, as well as checks on urinary and sexual function. Doctors may also recommend physiotherapy or lifestyle changes to support recovery.

18. Does prostate removal affect the risk of other cancers?

Prostate removal does not increase the risk of other cancers. However, men with a family history of prostate cancer may have a higher risk of developing other cancers, so regular health screenings are advised.

19. Can I drive after prostate removal surgery?

Driving is not recommended for at least two weeks after surgery, as sudden movements or discomfort could interfere with safe driving. Patients should wait until they can move comfortably and are off strong pain medications.

20. How do I choose the best hospital for prostate removal surgery?

When selecting a hospital, factors such as the experience of the surgeons, availability of advanced technology (such as robotic-assisted surgery), post-operative care, and patient success rates should be considered. Max Hospital is a trusted choice, offering expert care, state-of-the-art facilities, and a comprehensive recovery plan for patients undergoing prostate removal surgery.

Reviewed by Dr. Pankaj Panwar, Principal Consultant - Uro-Oncology and Robotic Surgery, Surgical Oncology, Cancer Care, on 07-April-2025.