Prostate removal surgery (Prostatectomy) | Dr Samson Olori

What is prostatectomy?

The prostate is a small gland below the bladder that produces fluid for semen. Prostatectomy is surgery to remove part or all of the prostate. It is used mainly to treat localised prostate cancer and sometimes severe benign prostatic hyperplasia (BPH) when other treatments have failed. Types include radical prostatectomy (removal of the whole gland, often with nearby lymph nodes, for cancer), simple prostatectomy (removal of the inner part of the gland for BPH to relieve urinary symptoms), and laparoscopic or robotic-assisted prostatectomy (minimally invasive approaches that may reduce blood loss and speed recovery).

Symptoms and diagnosis

Prostate cancer may cause difficulty urinating, blood in the urine or semen, frequent urination (especially at night), pain on urination or ejaculation, or pain in the back, hips, or pelvis. BPH causes similar urinary symptoms: frequency, urgency, weak stream, incomplete emptying, and dribbling. Diagnosis is made with a digital rectal examination (DRE), prostate-specific antigen (PSA) blood test, and often a prostate biopsy. Imaging (e.g. MRI, CT) may be used to stage cancer. We can refer you to a urologist for full assessment and to discuss whether surgery is the right option.

The procedure and aftercare

Radical prostatectomy can be done by open surgery, laparoscopy, or robot-assisted laparoscopy. The prostate and sometimes nearby lymph nodes are removed; the bladder is reconnected to the urethra. A urinary catheter stays in place for about 1–2 weeks. You will be encouraged to move soon after surgery to reduce the risk of blood clots. Pelvic floor (Kegel) exercises can be started before or soon after surgery to support urinary control. Avoid heavy lifting and strenuous activity for at least six weeks. Your urologist will advise on driving, return to work, and when you can resume sexual activity. Follow-up checks include wound healing, catheter removal, and—if done for cancer—PSA tests to monitor for recurrence.

Risks and recovery

Possible effects of prostatectomy include urinary incontinence (temporary or long-term—improved with pelvic floor exercises), erectile dysfunction (depends on age, nerve preservation, and type of surgery), infertility (semen is no longer produced), and changes in orgasm (e.g. dry orgasm). There are also general surgical risks such as bleeding, infection, and blood clots. Recovery typically involves 1–3 days in hospital, a urinary catheter for 1–2 weeks, and avoiding heavy lifting and strenuous activity for at least six weeks. Follow-up is important to monitor healing, urinary function, and, if done for cancer, PSA levels to check for recurrence.

Frequently asked questions

Will I be incontinent after prostatectomy?
Some men have temporary or lasting leakage of urine. Pelvic floor (Kegel) exercises and sometimes further treatment can help. We discuss this before surgery and support you during recovery.
Will I still be able to have sex?
Erectile function can be affected because nerves that run near the prostate may be damaged. Recovery varies; some men improve with time or with treatment. We can refer you for advice and support.
How often will I need follow-up?
If surgery was for cancer, PSA is usually checked every 3–6 months for the first years. We also monitor urinary function and any new symptoms. Your urologist will give you a schedule.
How long is the hospital stay?
Many men go home within 1–3 days after laparoscopic or robotic prostatectomy. Open surgery may require a slightly longer stay. Your urologist will advise based on your recovery.