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A prostatectomy is the surgical removal of all or part of the prostate gland. Enlargement of the prostate, commonly through benign prostatic hyperplasia (BPH), but sometimes through abnormalities such as a tumour, or from other causes, can restrict the normal flow of urine along the urethra, causing discomfort and difficulty voiding. Early preventive medical intervention with medications such as finasteride may forestall urinary restriction, making surgery unnecessary. Once a significant urinary restriction develops, however, it increases risks of obstructive uropathy, and even poses serious kidney damage from obstructive nephropathy if left untreated.
There are several forms of the operation:
This is used for benign prostatic hyperplasia (BPH), and sometimes for symptomatic relief in prostate cancer. 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 hyperplasia (BPH) and outcomes are excellent for a high percentage of these patients (80-90%).
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 is a newer technique that uses bipolar current to remove the tissue.  Bipolar TURP allows saline irrigation and eliminates the need for an ESU grounding pad thus preventing post-TURP hyponatremia (TUR syndrome) and reducing other complications. As a result bipolar Turp is also not subject to the same surgical time constraints of conventional TURP.
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 holmium-Nd:YAG high powered "red" or potassium titanyl phosphate (KTP) "green" 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 blood loss, elimination of the risk of post-TURP hyponatremia (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.
This procedure uses ionized vapour that heats up by low voltage electricity and semi-spherical button to vaporize the prostate tissue from inside and only leave a 2-3 mm shell. This procedure is considered to be the least intrusive of all techniques currently available and has less post-operative complications and a short convalescence.
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).
In RPP an incision is made in the perineum, 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.
Another type of open prostatectomy is suprapubic transvesical prostatectomy (SPP), or the Hryntschak Procedure, which was pioneered in the early 1930's by the Austrian Urologist, Theodor Hryntschak (1889 – 1952), where in 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.
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 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.
Surgical removal of the prostate risks an increased likelihood that patients will experience erectile dysfunction. 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.
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: