What is an open prostatectomy

An open prostatectomy is the removal of the obstructing portion of a benign prostate through a surgical incision. Open prostatectomies are usually reserved for large prostates that weigh more than 100 grams. The open prostatectomy allows for the greatest amount of prostate tissue to be removed, but the morbidity is greater than less invasive options because it is an open surgical procedure.

The most common approach to performing an open prostatectomy is through a lower abdominal incision that extends from the symphysis pubis to the umbilicus (belly button) (Figure 23).

retropubic approach

Figure 23 Types of surgical incisions for simple prostatectomy: suprapubic or retropubic approach and perineal approach.

After the surgeon enters the abdomen through this incision, he or she has two surgical choices. The first is to make an incision in the front wall of the bladder to approach the prostate. This is called a suprapubic prostatectomy. After the surgeon has entered the bladder, he or she can enucleate, or shell out, the center of the prostate with his or her index finger. After the inner portion of the prostate is enucleated, stitches are placed in the prostatic fossa (the shell of prostate that is left). Postop-eratively, the patient is left with a urethral catheter coming out of his penis and a suprapubic catheter coming out of the lower abdomen. A patient is usually in the hospital 3 or 4 days after a suprapubic prostatectomy.

A retropubic simple prostatectomy is similar to a suprapubic simple prostatectomy as it is also performed through a lower abdominal incision. When performing a retropubic simple prostatectomy, however, the urologist does not open the bladder but instead makes an

Open Simple Prostatectomy

retropubic approach

Figure 23 Types of surgical incisions for simple prostatectomy: suprapubic or retropubic approach and perineal approach.

Suprapubic or

Perineal approach

Suprapubic or

Perineal approach incision through the prostate capsule. As is done with a suprapubic prostatectomy, the inner portion of the prostate is enucleated. Because the bladder is not opened, it is not necessary to leave a suprapubic tube postoper-atively, but a urethral catheter is left in place. Like a suprapubic simple prostatectomy, the patient is usually in the hospital 3 or 4 days postoperatively. The retropubic approach tends to be associated with less bladder irritation after the procedure since the bladder itself is not opened.

In addition to the abdominal approaches described previously here, a benign prostate can be surgically approached via the perineum (Figure 23). When this approach is used, the perineal skin incision is used to expose the prostate; then an incision is made in the prostatic capsule, and the prostate is enucleated, similar to a simple retrop-ubic prostatectomy. A urethral catheter is left postopera-tively, and the patient is usually in the hospital 1 to 2 days.

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