Prostatectomy - Prostate Surgery in Hyderabad, India

Prostatectomy procedure steps

The urology team follows the below steps for performing prostatectomy surgery:

Before the Prostatectomy procedure

• Before having surgery, patients need to undergo various examinations and consultations with the urologist.
• Patients should see a urologist for a complete physical examination to ensure that their health status, such as diabetes, high blood pressure, and heart or lung disorders, are properly managed. More examinations are to be done to confirm bladder function.
• Patients who smoke need to give up smoking several weeks before the procedure.
• It is essential to inform the urologist about all medications, vitamins, and supplements patients use, including over-the-counter (OTC) medications.
• In the weeks before surgery, patients are required to stop taking anticoagulants and antiplatelets. On the day of surgery, patients are allowed to discuss with the surgeon the medications they should continue taking.
• Patients may take a specific laxative the day before surgery to clear the colon's contents.
• On the day of the procedure, eating or drinking need to be avoided the night before surgery, which begins at midnight.
• Patients can take the prescribed amount of medication together with a small sip of water.
• The patients will have to do a signature on a consent form authorizing the doctors to perform the surgery. Patients should carefully read the form; if there are any questions, they can ask the doctors.
  

• Procedures may change depending on the patient's condition and the doctor's practices.
• Patients will be asked to remove jewelry or other objects to avoid disrupting the treatment.
• Patients will be given a gown and asked to remove all their regular clothing.
• Before the procedure, individuals will be instructed to empty their bladder.
• The patient's hand or arm will receive an intravenous (IV) line.
• The hair at the surgery location may be shaved off if it grows too much.
• An antiseptic solution will clean the skin surrounding the surgery site.
• Throughout the procedure, the anesthesiologist will monitor the patient's breathing, blood pressure, heart rate, and blood oxygen saturation closely. 
• After patients have been put to sleep, a ventilator will be connected to them, and a breathing tube may be put down their neck and into their lungs to help them breathe during the procedure.
• The doctor might choose regional anesthesia rather than general anesthesia. Both analgesic and sedative medications will be given to help a patient relax and relieve pain. The doctor will select the type of anesthesia that is appropriate for patients.
• A catheter will collect the urine from the bladder.



• In transurethral resection of the prostate (TURP): The resectoscope, a tiny metal tube with a light, camera, and loop of wire inside, is inserted into the patient's urethra by the surgeon, who then uses the light and camera to guide it to the prostate location. A portion of the prostate is removed by heating the loop of wire with an electric current. Following the procedure, the removed prostate pieces are flushed out from the bladder using a catheter, which is a thin, flexible tube.
• In radical prostatectomy: From the navel (belly button) to the pubic area, an incision will be made. Usually, lymph node removal is done first by the urologist. The urethra needs to be detected, and the prostate glands nerve bundles will be carefully extracted. In addition, if required, the seminal vesicles may be extracted. They remove the prostate gland. Usually, a drain is placed in the lower right portion of the incision. Sutures are used to close the incisions and are covered with a sterile covering or bandage.
  

After the Prostatectomy procedure

• Following a prostatectomy, patients need to stay in the hospital for two to four days. Patients are required to stay in bed till the following morning. They will be asked to move around as much as they can after they are permitted to stand up. 
• The nurse will assist patients in switching bed positions. In addition, patients receive instruction on deep breathing and coughing exercises to maintain blood flow. 
• They need to perform the exercises every three to four hours. To keep their lungs clear, they might need to utilize a breathing machine and wear specific compression stockings. 
• Patients will have a Foley catheter in their bladder when they exit surgery.
• Some men have suprapubic catheters inserted into their abdominal walls to aid in bladder emptying.
  

Like every other surgical procedure, complications are likely to occur. Several risks can occur after having prostate surgery. The following are a few possible complications of both simple and radical prostatectomy:

• Urinary incontinence: Uncontrolled, involuntary urine leakage is known as incontinence, and it can get better over time even a year or so after surgery. However, if the patient is older than 70 years old when the procedure is done, this condition can get worse.
• Urinary dribbling or leakage: It is a type of overflow incontinence. This symptom is most severe immediately following surgery and usually gets better with time.
• Change in penis length: Penis length may decrease in a small percentage of cases having surgery.
• Erectile dysfunction: Impotence is another term for erectile dysfunction. After surgery, sexual function may not fully recover and may take up to two years. Although it reduces the chance of occurring, a nerve-sparing prostatectomy doesn't guarantee that impotence won't happen.
• Lymphedema: Swelling occurs when fluid builds up in the soft tissues, a condition known as lymphedema. Inflammation, blockage, or removal of the lymph nodes during surgery can all result in lymphedema. Fluid may eventually build up in the legs or genital area following a prostatectomy, despite being an uncommon consequence.
• Bleeding: Bleeding may occur after surgery and can need a blood transfusion. Rarely, a second procedure may be required.
• Infection: An intravenous (IV) needle or drip can cause an infection, which can also happen at the site of the wound in the urinary system. Antibiotics are one possible course of treatment.
• Deep vein thrombosis (DVT): It is a condition that causes blood clots. DVT may be dangerous if the clot breaks free inside a blood vessel and goes to the lungs (pulmonary embolism). Patients are provided with specialized stockings to wear during the procedure and the recovery phase. To avoid this complication, blood thinners are also administered to patients.
• Transurethral resection (TUR) syndrome: Complications following transurethral resection of the prostate (TURP) can include bleeding or irrigation fluid absorption (TUR syndrome), which may involve serious consequences such as bronchial or brain edema.
  

Difference between Laser prostatectomy vs TURP

Laser prostatectomy vs TURP

Transurethral resection of the prostate (TURP), a procedure based on electrocautery, has long been considered the gold standard for treating BPH. However, there has been a significant increase in the number of laser treatments being performed. Below are some of the parameters that differentiate laser prostatectomy and TURP.