When a surgeon removes some or all of your prostate gland, you are undergoing a prostatectomy. Reasons for this include the enlargement of the gland, most generally through BPH, but also through such anomalies as a tumor or other reasons, that restricts the general flow of urine through the urethra, leading to discomfort and a hard time eliminating.
There are several different forms of the prostatectomy. Transurethral resection of the prostate (TURP) is the most typical remedy for BPH and for the symptoms from prostate cancer. The doctor passes a cystoscope (a resectoscope with a viewing angle of 30 degrees, as well as a working element and sheath) up to the prostate, and the surrounding tissue of the prostate comes out. Outcomes are positive for between 80 and 90 percent of these patients.
Conventional TURP uses a wire loop that has electric current flowing one way, and it is this current that cuts the tissue. A grounding pad is necessary, as well as irrigation with a nonconducting fluid, to keep this current from harming the surrounding tissue areas. The fluid itself can be harmful, which means that surgery time needs to be limited.
A bipolar form of TRP utilizes bipolar current to get the tissue out. This allows you to irrigate with saline and dispense with the ESU grounding pad, reducing the possibility of hyponatremia and eliminating the need for surgical time limits.
Laser energy is the key to another method for removing prostate tissue. The surgeon pushes a fiber optic cable through the urethra, transmitting such lasers as the potassimumtitanyl phosphate (KTP) “green” or the holmium-Nd: YAG “red” to vaporize the tissue. A newer laser is based on a crystal from lithium triborate crystal. The benefits of using laser energy as opposed to the electrically based TURP is a drop in the blood loss, the ability to work with larger glands, treating patients who are undergoing anti-coagulation therapy, and eliminating the risk of hyponatremia with TURP.
Plasmakinetic resection is another form of prostatectomy that utilizes ionized vapor to empty out the tissue of the prostate from within, leaving behind a shell that is only a couple of millimeters thick. Low voltage electricity heats up the vapor. It is considered the least invasive of all of the techniques available to surgeons, and it has the shortest recovery time and the fewest complications after surgery.
If the surgeon decides that an incision is necessary, then an open prostatectomy is the better option. The surgeon makes the incision and accesses and sees the gland throughout the procedure. Radical retropublic prostatectomy (RRP) and radical perineal prostatectomy (RPP) are the most frequent types. With RRP, the surgeon makes an incision in the lower abdomen and goes behind the pubic bone to remove the prostate. With RPP, the surgeon makes an incision in the perineum, halfway between the scrotum and rectum, and removes the prostate that way. Because it is hard to avoid nerves with this technique, it is increasingly rare.
Hopefully this has answered your questions about the prostatectomy. Talk to your physician about questions connected to your individual situation.