Robotic Simple Prostatectomy For BPH

A simple prostatectomy is a surgical procedure to treat extreme enlargement of the prostate (BPH), usually when other approaches such as in-office procedures or TURP are not appropriate or have failed to offer relief of urinary symptoms. Dr. Losee typically performs a simple prostatectomy in an open manner while Dr. Engel prefers the robotic approach.

A simple prostatectomy is not an operation for prostate cancer but rather one typically offered in the setting of extreme prostate enlargement (BPH), or moderate enlargement with extenuating circumstances such as a bladder stone, bladder diverticulum, or when performing a prostate sparing cystectomy. Unlike robotic surgery for prostate cancer, where the advantages are myriad, here the advantage of the robotic approach over open surgery is present but less so. The main advantages of the robotic approach are better visualization of the urethra when separating it from the prostatic adenoma, less blood loss, and perhaps less pain. One should consider a Transurethral Resection of the Prostate (TURP) a more standard approach for moderate prostate enlargement when a minimally invasive office approach is not appropriate or chosen by the patient.

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How The Simple Prostatectomy Works

Unlike a TURP, which is performed through a scope inserted through the urethra, a simple prostatectomy is performed through the abdomen by making an incision through the bladder and removing the inside of the prostate, or the adenoma, rather than shaving it. What allows this to be possible is the anatomic fact that the prostate is largely comprised of an outer rind called the capsule, and the inner tissue called an adenoma – analogous to a naval orange where the pulp is the adenoma. There is usually an easily appreciable plane between the two that allows for easy dissection of the adenoma and removal of it whole. If not performed robotically, this operation can be performed through a lower midline abdominal incision. In that case, it can be done through an incision in the bladder (suprapubic) or an incision in the prostatic capsule (retropubic). Dr Losee typically offers the open approach, and Dr. Engel typically the robotic approach.

Warning, the video below represents an actual procedure – Content is graphic

A robotic simple prostatectomy as shown here is done through the same five small incisions, in a similar orientation, to the robotic prostatectomy for cancer.

Recovery After A Simple Prostatectomy

A catheter will be left in the bladder for approximately one week to allow the bladder to heal, and a drain will be left in the abdomen to be removed just prior to hospital discharge. This is not a particularly painful operation, and patients leave the hospital typically after one or two days. Near complete recovery occurs in approximately two weeks. The risks of this surgery include pain, infection, bleeding, urine leak, stricture, incontinence, or rare medical complications. Patients will take a bowel prep as for a cancer operation, and should go to the GW or Sibley Emergency room with fevers, abdominal distention or if clinical progress after surgery is not moving forward. Blood in the urine is to be expected, and as long as the catheter is functioning, should not cause concern. Patients may come to the office at any time if bleeding is concerning them.