Prostatectomy

Prostatectomy (from the Greek προστάτης prostátēs, 'prostate' and ἐκτομή ektomē, 'excision') is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention as well as for prostate cancer and for other cancers of the pelvis.

There are two main types of prostatectomy. A simple prostatectomy (also known as a subtotal prostatectomy) involves the removal of only part of the prostate. Surgeons typically carry out simple prostatectomies only for benign conditions. A radical prostatectomy, the removal of the entire prostate gland, the seminal vesicles and the vas deferens and pelvic lymph nodes, is performed for cancer.

There are several ways the operation can be done for benign prostatic hyperplasia (BPH): with open surgery (via a large incision through the lower abdomen), laparoscopically with the help of a robot (a type of minimally invasive surgery), through the urethra or through the perineum.

Laser prostatectomy or holmium laser enucleation of the prostate (HoLEP) is a minimally invasive surgery to treat BPH. The holmium laser is used to enucleate and remove excess prostate tissue that is blocking the urethra into urinary bladder. A morcellator is then used to cut the prostate tissue into smaller pieces before extracting it from the body. HoLEP can be an option for men who have a severely enlarged prostate. Due to the decreased risk of bleeding and recurrence of obstruction, HoLEP has started to replace transurethral resection of the prostate (TURP) operations, even for patients who have a smaller prostate. The procedure started to become extremely popular in Western countries and has recently gained popularity in the Middle East, including Jordan, Egypt, and Saudi Arabia.

Other terms that can be used to describe a radical prostatectomy include:

• Nerve-sparing: the blood vessels and nerves that promote penile erections are left behind in the body and not taken out with the prostate.
• Limited pelvic lymph node dissection: the lymph nodes surrounding and close to the prostate are taken out (typically the area defined by external iliac vein anteriorly, the obturator nerve posteriorly, the origin of the internal iliac artery proximally, Cooper's ligament distally, the bladder medially and the pelvic side wall laterally).
• Extended pelvic lymph node dissection (PLND): lymph nodes farther away from the prostate are taken out also (typically the area defined in a limited PLND with the posterior boundary as the floor of the pelvis).