Prostatectomy

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A Prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra.

There are four basic forms of the operation, of increasing order of invasiveness:

Transurethral resection of the prostate (TURP): a cystoscope is passed up the urethra to the prostate, where the surrounding prostate tissue is excised. This is a common operation for Benign Prostatic Hyperplasia (BPH) and outcomes are excellent for a high percentage of these patients (80-90%).
Laser Prostatectomy has become the gold standard treatment for benign prostate disease. Various lasers have been used to vaporize the prostate in the last 10 years starting with the ND:Yag laser for VLAP or Visual Laser Ablation of the Prostate. This procedure was abandoned after the depth of optical penetration into the prostatic tissue was seen to cause post-op irritative symptoms. The Holmium laser was used to ablate the prostate at a power setting of 60 Watts of pulsed energy but was deemed by many to be too slow for larger gland sizes. The Niagra laser was then introduced as an 80 Watt continuous wave KTP laser with a side firing laser fiber and has been through numerous studies at the Mayo Clinic. Later renamed the GreenLight laser it has been seen to vaporize the prostate and be more hemostatic than the traditional TURP * Transurethral resection of the prostate This procedure is usually done on an outpatient basis with minimal complications and patients are usually back to work in a few days. After the inception of the GreenLight laser the HoLap procedure was introduced with the same premise of an outpatient procedure with fewer complications. This new technology involves 100 Watts of pulsed Holmium Laser energy and a side firing laser fiber, similar to the GreenLight laser. Both procedures have seen widespread adoption in the urologic community.
DaVinci: or Nerve Sparing a laparoscopic or four small incisions are made in the abdomen, and the entire prostate is removed sparing nerves more easily damaged by a retropubic or suprapubic approach. This procedure is performed by a robot manipulated by a doctor. This is often preferred for men in early stages of prostate cancer. Risk of erectile dysfunction is significantly reduced for patients who undergo this procedure.
Radical perineal prostatectomy: an incision is made in the perineum, midway between rectum and scrotum, and the prostate is removed. Radical prostatectomy is one of the key treatments for prostate cancer.
Radical retropubic prostatectomy or Suprapubic: an incision is made in the lower abdomen, and the prostate removed, either by going behind the pubic bone (retropubic) or before it (suprapubic). Radical prostatectomy is one of the key treatments for prostate cancer.

Dr Varol (Sydney, Australia) has developed a novel laparoscopic (keyhole) prostatectomy procedure for prostate cancer which can emulate the open and robot radical prostatectomy technique. It allows for sparring of the nerves needed for erection with the benefit of a bloodless procedure. Patients are rapidly discharged with minimal discomfort. The operation can be performed more rapidly and economically than the robotic or open prostatectomy.

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