Open Prostatectomy
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What Is an Open Prostatectomy?
Open prostatectomy is a traditional surgical procedure used to treat Benign Prostatic Enlargement (BPE)—also known as Benign Prostatic Hyperplasia (BPH)—when the prostate is significantly enlarged, typically over 80–100 mL in volume. This is approximately three to four times larger than a normal prostate.
Although less invasive treatments like TURP (Transurethral Resection of the Prostate) or HoLEP (Holmium Laser Enucleation of the Prostate) are now common for moderate cases, open prostatectomy remains the preferred option for very large prostates or when complicating factors are present, such as bladder stones or structural abnormalities.
This is a highly effective surgery for relieving symptoms and restoring normal urinary flow, particularly in complex or advanced cases.
What Happens During the Procedure?
The procedure is performed under either:
- General anesthesia – You are fully asleep and unaware during the operation.
- Spinal anesthesia – You remain awake but are completely numb from the waist down.
Surgical Steps:
- A small incision is made in the lower abdomen to reach the prostate.
- The surgeon carefully removes the inner enlarged part of the prostate (the adenoma), similar to removing the pulp of an orange while leaving the outer rind intact.
- The bladder neck and urethra are repaired to ensure proper urine flow.
This type of surgery provides direct visual access, making it ideal for complex anatomical situations.
Post-Surgery: Catheter Placement
At the end of the procedure, a urinary catheter is placed through the urethra into the bladder to allow urine to drain while healing begins.
Why It’s Needed:
- To prevent strain on the healing tissues
- To allow continuous bladder irrigation with sterile fluid (flushing blood and clots)
- To monitor urine output and ensure normal kidney function
Key Points:
- The catheter is inserted while you’re still under anesthesia, so you won’t feel it.
- It remains in place for 5 to 10 days, depending on your recovery progress.
Removal is done by a nurse and is quick, simple, and generally painless.
Recovery and Sexual Function
Compared to minimally invasive techniques, open prostatectomy involves a longer recovery period, but provides excellent long-term outcomes.
What to Expect During Recovery:
- Hospital stay: Usually 2–5 days
- Full recovery: Typically within 4–6 weeks
- Restrictions: Avoid heavy lifting and strenuous activity during this time
Sexual Health After Surgery:
- You will still be able to achieve and feel orgasm, but ejaculation may no longer occur.
- This is known as retrograde ejaculation, where semen flows into the bladder instead of out the urethra.
- Erectile function is generally preserved, though pre-existing issues may remain unchanged.
It’s important to discuss your sexual health expectations and concerns with your urologist before the procedure.
When Is Open Prostatectomy Recommended?
Open prostatectomy is a traditional yet highly effective surgical treatment for Benign Prostatic Enlargement (BPE), particularly in cases where minimally invasive procedures may not be suitable. While less commonly performed today due to the rise of laser and robotic techniques, open prostatectomy remains an important option in complex or advanced scenarios.
This procedure involves a surgical incision—typically in the lower abdomen—to access and remove the overgrown portion of the prostate gland that is causing urinary obstruction. It is generally performed under general or spinal anesthesia and requires a longer hospital stay and recovery period compared to endoscopic methods.
Key Indications for Open Prostatectomy
Your urologist may recommend an open prostatectomy if one or more of the following conditions apply:
- Prostate Size Greater Than 80–100 mL
When the prostate is significantly enlarged, endoscopic techniques such as TURP (Transurethral Resection of the Prostate) or HoLEP (Holmium Laser Enucleation of the Prostate) may not effectively remove enough tissue. Open surgery provides better access for complete removal in such cases. - Ineligibility for Minimally Invasive Approaches
In some patients, anatomical challenges, comorbid conditions, or prior surgeries may make endoscopic approaches impractical or ineffective. - Coexisting Bladder Complications
If the patient also has large bladder stones, bladder diverticula, or significant bladder wall damage, open surgery allows these issues to be addressed simultaneously during the same procedure. - Simultaneous Surgical Needs
In patients who require repair of an inguinal hernia, bladder reconstruction, or treatment of other nearby abdominal or pelvic conditions, open prostatectomy enables surgeons to access multiple structures efficiently during a single operation. - Recurrent or Severe Urinary Complications
Men who experience persistent urinary retention, frequent infections, or resistance to medication and prior procedures may benefit from the more extensive removal of obstructive tissue achieved through open surgery.
Balancing Risks and Benefits
Although open prostatectomy involves a longer hospital stay, a visible incision, and a slightly higher risk of blood loss, it remains a highly effective solution for restoring urinary function in carefully selected patients.
Your care team at MedicalPoint Urology Department will perform a detailed evaluation, including imaging, PSA testing, and bladder assessments, to determine whether this approach is appropriate for your condition.
If you’ve been told your prostate is too large for other procedures or have ongoing urinary issues, consult our urology team to explore if open prostatectomy is right for you.
Advantages of Open Prostatectomy
Effective for large prostates not manageable by TURP or laser surgery
Direct removal of prostate tissue
Long-lasting symptom relief
Can be combined with treatment for other pelvic conditions during the same procedure
Risks and Considerations
Like all surgeries, open prostatectomy carries some risks. These may include:
- Infection or bleeding
- Blood clots
- Injury to surrounding structures (e.g., bladder, urethra)
- Temporary or, rarely, long-term incontinence
- Longer recovery time compared to minimally invasive options
Your surgeon will discuss all potential benefits and risks during your consultation, helping you make an informed decision.
Your Care at MedicalPoint Hospital
At MedicalPoint, our experienced urology team is dedicated to:
- Comprehensive evaluation and diagnosis
- Personalized treatment planning for enlarged prostate conditions
- Expert surgical care using evidence-based techniques
- Holistic support before, during, and after surgery
We understand the impact BPE can have on your quality of life—and we’re here to help you regain control, comfort, and confidence.
Schedule your consultation today to learn if open prostatectomy is the right solution for your prostate health.
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