What is Prostate Surgery? How is it Performed and Application Methods

Prostate surgery (prostatectomy) is the procedure of partially or completely removing the prostate gland using surgical methods. This surgery is typically performed for conditions such as prostate cancer or benign prostatic hyperplasia (BPH). The goal is to eliminate symptoms like difficulty urinating, pain, or obstruction, and to improve the patient's quality of life. Today, open, closed (laparoscopic), and robotic surgical methods are used. The choice of technique is determined by a urology specialist based on the patient's general condition and the stage of the disease.

What is Prostate Surgery?

Prostate surgery is a surgical method usually applied when medication therapy is insufficient or symptoms persist despite treatment. The main purpose of this surgery is to remove the part of the prostate gland that obstructs urine flow, or the entire gland, thereby eliminating problems such as difficulty urinating, frequent urination, pain, or urinary retention.
In patients with benign prostatic hyperplasia (BPH), medical treatment is usually the first approach. However, surgical treatment is considered for patients who do not respond to medication therapy, cannot take medication due to side effects, or develop complications such as bladder stones, recurrent infections, or blood in the urine.
Partial or complete removal of the prostate constitutes the basic principle of the surgery. Today, this procedure can be performed using open, closed (endoscopic), or laser-assisted surgical methods. When performed by an experienced urological surgeon, prostate surgery offers high success rates and a comfortable recovery process.

What is Closed Prostate Surgery and How is it Performed?

Closed prostate surgery, medically known as endoscopic prostate surgery, is a modern and reliable method used in the treatment of complaints arising from prostate gland enlargement, such as difficulty urinating, frequent urination, or urinary incontinence. This surgery is usually preferred for patients with benign prostatic hyperplasia (BPH) when medication therapy does not yield sufficient results.
In closed prostate surgery, the enlarged prostate tissue is removed or vaporized using special surgical instruments or laser methods by entering through the urethra without making an incision in the abdominal area. This reduces the risk of bleeding, minimizes post-operative pain, and allows patients to return to their daily lives more quickly.
The surgery is performed under general or spinal anesthesia and usually lasts between 1 to 2 hours. Key advantages of closed prostate surgery include: no incision or sutures, less blood loss, shorter hospital stay, and faster recovery.
When performed by an experienced urologist, closed prostate surgery provides safe and effective long-term results. However, determining its suitability for each patient requires a detailed examination and evaluation process.

What is Open Prostate Surgery and How is it Performed?

Open prostate surgery is a surgical treatment method where all or part of the prostate gland is removed through an incision made in the lower abdomen. This surgery is usually preferred for patients with a large prostate gland (over 80 ml), when closed methods are insufficient, or in cases of prostate cancer.
The prostate gland is an important part of the male reproductive system and tends to enlarge naturally with age. This enlargement can sometimes narrow the urethra, leading to complaints such as difficulty urinating, frequent urination, or reduced urine flow. If this condition cannot be controlled with medication or if cancer is suspected, surgical intervention may be necessary.
During open prostate surgery, the surgeon makes an incision of about 8–10 cm in the lower abdomen and removes the enlarged or tumorous prostate tissue. The procedure is usually performed under general anesthesia and lasts between 2 to 3 hours. Patients are typically kept under observation in the hospital for 3–7 days post-surgery.
The most important advantage of this method is the clear visualization of the entire prostate and surrounding tissues, and the possibility of removing lymph nodes if necessary. However, open surgery carries some risks such as bleeding, infection, or urinary incontinence. These risks can be minimized when performed by an experienced urological surgeon.
Although the recovery process after open prostate surgery is somewhat longer compared to closed methods, it offers a permanent and effective treatment option, especially for advanced prostate enlargement or prostate cancer cases.

How is Prostate Surgery Performed in Men and What Methods are Applied?

Prostate surgery is generally performed using three main methods: open surgery, closed (endoscopic or laser-assisted) surgery, and robotic surgery. The choice of method is determined by factors such as the patient's age, prostate size, general health status, and whether the diagnosis is benign (BPH) or malignant (prostate cancer).
For benign prostatic hyperplasia (BPH) cases, closed prostate surgery is usually preferred. In this method, the enlarged prostate tissue is removed or vaporized with laser energy by entering through the urethra. Laser-assisted methods such as HoLEP (Holmium Laser Enucleation of the Prostate) and ThuLEP (Thulium Laser Enucleation of the Prostate) are performed without incisions; they offer less bleeding, faster recovery, and shorter hospital stays.
Open prostate surgery is usually preferred for patients with a prostate volume over 80 ml or those with tissue too large to be removed by closed methods. The entire prostate gland is removed through an incision in the lower abdomen.
Robotic surgery (robot-assisted prostatectomy) is one of the most advanced surgical methods, especially in prostate cancer treatment. In this method, the surgeon performs the surgery using advanced technological devices like the Da Vinci robotic system under three-dimensional imaging. Robotic arms provide high-precision access to tissues; thus, nerve and vascular structures are preserved, and sexual function and urinary control can be better maintained.
Before surgery, tests such as PSA, MRI imaging, ultrasound, and biopsy are performed to determine the disease stage. Surgical planning is shaped according to these results. The goal of every method is to stop disease progression, improve urinary function, and enhance the patient's quality of life.

What is the Prostate Surgery Process Like in Elderly Patients?

Under normal conditions, the prostate gland is approximately 4 cm in diameter and weighs 25–30 grams. However, with age, prostate tissue can enlarge and reach up to 60–100 grams. When this condition causes complaints like difficulty urinating or reduced urine flow, surgical treatment is considered. The prostate surgery method to be applied to elderly patients is determined based on factors such as prostate size, the patient's general health status, and co-existing conditions like heart disease, hypertension, or diabetes.
Before surgery, elderly patients typically require additional tests such as blood tests, ECG, chest X-ray, PSA test, and anesthesia evaluation if needed. These tests ensure safe planning of the operation. Closed (laser-assisted) prostate surgery methods are generally preferred because these techniques reduce bleeding risk, require no incisions, and accelerate recovery. In suitable patients, robotic surgery can offer a more precise and controlled surgical experience. When performed by an experienced urology team, the prostate surgery process in elderly patients is generally safe and successful.

How is Prostate Surgery Performed and What Methods are Applied?

Prostate surgery (prostatectomy) is the surgical procedure to remove all or part of the prostate gland. This operation is performed for conditions such as prostate cancer or benign prostatic hyperplasia (BPH). The surgical method is determined based on the type and stage of the disease, prostate size, the patient's general health, and the surgeon's preference.

Open Radical Prostatectomy

In this traditional method, an incision of about 10–13 cm is made in the lower abdomen to access the prostate gland. The prostate, seminal vesicles, and, if necessary, lymph nodes are removed. This method is usually preferred for advanced-stage prostate cancer cases. Patients remain with a catheter for a few days post-operation, and the recovery process is somewhat longer than other techniques.

Laparoscopic Radical Prostatectomy

In this method, several small incisions are made in the abdominal area. A laparoscope (lighted camera) and thin surgical instruments are inserted. Using this imaging, the surgeon carefully removes the prostate. The laparoscopic method offers advantages over open surgery, such as less bleeding, less pain, and a shorter recovery time.

Robotic Radical Prostatectomy

Robotic surgery is the most advanced version of the laparoscopic method. Using advanced robotic systems like the Da Vinci surgical system, the surgeon performs the operation from a console. This method offers high precision, less blood loss, better nerve preservation, and better preservation of erectile function. It is commonly preferred in prostate cancer treatment.

Transurethral Resection of the Prostate (TURP)

Also known as closed prostate surgery, this method involves entering through the urethra to reach the prostate, where the enlarged inner tissue is cut and removed using an electric current. This procedure is typically used to treat benign prostatic hyperplasia (BPH). It requires no sutures, has a low bleeding risk, and patients are often discharged within 1–2 days.

Laser-Assisted Surgery (HoLEP and ThuLEP)

In HoLEP (Holmium Laser Enucleation of the Prostate) and ThuLEP (Thulium Laser Enucleation of the Prostate) methods, the prostate tissue is vaporized with laser energy or separated from its capsule and removed by entering through the urethra without an incision. These modern methods are particularly effective for large prostates, reduce bleeding risk, and provide rapid recovery.

Is Prostate Surgery Risky? What Complications Can Occur?

Prostate surgery is a procedure that has been safely applied for many years with a high success rate. However, as with any surgery, some risks and complications can arise. The frequency of these risks varies depending on the type of surgery (open, closed, laser, robotic), the patient's general health, and the surgeon's experience.

General Surgical Risks

•    Bleeding: Mild or moderate bleeding may occur during or after surgery.
•    Infection: There is a risk of infection in the urinary tract or surgical area.
•    Anesthesia complications: Although rare, allergic reactions, respiratory, or circulatory problems may occur.
•    Blood clot (thrombosis): Prolonged immobility can lead to clot formation in the veins.
•    Adjacent organ injury: Structures such as the rectum, bladder, or urethra can rarely be affected.

Risks Specific to Prostate Surgery

•    Urinary incontinence (incontinence): May occur temporarily and usually improves during recovery.
•    Erectile dysfunction: May rarely develop, especially in open or robotic surgeries where working close to nerve tissues is involved.
•    Urethral or bladder neck stricture: Narrowing may occur in the urinary tract after surgery.
•    Retrograde ejaculation: During ejaculation, semen may move towards the bladder instead of exiting.
•    Lymphedema: If lymph nodes were removed due to prostate cancer, mild swelling may develop in the legs.

The majority of these complications are temporary or treatable. When performed by an experienced urological surgeon using an appropriate method, the risk rate is quite low. Regular follow-up and adherence to doctor's recommendations play an important role in preventing complications.

What Should I Pay Attention to After Prostate Surgery?

The post-operative period is the most critical stage of recovery. The goals during this process are to accelerate wound healing, prevent infection and bleeding risk, preserve bladder function, and ensure the patient's safe return to daily life.
A urinary catheter may remain in place for a few days after surgery. During this time, the doctor's recommendations regarding catheter hygiene and bag emptying should be followed. Pain or burning sensation is normal; prescribed painkillers and antibiotics should be used regularly.
Avoid heavy lifting, bending, and sports activities in the first few days. Strenuous exercise, cycling, or weightlifting are not recommended for approximately 4–6 weeks. Taking short walks intermittently instead of sitting for long periods supports circulation and reduces clot risk.
Nutrition is very important during this period. To prevent constipation, consume fiber-rich foods (vegetables, fruits, whole grains) and drink plenty of water. Avoid gas-producing, spicy, and acidic foods. Alcohol, caffeinated beverages, and cigarettes are not recommended as they can irritate the urinary tract.
Choose comfortable, non-restrictive clothing. Driving is generally not recommended in the first week. If redness, swelling, or fever occurs at the surgical site, a doctor should be consulted immediately.
Urinary incontinence or erectile problems may occur; these are usually temporary. Pelvic floor (Kegel) exercises support recovery. Regular doctor check-ups are crucial for monitoring the recovery process and early detection of potential complications.

What is the Recovery Process Like After Prostate Surgery?

The recovery process after prostate surgery varies depending on the surgical method used and the patient's general health. The goals during this period are to support wound healing, restore urinary control, and accelerate the patient's safe return to daily life.
After open prostate surgery, the recovery process is generally longer. Since there is an incision, patients may stay in the hospital for 7–10 days, and the catheter is removed during this time. Complete healing of the incision site takes about 4–6 weeks. During this time, avoid heavy lifting, prolonged sitting, and sexual intercourse. Wound care and medication therapy as recommended by the doctor should be meticulously followed.
For patients undergoing closed prostate surgery, the recovery process is much faster. Patients are usually discharged within 1–2 days and can return to light daily activities within a few days. Patients often get rid of the catheter within a week and can start light-paced walks. With laser-assisted surgeries, recovery time is shorter due to minimal bleeding and pain.
Since each patient's recovery process is different, adherence to the follow-up program determined by the doctor is extremely important. Adequate fluid intake, a diet rich in fiber, pelvic floor exercises, and regular check-ups accelerate healing and reduce the risk of potential complications.

What are the Side Effects After Prostate Surgery?

Some side effects after prostate surgery may vary depending on the patient's age, the surgical method used (open, closed, laser, or robotic), and general health status. These effects are mostly temporary and diminish as the body's healing process completes. Regular doctor check-ups and adherence to prescribed medication help alleviate these side effects.

Commonly Seen Side Effects

•    Inability to urinate or urinary incontinence: Temporary urinary incontinence may occur due to weakened bladder muscles after surgery. Usually improves within a few weeks.
•    Sexual function problems: Erection or ejaculation problems may occur. Usually returns to normal as nerves heal.
•    Retrograde ejaculation: A condition where semen moves towards the bladder instead of exiting. It is not harmful to health but can affect fertility.
•    Infection: Infection may develop at the surgical site or in the urinary tract. Controlled with antibiotic treatment.
•    Bleeding: Especially after open surgeries, seeing slight blood in the urine is normal; consult a doctor in case of excessive bleeding.
•    Bowel problems: Temporary constipation may occur due to anesthesia or limited mobility. Plenty of water and fiber-rich foods are recommended.
•    Swelling and mild pain: Swelling, burning, or pain sensation may occur at the surgical site; this usually subsides within a few weeks.
Most of these side effects subside within 2–3 weeks, and the patient returns to normal life. To prevent permanent complaints, it is important to meticulously follow the doctor's recommendations in the post-operative period, perform pelvic floor exercises, and not miss check-ups.

What are the Signs of Infection After Prostate Surgery?

Some symptoms after prostate surgery may indicate the development of an infection. In such cases, early detection and prompt consultation with a doctor are crucial for preventing complications.

Possible Signs of Infection:

• Swelling, redness, hardening at the prostate area after surgery
• Fever
• Severe pain
• Nausea
• Vomiting
• Feeling of weakness or extreme fatigue

The appearance of one or several of these symptoms may indicate an infection risk. In such a case, a doctor should be consulted without delay, and the treatment recommended by the doctor should be started. Early intervention prevents the spread of infection and prolongation of the recovery process.