55821 Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages

Name of the Procedure:

Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages

Summary

A suprapubic subtotal prostatectomy is a surgical procedure that involves partial removal of the prostate gland through an incision in the lower abdomen. It may include additional treatments such as controlling postoperative bleeding, performing a vasectomy, enlarging the urethral opening (meatotomy), calibrating or dilating the urethra, and performing a urethrotomy to address blockages.

Purpose

This procedure aims to treat conditions like benign prostatic hyperplasia (BPH), prostate cancer, or other issues causing urinary obstruction or dysfunction. The goal is to alleviate symptoms, prevent complications like urinary retention or infections, and improve the patient's quality of life.

Indications

• Severe urinary symptoms unresponsive to medication
• Recurrent urinary tract infections
• Significant bladder stones or hematuria
• Urinary retention
• Diagnosed prostate cancer requiring partial removal

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting or stopping certain medications, as instructed by the doctor
• Preoperative blood tests, urine tests, and imaging studies like ultrasound or MRI
• Consultation with anesthesia for suitability and planning

Procedure Description

1. Anesthesia: General or spinal anesthesia is administered.
2. Incision: A vertical incision is made in the lower abdomen, above the pubic bone.
3. Accessing the Prostate: The surgeon identifies and exposes the prostate.
4. Partial Removal: The surgeon carefully removes part of the prostate tissue.
5. Additional Treatments: If needed, the surgeon controls any postoperative bleeding, performs a vasectomy, makes a meatotomy, calibrates/dilates the urethra, and/or performs an internal urethrotomy.
6. Closure: The surgical site is closed with sutures or staples, and a catheter is usually placed for urinary drainage.

Duration

The procedure typically takes 2-4 hours, depending on the extent of intervention needed.

Setting

The procedure is performed in a hospital operating room under sterile conditions.

Personnel

• Urologic surgeon
• Surgical nursing team
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection
• Bleeding
• Injury to adjacent structures (bladder, urethra)
• Urinary incontinence
• Erectile dysfunction
• Blood clots
• Need for further surgeries

Benefits

• Relief from urinary symptoms
• Reduced risk of urinary retention and infections
• Improved quality of life
• Potential treatment or management of prostate cancer

Recovery

• Overnight hospital stay typically required
• Pain management with medications
• Catheter care for a few days post-surgery
• Gradual return to normal activities over 4-6 weeks
• Follow-up appointments to monitor recovery and remove catheter/stitches

Alternatives

• Medications (e.g., alpha-blockers, 5-alpha-reductase inhibitors)
• Minimally invasive procedures (TURP, laser therapy)
• Watchful waiting in less severe cases

Pros of alternatives: Less invasive, shorter recovery time Cons of alternatives: May not be effective for all patients or provide long-term relief

Patient Experience

During surgery, the patient is under anesthesia and feels no pain. Postoperatively, patients can expect some pain and discomfort, managed with medications. Full recovery involves following specific care instructions to ensure proper healing and avoiding strenuous activities as prescribed by the surgeon.