Suprapubic Prostatectomy

WHAT YOU SHOULD KNOW:

  • Suprapubic prostatectomy, also called transvesical prostatectomy, is surgery to remove part or all of your prostate gland. Your prostate gland is a male sex gland that makes the fluid part of your semen (fluid containing sperm). Your prostate gland is found below your bladder and surrounds the top of your urethra. Your urethra is a tube that carries urine outside your body. You may need a suprapubic prostatectomy if you have benign prostatic hypertrophy (BPH). BPH is a condition that increases the size of your prostate gland. With BPH, your enlarged prostate may squeeze your urethra and slow or block your urine flow. Blocked urine flow may lead to problems, such as incomplete bladder emptying, and bladder and kidney infections. You may leak urine, and urine may build up in your bladder and cause bladder stones.

  • During suprapubic prostatectomy surgery, an incision (cut) is made in your suprapubic area and into your bladder. Suprapubic means the area above your penis, in your lower abdomen. Your prostate is removed through the cuts in your skin and bladder. Your caregiver may also remove bladder stones or growths at the same time. A suprapubic prostatectomy may treat your BPH. After surgery, you may find it easier to urinate, and you may urinate less often. A suprapubic prostatectomy may also help decrease your risk for urinary tract infections.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During surgery, your bladder, urethra, penis, or nearby tissues may be damaged. You may bleed more then expected and need a blood transfusion. After surgery, you may have blood in your urine and blood clots in your bladder. Your surgery area may be bruised and swollen. Your urethra may narrow, and block the flow of your urine. The muscle at the base of your bladder may shorten, causing you to leak urine. Urine may leak from your bladder and collect in nearby areas, such as your scrotum. Your scrotum is the skin sac that holds your testicles, which make and store sperm.

  • You may get an infection in your wound, urinary tract, or testicles. Your kidneys may stop working properly. You may have trouble having an erection (hardening of your penis). When you ejaculate (release sperm), your semen may travel backward into your bladder. You could get a blood clot in your leg that causes pain and swelling, and blocks blood flow. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Without treatment, your prostate gland may become larger and your symptoms may get worse. Your urine flow may become blocked and urine may build up in your bladder. You may leak urine because your bladder is too full. The urine build-up may cause stones to form in your bladder and kidneys. You may have blood in your urine. You may get urinary tract infections, and your urinary tract may be damaged. Your kidneys may fail. Talk with your caregiver if you have questions or concerns about your condition, surgery, or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Medicines:

    • Enema: You may be given an enema (liquid medicine put in your rectum) to help clean out your bowel. Your rectum is the lowest section of bowel that holds your stool until you have a bowel movement (BM).

    • Antibiotics: Antibiotics may be given to help prevent an infection caused by germs called bacteria. You may have antibiotic medicine before and after your surgery.

    • Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise.

  • Tests:

    • Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor to take pictures.


  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Anesthesia: Anesthesia medicine makes you comfortable during your surgery. Caregivers work with you to decide which anesthesia is best for you. You may have one of the following:

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

    • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

  • Blood transfusion: You may need a blood transfusion if you lose a lot of blood during surgery. During a blood transfusion, you get whole blood, or parts of blood, through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile virus.

During your surgery:

  • Your abdomen and the area around your penis will be may be shaved and cleaned. A catheter (long, thin tube) is inserted in your urethra and into your bladder to drain your urine. Your bladder is filled with air or gas to help your caregiver see inside your bladder better. A cut is made in your abdomen below your belly button. Your skin, tissue, and muscle are secured out of the way.

  • A cut is made through the front of your bladder. Another cut is made in the base (bottom) of your bladder to reach your prostate. Your caregiver removes part or all your prostate gland through the cuts. Your caregiver will stop any bleeding from the area where your prostate gland was removed. A tube may be placed into your bladder through a cut in your abdomen to drain your urine. The tube is called a suprapubic catheter. The cuts in your bladder are closed with stitches.

  • The bladder catheter in your urethra is removed, and a new catheter is put in. A balloon on the end of the catheter is filled with fluid. The balloon holds the catheter in place inside your bladder. The balloon also puts pressure on the area where your prostate gland was removed to help control bleeding. A drain (tube) is placed near your bladder that will remove extra blood and fluid from around your cut. Your caregiver uses stitches and staples to close your abdomen and the cut in your skin. The prostate tissue that was removed may be sent to a lab for tests.

After your surgery:

You are taken to a room to rest until you are awake. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are not having problems, you are taken back to your room.

  • Activity: Activity can help decrease your risk for blood clots after surgery. Caregivers may have you move your feet up and down 100 times per hour while you are awake. You may also need to walk at least four times each day, starting the first day after your surgery.

  • Bladder catheters: You may have one or two bladder catheters in place after surgery. One may be in your urethra, and one in your suprapubic area. Each catheter is attached to a bag that collects your urine. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheters because this may cause pain and bleeding, and the catheters may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.

  • Bladder irrigation: A constant flow of fluid may be put through your bladder catheter to flush out blood and prevent blood clots The fluid will go in one bladder catheter and out another, or in and out of the same bladder catheter.

  • Blood and urine output: Your caregivers will measure the amount of blood and urine that drain from your wound drain and catheters.

  • Deep breathing and coughing: Breathing exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake, even if you wake up during the night.

    • Hold a pillow tightly against your wound when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.

    • You may be asked to use an incentive spirometer. An incentive spirometer helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Drain: The drain in your wound (surgery area) will be removed when it stops draining blood and fluid.

  • Medicines:

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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