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.

Getting Ready

Before your surgery:

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • You may be told to limit caffeine and alcohol. Caffeine can be found in chocolate, coffee, tea, and some soft drinks. Alcohol is found in beer, wine, whiskey, and other adult drinks. You may also be told to avoid taking cold and decongestant medicines. Caffeine, alcohol, and certain medicines can make your BPH symptoms worse.

  • You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.

  • You may need a biopsy of your prostate gland to check for cancer. During a biopsy, a tissue sample is taken from your prostate gland and sent to a lab for tests. Ask your caregiver for more information about a prostate gland biopsy.

  • You may need blood and urine tests, a transrectal and kidney ultrasound, and a cystoscopy. You may also need an intravenous pyelogram, computed tomography (CT) scan, a chest x-ray, and an electrocardiogram (ECG). Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

  • Ask caregivers about directions for eating and drinking.

The day of your surgery:

  • Write down the correct date, time, and location of your surgery.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

  • 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).

  • You may need to take medicine to prevent blood clots. You may need to take antibiotic medicine to help treat or prevent an infection caused by germs called bacteria. You may have antibiotic medicine before and after your surgery.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

Treatment

What will happen:

  • You may be given spinal or epidural anesthesia so you will not feel pain below your waist during surgery. With spinal or epidural anesthesia, you will be awake during your surgery. You may get general anesthesia during surgery to keep you asleep and free from pain. Caregivers will work with you to decide which anesthesia is best for you. You will lie on your back on a table or bed. Your abdomen and the area around your penis may be shaved and cleaned. A catheter (long, thin tube) will be inserted in your urethra and into your bladder to drain your urine. Your bladder will be filled with air or gas to help your caregiver see inside your bladder better. A cut will be made in your abdomen below your belly button.

  • A cut will be made through the front of your bladder. Another cut is made in the base (bottom) of your bladder to reach your prostate. Your caregiver will remove 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 the cut in your abdomen to drain your urine. The tube is called a suprapubic catheter. The cuts in your bladder will be closed with stitches.

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

After your surgery:

You will be taken to a room to rest until you are awake. Caregivers will check your drain and catheters for urine and blood. 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. You may be given medicine to decrease or take away your pain. Do not get out of bed until your caregiver says it is okay. Once caregivers see that you are not having any problems, you will be taken to your hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You have a fever.

  • You are late or cannot make it to your surgery.

  • You see blood in your urine.

  • Your symptoms of BPH, such as decreased urination or a slow urine stream, become worse.

  • Your urine is cloudy and smells bad.

Seek Care Immediately if

  • You feel the urge to urinate, but no urine comes out.

  • You have pain in your lower abdomen or back that does not go away.

© 2013 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.

Hide
(web1)