A prostatectomy is the surgical removal of all or part of the
prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the
urethra.
There are several forms of the operation:
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Transurethral resection of the prostate: Also called a TURP, this is a
cystoscope [A Resectoscope Rather, which has 30 degree of viewing angle, along with Resectoscopy Sheath & Working Element] is passed up the urethra to the prostate, where the surrounding prostate tissue is excised. This is a common operation for
benign prostatic hyperplasia (BPH) and outcomes are excellent for a high percentage of these patients (80-90%). A more refined and safer operation is by means of a holmium(Nd:YAG) high powered "red" laser. A related laser procedure for relief of prostatic obstruction utilizes a potassium titanyl phosphate(KTP) laser to vaporize the adenoma. More recently the KTP laser has been supplanted by a higher power laser source based on a lithium triborate crystal, though it is still commonly referred to as a "Greenlight" or KTP procedure. The specific advantages of utilizing laser energy rather than a traditional electrosurgical TURP is a decrease in the relative bloodloss, elimination of the risk of TUR-syndrome, the ability to treat larger glands, as well as treating patients who are actively being treated with anti-coagulation therapy for unrelated diagnoses.3,4
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Open Prostatectomy: A surgical procedure involving a skin incision and enucleation of the prostatic adenoma, through the prostatic capsule (RPP-retropubic prostatectomy) or through the
bladder (SPP-suprapubic prostatectomy). Reserved for extremely large prostates. Both techniques have advantages and disadvantages, with the suprapubic technique being a better choice is patients with prostate volumes that are much larger.