Classical Open Surgery for BPH

What is Classical Open Surgery?

Classical open surgery, also known as open prostatectomy, is a technique that involves removing hyperplastic tissue to restore the normal flow of urine.

As it is an open surgical operation and more aggressive than other alternatives, it is generally reserved for very specific situations, such as:

Men with voluminous prostates;
Existence of voluminous bladder stones;
Need to remove diverticula.

The classical method can also be used when patients, for any reason, cannot adopt the position necessary to undergo other techniques performed endoscopically via the urethra.

Open surgery can be performed through the bladder, known as transvesical or transcervical prostatectomy, or without opening the bladder, called retropubic prostatectomy (preferable and more commonly used).

Although more invasive, the procedure seems to have slightly better results than endoscopic techniques with regard to the percentage improvement to lower urinary tract issues and maximum urine flow.

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What is the Open Surgery Procedure Like?

It involves performing a prior medical assessment as well as a range of tests and analyses.

The patient must not eat, drink or smoke in the hours before surgery. It may also be necessary to stop some medication several days before the operation.

The patient must receive all of these indications from their specialist.

Given the nature of the operation, it is performed under general or spinal anaesthetic (i.e., temporary loss of feeling in the lower limbs and lower abdominal region).

In either of the anaesthetic options, the patient does not feel any pain or discomfort during the operation.

The aim of open surgery is to remove the obstructing and hyperplastic tissue, while maintaining the peripheral zone of the prostate intact.

The procedure involves making a small incision in the skin (generally between 7 and 10 cm) right below the navel.
Via this point of access to the prostate, a digital enucleation of the hyperplastic tissue is performed through the prostate capsule or bladder (less recommended).
After isolating the prostate, the surgeon removes the tissue causing the obstruction/compression of the urethra inside the organ.

Open surgery has very good results in improving BPH symptoms.

While not risk free, the mortality rate for this procedure is very low – below 0.25% - for the various techniques and surgeries as a whole.

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The operation is indicated for men with severe urinary symptoms and a very enlarged prostate. It significantly improves patients’ quality of life.

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What is Open Surgery Post-Treatment Like?

Operated patients are assessed immediately after surgery, in the following days and every day until discharged from hospital.

During the procedure, a catheter is inserted which remains in place in the days following the operation. This narrow and malleable tube ensures correct drainage of the urine and allows the organ to be irrigated with a solution that prevents clotting.

The catheter is removed once the wound has healed, and the patient has no problems urinating. Normally, patients should expect 5–7 days of hospitalisation.

Depending on their state of health, it can take between 2 and 6 weeks to fully recover from the operation.

Operated patients need continued regular surveillance of their prostate, since surgery does not dispense with the need for this.

A consultation is required 15–30 days after surgery and, usually, a new consultation around 3 months after. After this period, patients must have at least one annual consultation with a DRE and PSA for early diagnosis of prostate cancer.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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