Simple Prostatectomy – Robotic Assisted Enucleation

Why is it done?

• This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
• Your prostate is larger than 120 cc
• Symptoms include: LUTS
  • a weak stream,
  • nightly urination,
  • frequent urination,
  • inability to urinate,
  • kidney failure due to the weak urination (obstruction),
  • bladder stones,
  • recurrent bladder infections.
• Medication such as Flomaxtra, Xatral Minipress etc. should always be given as a first resort.
• Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar and can be used as a first line in these huge prostates.
• Conservative management with medication has failed
• Doing transurethral resection may take excessively long causing side-effects to your urethra as well as risk of irrigation fluid being reabsorbed in your vascular system leading to increased cardiac load
• You may be at risk for electrolyte disturbances with a transurethral resection of the prostate when Glycine is used
• You have BPH—benign prostate enlargement
• Prostate cancer has been ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
• A staged-TURP can also be performed to dis-obstruct a huge prostate. Either Bipolar resection or Laser can be utilized.
• Patient informed decision is vital.
• It provides a quicker solution with more marked side-effects and risks.

How is it done?

• Patients will receive a general anesthesia, unless contra-indicated.
• Prophylactic anti-biotics is given.
• A Flexible cystoscopy is done to exclude any urethral strictures, bladder cancers and any other pathology
• An IDC is then placed
• A Camera port is placed above the Umbilicus
• 3 Additional ports for robotic arms in a horizontal line on the abdomen with 2 assistant ports on the right side of the abdomen
• The abdominal space is entered and the bladder dropped from the abdominal wall.
• Bladder opened at the dome as the prostate will be removed through the bladder
• Bladder neck opened
• Prostate adenoma enucleated
• Haemostasis
• Trigonalization of bladder, bladder pulled down into prostate cavity
• Catheter replaced
• Drain placed if required

What next?

• You will spend up to 5-7 nights in hospital.
• You will have a catheter for that time.
• A drain for 2-3 days.
• You will a trial without the catheter on the 5th day.
• You will be discharged as soon as you can completely empty your bladder.
• You may initially suffer from urge incontinence and dysuria (irritable voiding) and will improve within the next 6 weeks.
• Allow for 6 weeks for stabilization of symptoms.
• There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporisation.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side-effects

• Blood loss requiring blood transfusion.
• Infection.
• Prolonged hospital stays.
• Retrograde ejaculation in more than 90% of patients. Therefore, if you have not completed your family, this procedure is not for you unless absolutely necessary.
• Infertility as a result of the retrograde ejaculation.
• Stress incontinence especially in the elderly and the diabetic patients.
• Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
• Less chance of growth of prostate lobes usually within 3-5 years requiring a second procedure.
• NB! Each person is unique and for this reason symptoms vary!

Remember

You still have a peripheral zone of your prostate and regular PSA reviews are required up to the age of 75.

Download Information Sheet

Wes RA-Enucleation Prostatectomy BPH