Prostate Surgery

Prostate surgery covers the operations used to treat disease of the prostate, the small gland that sits below the bladder and surrounds the urinary channel. The two main reasons for surgery are benign prostatic enlargement, where the gland grows with age and squeezes the channel, and prostate cancer. For benign enlargement, the surgeon removes or vaporises the overgrown inner tissue so urine can flow freely again, leaving the outer gland in place. For cancer that is contained within the gland, the surgeon removes the whole prostate in an operation called radical prostatectomy. There is more than one technique for each situation, and the right one is chosen only after the size of the gland, the symptoms and the diagnosis have been clearly established.

For benign enlargement, surgery is considered when bothersome urinary symptoms are no longer controlled by medication, or when the blockage has caused complications such as repeated infections, bladder stones, blood in the urine, or an inability to empty the bladder at all. Typical symptoms include a weak or slow stream, difficulty starting, frequent trips at night, a feeling that the bladder never fully empties, and sudden urgency. For prostate cancer, surgery is one of the main curative treatments when the disease is confined to the gland and the man is otherwise fit, and the decision is made together with the patient after staging and a discussion of the alternatives. A raised PSA blood test or an abnormal examination is what usually leads to that diagnosis.

The technique is matched to the problem. For benign enlargement, most procedures are transurethral, meaning the surgeon works through the urinary channel with no external incision: the overgrown tissue is removed or vaporised electrically or with a laser, and laser enucleation can shell out larger glands in one piece. These keyhole methods avoid a cut and shorten recovery. For prostate cancer, radical prostatectomy removes the entire gland and can be performed by open surgery, by laparoscopy, or robotically through a few small incisions, where the magnified three-dimensional view helps the surgeon spare the delicate nerves that control continence and erections. Benign procedures are often done under spinal anaesthesia, while radical removal is usually performed under general anaesthesia. Depending on the method, the operation takes roughly one to three hours.

A good candidate is a man whose symptoms or diagnosis justify surgery and who is fit enough for anaesthesia. Assessment includes a flow study and measurement of how well the bladder empties for benign enlargement, and a PSA test, examination, imaging and a biopsy when cancer is suspected. Routine blood tests, a urine test to rule out infection, and a heart trace where appropriate confirm fitness for the operation. Blood-thinning medicines and certain supplements are paused beforehand on medical advice, and any urine infection is treated first. For international patients much of this work-up can begin remotely: scans, biopsy slides and reports are reviewed before travel, so that on arrival the plan is confirmed quickly and the operation can go ahead with little delay.

After surgery a thin catheter drains the bladder for a few days while the area heals, and it is removed before discharge or at an early follow-up visit. Most men stay in hospital for one to three nights depending on the operation. Light activity resumes within one to two weeks, while heavy lifting and strenuous exercise are avoided for about four to six weeks. It is sensible to plan to stay in the destination city for around 7 to 10 days, so the catheter can be removed and healing checked before flying. Mild blood in the urine and a frequent or urgent need to pass urine are common in the early weeks and settle steadily. Once home, follow-up continues remotely by message or video, and after cancer surgery your team arranges the schedule of PSA tests that can be done near your home and shared with the surgeon.

Prostate surgery is a well-established and safe operation in experienced hands, though, like any surgery, it carries some risk. Common temporary effects include blood in the urine and urinary urgency or frequency that ease over the following weeks. Less common risks include bleeding that needs attention, infection, narrowing of the channel over time, and temporary difficulty passing urine after the catheter comes out. Continence and erectile function can be affected, particularly after radical prostatectomy, but nerve-sparing technique and rehabilitation help recovery in many men, and changes are often temporary. Most men who have surgery for benign enlargement enjoy a markedly stronger, more comfortable urine flow, and for localised cancer surgery offers excellent long-term control, tracked afterwards with simple PSA blood tests.