Open prostatectomy 

A surgical option for enlarged prostates

Open prostatectomy is a traditional surgical procedure used to treat very large prostates or severe symptoms associated with prostate enlargement.

During this surgery, the surgeon makes a larger incision in the lower abdomen to access the prostate gland directly. This allows for the removal of the enlarged portion of the prostate.

Compared to trans-urethral resection of the prostate (TURP), open prostatectomy is more extensive and involves a longer recovery period. However, it may be necessary for larger prostates or in more complex cases where other treatments may not be suitable.

For individuals with significant urinary issues caused by prostate enlargement, open prostatectomy provides a viable treatment option aimed at relieving symptoms and improving quality of life.

Who is a Candidate?

Men with very large prostates causing severe lower urinary tract symptoms or urinary retention not manageable by TURP surgery or medication.

Indications include:

• Severe benign prostatic hyperplasia (BPH) causing significant obstruction
• Recurrent urinary retention or bladder stones due to obstruction
• Diverticula or bladder damage from long-term obstruction
• Failed minimally invasive procedures (e.g. TURP, laser prostatectomy).

Recovery Timeline

This is likely to vary with provider.

• Hospital stay: Usually 3–7 days.
• Catheter: Typically kept in for 5–7 days post-surgery.
• Initial recovery:
  • Discomfort and blood in urine for up to 1–2 weeks.
  • Gradual improvement in urinary flow after catheter removal.
• Return to light activities: 4–6 weeks.
• Full recovery: Around 6–8 weeks, depending on age and general health.

Benefits

• Effective removal of large prostate tissue that cannot be managed with less invasive methods
• Dramatic improvement in urinary flow and symptom relief
• Durable, long-term results - often no need for repeat procedures
• Allows treatment of associated bladder pathology during the same surgery (e.g. stones).

Risks

• Bleeding (higher risk than with TURP; may require transfusion)
• Infection (wound or urinary tract)
• Urinary incontinence (temporary, rarely persistent)
• Retrograde ejaculation (common but harmless)
• Erectile dysfunction (less common but possible)
• Wound complications (due to open incision)
• Longer hospital stay and recovery compared to TURP or laser surgery.

This is just an outline. Your specialist urology surgeon will be able to talk to you about these issues in more detail and make sure that there is informed consent.

Open prostatectomy remains the preferred option for very large prostates or when other methods are unsuitable, providing excellent long-term relief but with greater invasiveness and longer recovery than minimally invasive alternatives.