The prostate is the male gland which leys on the muscles of the pelvic floor beneath the bladder surrounding the urethra. It consists of two side lobes, a central lob and the colleculus seminales which is an elevation through which the semen spurts out during ejaculation. This part is considered the lower limit for the prostate during a surgical operation.

The prostate produces the largest part of seminal fluid and it is affected by the male hormone testosterone. The prostate enlarges on aging causing difficulty during urination. The causes of this enlargement are not well known and the enlargement is treated either medically or surgically.
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Prostate Anatomy
a = bladder / b = bladder neck
c = right prostate lobe / d = left prostatic lobe
s = seed hill / f = urethra
g = capsule of the prostate gland / h = nerves and blood vessels of the prostate
i = adductor

Accumulation of alpha-2 receptors at the bladder neck
a = bladder neck
b = alpha-2 receptors

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Men who did not profit from the medical treatment and whom suffer a weak urinary stream, dribbling after micturition or even unable to void urine.

There are other symptoms like the increased frequency of urination and desire to evacuate the bladder or the burning during micturition and disturbed sleep due to the frequent desire to urinate which are considered as signs for removal of the prostate by the endoscope.

How is the operation done:

The patient leys on his back. An incision is done at the lower part of the abdomen to reach the prostate which leys outside the peritoneum which wraps the intestine. The capsule of the prostate is opened and the gland is removed in a piece. A catheter is put through the urethra and another through the abdominal wall into the bladder. The bladder is evacuated through the last mentioned catheter until complete healing takes place and until it is sure that the urine flows in a strong stream.

The blood vessels are closed by a high frequency currant. Blood loss is mostly minimum. The bladder is irrigated for at least a day. The patient stays for a day to three days before leaving home.

Healing:

The patient leaves after one to three days and continue follow up on ambulant basis. The suprapubic catheter stays in place until urination is normal. This catheter is connected to a urine collecting bag and put under the clothes in an unremarkable way.

The lobes of the healthy Prostatic urethra a = prostate b = urethra c = bladder suche	The lobes of the enlarged Constrict the prostate urethra a = prostate b = urethra c = bladder

Frequently asked questions:

1. Is this operation done under anesthesia?
   
   Yes, it is done under general or spinal anesthesia.
   
   
2. What is the suprapubic catheter?
   
   It is a catheter pushed temporarily through the wall of the abdomen to the bladder. It is a safe and a clean way of emptying the bladder.
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3. Is the effect of the operation immediate?
   
   No, complete healing requires a week. This is why do we leave the catheter that long until conditions return to normal.
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4. Does this operation mean the complete removal of the prostate?
   
   No, it means removal of the enlarged part only. The capsule of the prostate remains in place.
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5. Is there a danger that incontinence may take place after the surgery?
   
   The possibility of occurring of incontinence is rare and there are many ways to treat it.
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6. What are the complications of the operation?
   
   It is rare to observe complications after this surgery like the inability to control urine (incontinence), bladder infection, weak erection, loss of some blood and lastly the retrograde ejaculation which is the most frequent complication.