Suprapubic Prostatectomy

What is a Suprapubic Prostatectomy?

A suprapubic prostatectomy is an open surgical procedure used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. The surgery removes the enlarged inner portion of the prostate through an incision made in the lower abdomen and bladder, relieving blockage of the urethra and improving urine flow.

Unlike a radical prostatectomy, which removes the entire prostate to treat prostate cancer, a suprapubic prostatectomy removes only the enlarged tissue causing urinary obstruction. This preserves the outer portion of the prostate while effectively relieving symptoms associated with severe BPH.

Although newer minimally invasive treatments are available for many men, a suprapubic prostatectomy remains an excellent option for patients with very large prostates or when other bladder conditions need to be treated during the same operation.

What are the Benefits of a Suprapubic Prostatectomy?

A suprapubic prostatectomy provides effective, long-term relief for men with severe urinary symptoms caused by a significantly enlarged prostate. Benefits include:

• Effectively treats very large prostates that may not be suitable for minimally invasive procedures.
• Improves urine flow by removing the tissue causing blockage.
• Relieves difficulty starting and maintaining urination.
• Reduces frequent urination, urgency, and nighttime urination (nocturia).
• Helps empty the bladder more completely.
• Decreases the risk of recurrent urinary retention.
• Reduces urinary tract infections related to bladder outlet obstruction.
• Allows treatment of bladder stones or bladder diverticula during the same surgery, if needed.
• Provides durable, long-lasting symptom relief.
• Improves overall quality of life.

When is a Suprapubic Prostatectomy Recommended?

Your urologist may recommend a suprapubic prostatectomy if your prostate is significantly enlarged or if other treatments have not been effective. Common reasons include:

• Severe benign prostatic hyperplasia (BPH).
• Very large prostate gland (typically larger than 80–100 grams).
• Recurrent urinary retention.
• Difficulty completely emptying the bladder.
• Persistent or severe lower urinary tract symptoms.
• Recurrent urinary tract infections caused by bladder obstruction.
• Bladder stones associated with an enlarged prostate.
• Bladder diverticula requiring surgical repair.
• Blood in the urine caused by BPH.
• Failure of medication or minimally invasive BPH procedures to adequately relieve symptoms.

What Does Preparation for a Suprapubic Prostatectomy Involve?

Before surgery, your urologist will review your medical history and perform a physical examination. Blood tests, urine analysis, and imaging studies may be ordered to evaluate your urinary tract and overall health. Additional tests such as uroflowmetry, cystoscopy, or post-void residual urine measurement may also be recommended.

You should inform your doctor about all medications, vitamins, and supplements you are taking. Blood-thinning medications may need to be temporarily stopped before surgery under your physician's guidance. You will also receive instructions regarding fasting before anesthesia and what to expect on the day of your procedure.

Your surgeon will explain the benefits, risks, recovery process, and expected outcomes before obtaining your informed consent.

How is a Suprapubic Prostatectomy Performed?

A suprapubic prostatectomy is performed under general or spinal anesthesia. After the anesthesia has taken effect, the surgeon makes an incision in the lower abdomen just above the pubic bone. The bladder is then opened to allow direct access to the enlarged prostate.

The surgeon carefully removes the enlarged inner portion of the prostate that is blocking urine flow while leaving the outer capsule of the prostate intact. This creates a wider channel through the urethra, allowing urine to pass more freely. If bladder stones or other bladder abnormalities are present, they can often be treated during the same operation.

After the prostate tissue has been removed, bleeding is controlled, and the bladder is closed with sutures. A urinary catheter is placed through the urethra to drain urine and support healing. In some cases, a temporary suprapubic catheter may also be inserted through the lower abdomen. The abdominal incision is then closed.

The procedure typically takes between two and three hours, depending on the size of the prostate and the complexity of the surgery.

What to Expect During Recovery After a Suprapubic Prostatectomy?

Following surgery, most patients remain in the hospital for several days for monitoring and pain management. A urinary catheter is usually left in place for one to two weeks while the bladder heals.

It is common to experience mild discomfort, temporary blood in the urine, bladder spasms, or urinary urgency during the early stages of recovery. Your healthcare team will provide instructions for catheter care, activity restrictions, hydration, and medications to support healing.

Most men can gradually resume light daily activities within two to four weeks, while strenuous exercise and heavy lifting should be avoided for several weeks. Urinary symptoms typically continue to improve as swelling decreases and healing progresses.

What are the Risks and Complications of a Suprapubic Prostatectomy?

Like all surgical procedures, a suprapubic prostatectomy carries some risks, although serious complications are uncommon. Potential risks include:

• Bleeding during or after surgery.
• Urinary tract infection.
• Blood clots.
• Temporary blood in the urine.
• Bladder spasms.
• Temporary urinary incontinence.
• Retrograde ejaculation.
• Urethral stricture or bladder neck narrowing.
• Erectile dysfunction (less common than after radical prostatectomy).
• Injury to surrounding structures.
• Risks associated with anesthesia.