Robotic Prostate Adenomectomy

The Prostate: A gland in the male reproductive system, roughly the size of a walnut, located immediately below the bladder and in front of the rectum.

The Urethra: The canal that carries urine from the bladder to the outside passes through the center of the prostate.

BPH: An enlargement that occurs naturally with aging in most men. As the inner part of the prostate (called the adenoma or transition zone) grows, it can compress the urethra, making it difficult for urine to pass and causing various Lower Urinary Tract Symptoms (LUTS).

Important Distinction: It is crucial to differentiate BPH from prostate cancer. BPH is not cancer and does not turn into cancer. However, both conditions can coexist. The tissue removed during an adenomectomy is always sent for analysis to rule out the presence of incidental cancer.

Definition: Also known as simple prostatectomy, this procedure involves the removal (enucleation) of the enlarged internal portion of the prostate—the adenoma—that is obstructing urinary flow. The outer capsule of the prostate is left in place.

Difference from Radical Prostatectomy: In radical prostatectomy (performed for prostate cancer), the entire gland, seminal vesicles, and sometimes lymph nodes are removed. Adenomectomy is less extensive, focusing only on the obstructive benign tissue.

Difference from Transurethral Procedures (TURP, Laser, etc.): While TURP or laser therapies remove tissue through the urethra (“from the inside”), adenomectomy is generally reserved for considerably larger prostates where transurethral removal would be less effective or carry a higher risk of complications.

Main Objective: To provide significant and long-lasting relief from urinary obstruction and symptoms caused by a large-volume BPH.

How Robotic Surgery Works:

• It is a minimally invasive technique performed under general anesthesia.
• Several small incisions (usually 4 to 6, about 0.5 to 1.5 cm each) are made in the abdomen.
• Through these “ports,” a high-definition 3D camera and miniaturized, articulated instruments are inserted.
• The surgeon operates from an ergonomic console, controlling robotic arms that translate hand movements into precise, filtered actions inside the patient’s body.

Differences from Open Adenomectomy:

• Traditional Open Surgery: Requires a larger abdominal incision from the navel to the pubic bone. It was the standard for very large prostates before robotics.
• Robotic Surgery: Achieves the same goals of complete adenoma removal but with smaller incisions, less trauma, and faster recovery.

Magnified 3D HD Vision: Excellent visualization of the prostate capsule, adenoma, bladder neck, and blood vessels.

Greater Precision: Articulated instruments (EndoWrist®) allow for fine movements, essential for the careful enucleation of the adenoma and suturing.

Less Blood Loss: Significantly reduced bleeding compared to traditional open surgery.

Faster Recovery: Shorter hospital stays and a quicker return to work and normal activities.

Better Aesthetic Results: Smaller, more discreet scars.

Effective for Very Large Adenomas: Successfully treats prostate volumes that would be difficult or impossible to manage adequately via transurethral routes.

Moderate to Severe LUTS: Men who have not responded well to medical treatment.

Large Volume Prostates: Typically considered for prostates exceeding 80–100 grams.

Complications of BPH: Including recurrent urinary retention, large bladder stones, recurrent blood in the urine (hematuria), or bladder diverticula.

Adequate Physical Condition: Patients fit enough to tolerate general anesthesia and the surgical position.

Pre-Operative Exams: Blood tests, EKG, etc.

Medication Adjustment: Suspending anticoagulants or antiplatelet agents as directed.

Fasting: No food or drink for several hours before the procedure.

Anesthesia: Performed under general anesthesia.

Access: The surgeon accesses the adenoma either through the bladder (Transvesical) or directly through the prostate capsule (Retropúbica/Transcápsular).

Enucleation: The enlarged tissue is carefully dissected and removed from within the capsule.

Hemostasis: Blood vessels are controlled with high precision.

Reconstruction: The incision in the bladder or capsule is sutured. The removed tissue is placed in an extraction bag and taken out through one of the slightly enlarged incisions.

Catheterization: A urinary catheter is placed, usually with a continuous irrigation system to prevent clot formation.

Hospital Stay: Typically lasts 2 to 4 days.

Urinary Catheter: Usually maintained for 5 to 7 days. You will receive instructions on how to care for it at home.

Continuous Irrigation: Used in the first hours or days to keep the bladder clear.

Activity: Physical activity should be increased gradually. Avoid heavy lifting for 4 to 6 weeks.

Hydration: Maintaining good fluid intake is essential.

Results:
The primary goal is a marked, long-lasting improvement in urinary flow. Adenomectomy offers the highest success rates for relieving obstruction in men with very large prostates.

Potential Side Effects:

• Retrograde Ejaculation (“Dry Orgasm”): This is a very common and expected effect. During orgasm, semen enters the bladder instead of exiting the urethra. It is not harmful to health but results in infertility.
• Bleeding: Lower risk with robotics, but still possible.
• Urinary Incontinence: Temporary leakage may occur after catheter removal but usually improves with time and pelvic floor exercises.
• General Risks: Like any major surgery, there are risks of infection, thrombosis, or incisional hernia.

Periodic consultations and symptom evaluations.

Uroflowmetry: To confirm a good functional result.

Pathology Review: Discussion of the lab results of the removed tissue.

If you have been told you need surgery to remove the “core” of your prostate due to its size, robotic adenomectomy may be the best path forward. I invite you to schedule a consultation to discuss your specific case and help you make the most informed decision for your health.