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In a retropubic (meaning behind the public bone) prostatectomy, the patient is operated on while lying on his back, and a five-inch incision is made in the lower abdomen. The muscle is separated, and the sac containing the intestines is moved away from the bladder. The surgeon then makes an incision into the prostate gland and removes the tissue causing the urethral obstruction. The tissue is sent to the laboratory to see if any cancer is present. The surgeon closes the prostate capsule with sutures, and the muscle fascia and skin are put back in place and closed with stitches.
The advantage of this type of surgery, which became popular in the 1940s, is that it provides a better view of the prostate gland and the bladder neck. This helps to control bleeding after the problem tissue is taken out. Since the bladder itself is not opened, there is no need for a catheter coming through the bladder wall following surgery, as in the suprapubic approach (see below).
The lesser violation of the body offers less potential for problems and is conducive to speedier recovery. Since this technique causes less stress to the patient, it is the preferred choice by most urologists. It is also used when the prostate tissue is too large to be removed by a TURP.
Concerns Obese men and those with a particularly narrow or bony pelvis are not likely candidates for this approach, as it is difficult for the surgeon to have good exposure of the prostate gland.