⚕️ Prostate Surgery

Open Prostatectomy

Open prostatectomy is the gold standard surgical treatment for large prostates — particularly those over 80 grams. Using a suprapubic or retropubic approach, the entire prostate adenoma is removed, delivering permanent, lasting relief.

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Open prostatectomy (simple prostatectomy) is the surgical treatment for benign prostatic hyperplasia (BPH). It is the preferred approach for prostates over 80 grams, or in patients where TURP or HoLEP cannot be performed. According to European Association of Urology (EAU) guidelines, the procedure is carried out using either a suprapubic or retropubic approach.

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Detail	Information
Procedure	Open Prostatectomy (Simple Prostatectomy)
Surgeon	Prof. Dr. Özkan Onuk — Urologist
Clinic	Urologica, Istanbul, Turkey
Surgery Duration	90–120 minutes
Anaesthesia	General or spinal anaesthesia
Hospital Stay	3–5 days
Recovery	4–6 weeks
Accreditation	Turkish Urology Association and EAU standards
Pricing	Confirmed during your consultation
Contact	WhatsApp: +90 541 123 06 03

What Is Open Prostatectomy?

Open prostatectomy is a surgical procedure in which the inner portion of the prostate gland (the adenoma) is removed through an incision in the lower abdomen. The procedure is used primarily in the treatment of benign prostatic hyperplasia (BPH). The outer capsule of the prostate is left in place, while the inner tissue obstructing the urinary tract is removed.

The prostate gland is an organ located just below the bladder in men, surrounding the urethra. With age, the prostate can enlarge and obstruct urinary flow. For mild to moderate enlargement, medication or minimally invasive procedures are typically preferred — but for very large prostates, open prostatectomy can be the most effective treatment option available.

The term “open prostatectomy” is sometimes confused with prostate cancer surgery (radical prostatectomy). However, these are two distinct procedures. In open prostatectomy for BPH (simple prostatectomy), only the inner portion of the prostate is removed, whereas radical prostatectomy for prostate cancer involves removal of the entire prostate gland and surrounding tissues.

According to European Association of Urology (EAU) guidelines, open prostatectomy is recognised as one of the gold standard treatment options for patients with a prostate volume exceeding 80 millilitres. The procedure has been performed successfully for decades and its long-term outcomes are well documented.

Who Is a Candidate?

Open prostatectomy is not performed for every BPH patient. The procedure is recommended for patients who meet specific criteria.

Suitable candidates for open prostatectomy include: patients with a prostate volume exceeding 80–100 millilitres; patients who have not responded to medication or cannot tolerate it; patients experiencing recurrent urinary tract infections; patients who have developed bladder stones; patients who have had episodes of acute urinary retention (inability to urinate); and patients whose kidney function has been affected by prostatic obstruction.

Some patients may also present with co-existing conditions such as a bladder diverticulum (a pocket-like formation in the bladder wall) or an inguinal hernia. In these cases, open surgery allows both the prostate condition and the accompanying issue to be addressed in a single procedure.

The decision to proceed with open prostatectomy is made following a thorough assessment. This evaluation includes a prostate-specific antigen (PSA) test, urinary flow rate measurement (uroflowmetry), post-void residual urine volume measurement, prostate ultrasound, and where necessary, cystoscopy.

Who Is Not a Candidate?

There are situations in which open prostatectomy cannot be performed, or where careful evaluation is required before proceeding.

Absolute contraindications include: untreated urinary tract infection, uncontrolled bleeding disorders, patients who are not suitable for general or spinal anaesthesia, and active prostate cancer (in which case radical prostatectomy may be required instead).

Relative contraindications and situations requiring careful assessment include: significant cardiovascular disease, uncontrolled diabetes, severe obesity, patients who have previously undergone pelvic radiotherapy, and severe chronic obstructive pulmonary disease (COPD).

Patients taking blood-thinning medication may need to stop or switch their medication for a specified period before surgery. This adjustment is made in coordination with the patient’s cardiologist.

For small to moderate-sized prostates, less invasive procedures such as TURP (transurethral resection of the prostate) or laser treatment are preferred over open surgery. The choice of surgical method is determined based on the patient’s overall health and prostate size.

Treatment Options Compared

Several surgical options are available for the treatment of benign prostatic hyperplasia (BPH). Each approach has its own distinct advantages and limitations.

Feature	Open Prostatectomy	TURP	HoLEP
Suitable Prostate Size	>80–100 ml	30–80 ml	Any size
Surgery Duration	90–120 min	60–90 min	60–120 min
Hospital Stay	3–5 days	1–3 days	1–2 days
Catheter Duration	5–7 days	2–3 days	1–2 days
Full Recovery	4–6 weeks	2–4 weeks	2–4 weeks
Blood Loss	Higher	Moderate	Low
Recurrence Risk	Low	Moderate	Low
Equipment Required	Standard surgical instruments	Resectoscope	Holmium laser

The advantages of open prostatectomy include: effective treatment for very large prostates, the ability to obtain a tissue specimen for pathological examination, the option to treat co-existing bladder stones or diverticula in the same procedure, and a low long-term recurrence rate.

The limitations include: a longer hospital stay, a longer recovery period, a surgical incision scar on the lower abdomen, and a higher likelihood of blood loss compared to other approaches. The choice of treatment method is determined based on each patient’s individual circumstances.

What to Expect

The vast majority of patients experience a noticeable improvement in urinary flow following open prostatectomy. However, as with any surgical procedure, results can vary between individuals.

Improvements typically seen after surgery include: increased urinary flow rate, fewer episodes of nocturia (waking at night to urinate), reduced urgency, complete bladder emptying, and a decrease in recurrent urinary tract infections.

It is important to have realistic expectations about what the surgery cannot achieve. Prostate surgery cannot reverse age-related loss of bladder function. Permanent changes in the bladder muscle caused by long-standing obstruction may persist after surgery. For this reason, early treatment leads to better outcomes.

Regarding sexual function, retrograde ejaculation (dry orgasm) is a likely outcome following open prostatectomy. In this condition, ejaculatory fluid flows back into the bladder rather than being expelled. This may affect fertility, but the sensation of orgasm is generally preserved. Erectile function tends to remain at its pre-operative level.

How Is the Surgery Performed?

Open prostatectomy is performed under general or spinal anaesthesia. Before surgery, the patient is given intravenous antibiotics and a urinary catheter is inserted.

Two primary surgical approaches are used. In the suprapubic (transvesical) approach, an incision is made below the navel, the bladder is opened, and the prostate tissue is accessed through it. In the retropubic approach, the prostate tissue is accessed directly through the prostatic capsule without opening the bladder. Both techniques have their own distinct advantages, and the choice is made based on the surgeon’s preference and the patient’s individual circumstances.

The key steps of the procedure can be summarised as follows: an incision of approximately 8–10 centimetres is made in the lower abdomen; the bladder or prostatic capsule is accessed; the prostate adenoma (inner tissue) is separated from the capsule and removed using fingers or surgical instruments; bleeding is controlled; a urinary catheter and, where necessary, suprapubic drainage are placed; and the layers are closed.

Surgery duration ranges from 90 to 120 minutes depending on prostate size and any additional procedures performed. The removed prostate tissue is sent for pathological examination — an important step for detecting any prostate cancer that may not have been identified beforehand.

Risks and Complications

Open prostatectomy is a safe procedure, but like any surgery it carries certain risks. Understanding these risks is an important part of making an informed decision.

Intraoperative and early post-operative risks include: bleeding and the potential need for blood transfusion (rare), infection, deep vein thrombosis, wound healing complications, and anaesthesia-related complications.

Late-onset complications may include: retrograde ejaculation (common — affecting the majority of patients), temporary urinary incontinence (usually resolves within a few weeks), permanent urinary incontinence (rare), urethral stricture (rare), bladder neck contracture (rare), and erectile dysfunction (dependent on pre-operative status).

Complication	Frequency
Retrograde ejaculation	Common (65–80%)
Temporary urinary incontinence	Moderate (5–10%)
Need for blood transfusion	Low (2–5%)
Permanent urinary incontinence	Rare (1–2%)
Urethral / bladder neck stricture	Rare (1–3%)

These complication rates are based on published literature and may vary depending on individual risk factors. A thorough pre-operative assessment plays an important role in minimising risk.

Recovery Process

Recovery following open prostatectomy requires careful monitoring. The key stages can be summarised as follows.

Hospital stay is typically 3–5 days. During this time, the urinary catheter remains in place, intravenous fluids and antibiotics are administered, pain is managed, and early mobilisation (walking) is encouraged.

The urinary catheter is usually removed on day 5–7 after surgery. Before removal, bladder capacity and the ability to urinate are assessed. In some patients, the catheter may be removed earlier or later depending on progress.

Rest is recommended for the first two weeks following discharge. During this period, heavy lifting, strenuous physical activity, and sexual intercourse are not advised. Staying well hydrated, avoiding constipation, and regular gentle walking all support recovery.

Urinary burning and increased frequency are considered normal in the first few weeks. Light bleeding or clots in the urine may also occur during the early weeks — drinking plenty of water helps resolve this.

Full recovery is typically complete within 4–6 weeks, after which the majority of patients are able to return to their normal activities. Sexual activity can generally be resumed after 4–6 weeks. Follow-up appointments are scheduled at 1 month, 3 months, and 1 year post-surgery.

About Prof. Dr. Özkan Onuk

Prof. Dr. Özkan Onuk is a practising academic physician specialising in urology and andrology.

Prof. Dr. Özkan Onuk serves as a faculty member in the Department of Urology at Biruni University Faculty of Medicine.

Academic Position: Faculty Member, Department of Urology, Biruni University Faculty of Medicine

Areas of Expertise:

Prostate diseases and surgery
Benign prostatic hyperplasia (BPH) treatment
Open and minimally invasive prostate surgery
Erectile dysfunction treatment
Penile implant surgery
Andrological conditions

Memberships:

European Association of Urology (EAU)
Turkish Urology Association
International Society for Sexual Medicine (ISSM)

Clinical Practice: Prof. Dr. Onuk provides consultations and treatment for prostate conditions and men’s health at Urologica Clinic in Istanbul. To book an appointment and learn more about open prostatectomy and other prostate treatment options, contact us today.

Book a Consultation

To learn more about open prostatectomy and arrange a personalised assessment, you can book a consultation with Prof. Dr. Özkan Onuk.

During your consultation, your medical history will be reviewed, a physical examination will be performed, any necessary investigations will be planned, and treatment options will be discussed. The most appropriate treatment approach will be determined together, based on your prostate size and overall health.

Contact:

📱 WhatsApp: +90 541 123 06 03 📧 Email: Urologica.tr@gmail.com 📍 Location: Urologica, Istanbul, Turkey

Medical Disclaimer

The information on this page is provided for informational purposes only and does not substitute professional medical advice. Always consult a qualified physician regarding any medical condition. Individual results may vary. Prof. Dr. Özkan Onuk and Urologica accept no responsibility for decisions made based on the information provided here. This content has been prepared in accordance with the regulations of the Turkish Ministry of Health.

Medically reviewed by: Prof. Dr. Özkan Onuk, Faculty Member, Department of Urology
Last updated: February 2026 | Next review: May 2026

Why Urologica?

Why Choose Us for Open Prostatectomy?

Safe and effective surgery for large prostates — an experienced team delivering comprehensive care.

Prof. Dr. Özkan Onuk

Urologist | Clinical Director

Rigicon Global Reference Center

Expertise in Large Prostates

Safe and complete adenoma removal via open prostatectomy for prostates over 100 grams.

Low Complication Rate

Experienced surgical technique with minimal blood loss and low risk of infection.

Streamlined Recovery

An optimised post-operative care protocol ensures a shorter hospital stay and an earlier return to daily life.

Comprehensive Follow-Up Programme

Long-term outcome monitoring through scheduled post-operative check-ups, urinary flow testing, and PSA surveillance.

20+

Years of Experience

3,000+

Successful Surgeries

95%+

Symptom Improvement

5,000+

Happy Patients

Frequently Asked Questions

Open Prostatectomy — Frequently Asked Questions

The most common questions about open prostatectomy, answered.

Open prostatectomy is performed through an incision in the lower abdomen, while TURP (transurethral resection of the prostate) is carried out endoscopically through the urethra — no external incision required. Open surgery is preferred for very large prostates, whereas TURP is used for moderate-sized prostates.

Surgery duration ranges from 90 to 120 minutes depending on prostate size and the patient's individual circumstances. If additional procedures are required — such as treating a bladder stone or diverticulum — the duration may be longer.

As the procedure is performed under general or spinal anaesthesia, no pain is felt during surgery. Post-operative pain is effectively managed with prescription analgesics. Most patients describe only mild to moderate discomfort.

Hospital stay is typically 3–5 days. This may vary depending on the patient's general condition and the pace of recovery.

The urinary catheter is typically kept in place for 5–7 days after surgery. Once removed, patients are able to urinate independently.

Erectile function generally remains at its pre-operative level. However, retrograde ejaculation (dry orgasm) occurs in the majority of patients — ejaculatory fluid flows back into the bladder rather than being expelled. The sensation of orgasm is preserved.

Because the entire prostate adenoma is removed during open prostatectomy, the recurrence rate is low. However, over a very long period, some regrowth from the remaining tissue is possible.

Some temporary urinary incontinence may occur after surgery, but this usually resolves within a few weeks. Permanent urinary incontinence is rare. Pelvic floor exercises can help speed up recovery.

Patients with desk jobs can typically return to work after 2–3 weeks. Those in physically demanding roles should allow 4–6 weeks. These timelines may vary depending on individual recovery.

Pre-operative blood tests, urinalysis, and imaging are carried out beforehand. Blood-thinning medications may need to be adjusted. Patients must fast from midnight before the day of surgery.

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