Simple prostatectomy
A simple prostatectomy removes the overgrown inner part of a very large prostate through the bladder, using robotic keyhole surgery or an open incision. The outer shell of the prostate stays in place. It is an operation for BPH, not cancer.
Also called simple prostatectomy, robotic simple prostatectomy, RASP, open simple prostatectomy, suprapubic prostatectomy, retropubic prostatectomy for BPH, transvesical prostatectomy, Millin prostatectomy
- Where
- Hospital operating room
- Anesthesia
- General anesthesia
- Time in the room
- About 2 to 4 hours
- Hospital stay
- Robotic: usually 1 to 2 nights. Open: usually 3 to 5 nights
- Going home with
- Urinary catheter for about 5 to 10 days, sometimes a small drain for a day or two
- Back to normal
- About 3 to 4 weeks after robotic surgery; 6 weeks or more after open surgery
- Back to work
- Desk work in about 2 to 3 weeks; heavy work in about 6 weeks
Overview
Simple prostatectomy is the oldest surgery for BPH (benign prostatic hyperplasia), and it is still used for very large prostates. The word simple means that only the overgrown inner part, called the adenoma, is removed. This is different from a radical prostatectomy for cancer, which removes the whole prostate and seminal vesicles and requires rejoining the bladder to the urethra.
The surgeon reaches the prostate through the bladder. In robotic surgery, this is done through several small keyhole cuts in the belly. In open surgery, it is done through a single cut in the lower belly. The bladder is opened, the inner prostate is shelled out from its outer shell with a finger or robotic instruments, and the bladder is closed.
The AUA guideline lists open, laparoscopic, or robotic simple prostatectomy as options for large to very large prostates. Laser enucleation (HoLEP) removes the same tissue through the urethra and is often preferred where available. Simple prostatectomy remains a good choice when HoLEP is not available, or when a bladder stone or bladder pouch also needs fixing.
Results are excellent and very long-lasting. The trade-offs are a longer catheter time, a hospital stay, belly incisions, and dry orgasms for most men. Robotic surgery usually means less blood loss and a shorter stay than open surgery.
The parts of your body involved
The prostate sits below the bladder, behind the pubic bone, and in front of the rectum. In BPH, the inner prostate can grow very large, sometimes many times its normal size, and press the outer prostate into a thin shell. There is a natural layer between the inner growth and the shell. The continence muscle sits just below the prostate, and the erection nerves run along the outside of the shell.
- Adenoma
The overgrown inner prostate. This is what is removed.
- Prostate capsule
The outer shell, left in place.
- Bladder
Opened to reach the prostate from above, then closed with stitches.
- Bladder neck and ureter openings
The bladder's outlet and the two openings where urine enters from the kidneys. The surgeon protects the openings.
- External sphincter
The muscle that keeps you dry, just below the prostate. It is protected.
- Erection nerves
Run outside the shell and are usually not disturbed.
Why it’s done
Simple prostatectomy is offered when a very large prostate causes bothersome symptoms or blockage that needs surgery, and an operation through the urethra is not a good fit or not available.
- Very large prostate
Often over about 80 to 100 grams, where TURP would be too long and too bloody.
- Retention
A bladder that will not empty, often with a catheter already in place.
- Other bladder problems
Large bladder stones or a bladder pouch can be fixed during the same operation.
- Complications
Repeated infections, bleeding from the prostate, or kidney strain.
- Lasting result
Retreatment for regrowth is rare.
Other options
- Watching and waiting or medicines
If symptoms are mild and there is no damage, medicines may be enough. Finasteride or dutasteride can shrink a large prostate over months.
- HoLEP
Removes the same tissue through the urethra with a laser. No belly cuts and a shorter catheter time. Needs a surgeon experienced with large glands.
- Aquablation
A robot-guided waterjet through the urethra for prostates up to about 150 grams.
- Prostate artery embolization
Shrinks the prostate by blocking its blood supply. Avoids general anesthesia, with smaller improvement.
- Long-term catheter
For men who cannot safely have surgery, a catheter through the belly or urethra can drain the bladder.
Getting ready
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Weeks before
The week before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia
You are put fully to sleep with a breathing tube. A catheter is placed in the bladder.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
You wake with a catheter, often with salt water rinsing the bladder, and sometimes a drain.
- Pain
Incision pain is managed with acetaminophen, anti-inflammatory medicine if safe, and short-term opioids if needed. After robotic surgery, some men feel shoulder-tip pain from the gas for a day or two.
- Bladder spasms
Common with the catheter and treated with medicine.
- Walking and eating
You walk the same day or next morning and start eating as your bowels wake up.
- Drain out
The drain usually comes out before you go home.
- Going home
Usually after 1 to 2 nights for robotic surgery, or longer after open surgery, with the catheter still in place.
At home
- Catheter
Usually stays about 5 to 10 days, longer after open surgery. A test called a cystogram may check that the bladder has healed before removal.
- Incisions
Keep them clean and dry. Shower after 24 to 48 hours; pat dry. No baths or swimming for about 2 to 4 weeks.
- Pain
Usually improves steadily over the first week or two.
- Blood in the urine
Pink urine on and off for several weeks is common.
- Drinking
Aim for about 6 to 8 glasses of water a day unless told otherwise.
- Bowels
Use a stool softener; avoid straining.
- Lifting
Avoid lifting more than about 10 to 15 pounds (5 to 7 kg) for about 4 to 6 weeks.
- Driving
Not with a catheter or while taking opioids, and not until you can brake hard without pain.
- Sex
Usually after about 4 to 6 weeks. Most men have dry orgasms afterward.
- Work
Desk work in about 2 to 3 weeks; heavy work in about 6 weeks.
Recovery timeline
- Day 0Surgery
Catheter and rinse in place; walking that evening if possible.
- Days 1 to 2Home (robotic)
Drain out; home with the catheter.
- Week 1Catheter out
Usually 5 to 10 days after surgery, sometimes after a bladder X-ray.
- Weeks 2 to 3Urinating freely
Burning and urgency improve. A strong stream.
- Weeks 4 to 6Back to full activity
Most lifting and exercise allowed.
- 6 to 12 weeksFollow-up
Symptoms, flow, and emptying are checked; lab results reviewed.
- 3 to 6 monthsFully healed
Urgency and night-time trips continue to improve.
- Long termLasting result
Retreatment is rare. PSA checks continue as advised, starting from a new lower baseline.
What it feels like
This is a bigger operation than scope surgery for BPH, but recovery is usually steady. The catheter is what most men remember.
Before surgery
Worry about belly surgery and about losing control of urine.
What helpsAsk how your surgeon protects the continence muscle, and what most patients experience.
Waking up
Sore belly, catheter discomfort, and sometimes shoulder-tip pain from the gas after robotic surgery.
What helpsPain medicine, walking, and time. Shoulder pain fades in a day or two.
Bladder spasms
Sudden cramps and urges, sometimes leaking around the catheter.
What helpsSpasm medicine and keeping the catheter tube free of kinks.
Going home with the catheter
Frustration at having it for a week or more.
What helpsA leg bag under loose pants, and counting down to removal day.
Catheter removal
Burning and frequent urges, but often the strongest stream in years.
What helpsDrink steadily and be patient with the burning.
Intimacy
Erections usually unchanged but orgasms dry for most men.
What helpsTalk with your partner in advance.
Months later
Relief from years of struggle to urinate.
What helpsFollow-up and PSA checks as advised.
How well it works
Simple prostatectomy gives one of the largest and most lasting improvements of any BPH treatment.
- Symptoms
Symptom scores usually fall by two-thirds or more.
- Flow and emptying
Flow rate usually rises a lot, and leftover urine falls.
- Durability
Regrowth needing another operation is rare.
- Pathology
All tissue goes to the lab. A small number of men are found to have a small area of unexpected cancer.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Semen goes into the bladder. Orgasm usually still feels the same.
For several weeks after the catheter comes out.
On and off for several weeks.
Usually improves over weeks to a few months with pelvic floor exercises.
Less common
Less common with robotic surgery than open surgery.
Treated with antibiotics.
Usually heals with the catheter left in longer.
At the bladder neck or in the urethra; may need a small procedure later.
Infection or a hernia at a cut, more likely with open surgery.
Rare
Stress leaking that does not settle.
Rare.
Prevented with walking, compression sleeves, and sometimes blood thinner shots.
As with any major operation under general anesthesia.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- No urine draining from your catheter for 1 hour
- Thick dark red urine or clots that block the flow
- Redness, swelling, or pus at an incision
- Belly swelling, vomiting, or not passing gas
- Pain, swelling, or warmth in one leg
- Chest pain or sudden shortness of breath (call 911)
Questions to ask your surgeon
- Why do you recommend simple prostatectomy over HoLEP for me?
- Will you do it robotically or open?
- How many simple prostatectomies have you done?
- How long will I stay in the hospital?
- How long will I have a catheter? Will I need a bladder X-ray before it comes out?
- What is my chance of needing a blood transfusion?
- Can you fix my bladder stones or bladder pouch at the same time?
- What are my chances of dry orgasm and short-term leaking?
- Will this affect my erections?
- How will my PSA be followed afterward?
Words you may hear
- Pneumoperitoneum
- The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
- Simple prostatectomy
- Removal of the inner prostate growth, leaving the outer shell, for BPH.
- Radical prostatectomy
- Removal of the whole prostate for cancer, a different operation.
- Adenoma
- The overgrown inner prostate tissue.
- Capsule
- The outer shell of the prostate.
- Cystotomy
- An opening made in the bladder.
- Transvesical
- Through the bladder.
- Retrograde ejaculation
- Semen going into the bladder instead of out during orgasm.
- Cystogram
- An X-ray with dye in the bladder to check for leaks.
- Insufflation
- Filling the belly with gas to make space during keyhole surgery.
- Bladder diverticulum
- A pouch that bulges out through a weak spot in the bladder wall.
- BPH
- Benign prostatic hyperplasia: non-cancer growth of the prostate.
Common questions
Is this cancer surgery?
No. It removes only the inner growth that blocks urine. The outer prostate stays, so you still need PSA checks as advised.
Will I lose control of my urine?
Short-term leaking is common and usually improves. Lasting leakage is uncommon because the continence muscle is protected.
Will I have erection problems?
Most men notice no change because the nerves run outside the shell, which stays in place.
Robotic or open?
Robotic surgery usually means less bleeding, less pain, and a shorter stay. Open surgery remains a good, proven option.
Why so long with a catheter?
The bladder was opened and closed, and it needs time to heal watertight.
Could HoLEP do the same thing?
Yes, HoLEP removes the same tissue through the urethra. Availability and surgeon experience often decide which is used.
Sources this page draws on
- American Urological Association, Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline
- European Association of Urology, EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms
- Urology Care Foundation, Benign Prostatic Hyperplasia (BPH)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Prostate Enlargement (Benign Prostatic Hyperplasia)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.