A simple prostatectomy is a surgery that removes the inner portion of the prostate gland while leaving the outer shell intact. It treats severe urinary symptoms caused by a very enlarged prostate, a condition called benign prostatic hyperplasia (BPH). This is not a cancer operation. It’s sometimes called a partial prostatectomy, and it’s typically recommended when the prostate has grown large enough that less invasive procedures won’t work effectively.
How It Differs From Radical Prostatectomy
The name “simple” doesn’t mean the surgery is minor. It refers to what’s being removed. In a simple prostatectomy, the surgeon shells out the enlarged inner tissue (the adenoma) that’s squeezing the urethra and blocking urine flow, while preserving the outer capsule of the prostate. Think of it like scooping out the inside of an avocado and leaving the skin.
A radical prostatectomy, by contrast, removes the entire prostate gland along with surrounding tissue, seminal vesicles, and sometimes nearby lymph nodes. That operation treats prostate cancer. Because a simple prostatectomy leaves the outer zone of the prostate in place, prostate cancer can still develop in the remaining tissue. You’ll still need routine prostate cancer screening afterward.
Who Needs This Surgery
Simple prostatectomy is generally reserved for men with very large prostates. Many minimally invasive BPH treatments, such as water vapor therapy and prostatic urethral lifts, are only approved for prostates between 30 and 80 grams. When the gland grows well beyond that range, those options become less effective or aren’t indicated at all. American Urological Association guidelines recommend that clinicians consider open, laparoscopic, or robotic-assisted prostatectomy for patients with large prostates, particularly when transurethral approaches aren’t feasible or available.
Some surgeons do treat large glands using transurethral techniques like laser enucleation, but not every hospital has the equipment or the surgical expertise for those procedures. For many patients with severely enlarged prostates causing significant urinary obstruction, simple prostatectomy remains the most practical and durable solution.
Open vs. Robotic Approaches
There are two main ways to perform a simple prostatectomy. The traditional open approach involves a vertical incision in the lower abdomen. The surgeon reaches the prostate either through the bladder wall (suprapubic approach) or through the front of the prostate capsule itself (retropubic approach). In both cases, the surgeon identifies the plane between the adenoma and the capsule, then manually separates and removes the overgrown tissue.
The robotic-assisted version accomplishes the same thing through smaller incisions using a surgical robot. A meta-analysis published in Frontiers in Surgery found that robotic simple prostatectomy takes about an hour longer in the operating room but results in roughly 300 mL less blood loss and nearly three fewer days in the hospital compared to the open approach. Symptom relief and long-term outcomes are similar between the two techniques, so the choice often depends on what your surgeon has the most experience with and what’s available at your hospital.
How Well It Works
Simple prostatectomy is one of the most effective and durable treatments for BPH. It removes a large volume of obstructing tissue in a single procedure, which typically produces a dramatic improvement in urinary flow and symptom scores. The surgery also has a remarkably low retreatment rate. A nationwide real-world analysis using data from the Epic Cosmos database found that only 1.2% of patients needed retreatment within five years, compared to 7.1% for TURP (the standard transurethral resection). That durability is a major advantage for men whose prostates are large enough to warrant this approach.
What Recovery Looks Like
After an open simple prostatectomy, most patients spend several days in the hospital. The robotic approach tends to shorten that stay. You’ll have a urinary catheter in place while the surgical site heals, typically for one to two weeks depending on how quickly the tissue recovers. Expect some blood in the urine during this period, which gradually clears.
For the first several weeks, you’ll need to avoid heavy lifting and strenuous physical activity to allow the incision and internal tissues to heal. Most men return to light daily activities within two to three weeks and resume normal routines, including exercise, around four to six weeks after surgery. The improvement in urinary symptoms is usually noticeable soon after the catheter is removed, though it can take a few months for things to fully settle.
Side Effects to Expect
The most common lasting side effect is retrograde ejaculation, where semen travels backward into the bladder during orgasm instead of exiting through the penis. This happens in the majority of patients. Conventional enucleation procedures carry retrograde ejaculation rates above 70%. The condition is harmless and doesn’t affect the sensation of orgasm, but it does affect fertility. Newer robotic techniques that specifically aim to preserve ejaculatory function have shown more promising results, with one study reporting that 81% of patients maintained normal ejaculation at one year, though this approach isn’t widely available yet.
Urinary incontinence after simple prostatectomy is uncommon, especially compared to radical prostatectomy. Most men regain full urinary control. Erectile dysfunction is also relatively rare with this procedure because the nerves responsible for erections run along the outside of the prostate capsule, which is left intact. That said, any pelvic surgery carries some risk to these structures, and men who already have some degree of erectile difficulty before surgery may notice a change afterward.
Short-term risks include bleeding (which occasionally requires a transfusion, more so with the open approach), urinary tract infection, and temporary difficulty urinating as swelling resolves. These complications are generally manageable and resolve within the first few weeks of recovery.