In case of very large prostate enlargement, and conditions where all other modes of treatments have failed this is the best method. Here the enlarged portion of the prostate is removed through surgery. Prior to the surgery, a cytoscopy is performed so as to determine the exact location and size of the prostate gland and the enlargement. The bladder and the urinary tract are also thoroughly examined. Once the surgical area is determined it is cleaned and prepared for incision. A catheter is placed in the urethra to drain out urine temporarily. Normally the incision is made just below the navel. The abdominal muscles are separated from the surgical field and in order to widen it, a retractor is placed. The bladder neck and the veins are clearly identified and after the blood supply is carefully controlled, incision is made deep into the affected area. The prostatic tissue causing the enlargement is dissected with scissors. After the complete removal of the tissue and stoppage of bleeding the wound is closed.
The disadvantages of open prostatectomy are morbidity and longer hospitalization time. Also sometimes blood transfusion may become necessary in case of serious hemorrhage during surgery. However it ensures complete removal of the affected tissue and causes no damage to the urinary bladder or other parts of the urinary system.