Reagan to Have Surgery on Prostate Next Month

President Reagan, suffering discomfort caused by an enlarged prostate gland, will undergo surgery next month to widen his urinary tract, White House spokesman Larry Speakes said Wednesday.

The operation, to be performed under a low-level anesthetic administered through the spine, will require Reagan to be hospitalized at the Bethesda Naval Medical Center for three or four days beginning Jan. 4--one month and two days before his 76th birthday.

The procedure, which is considered routine by medical experts, is known as a transurethral resection. It involves reaching the prostate through the urinary tract, slicing away enlarged tissue and then sealing blood vessels to limit post-operative bleeding. Reagan “will be fully awake at all times,” Speakes said.

Speakes added that there is no evidence Reagan has cancer of the prostate, although tissue removed during the procedure normally is examined for signs of malignancy.

The President last visited the hospital on Aug. 9, when a urinary tract examination found no abnormalities, tumors or indications of other disease, his doctors reported. However, he has periodically been troubled by urinary tract disorders and at times has been treated with antibiotics. In 1967, he underwent a procedure similar to that to be performed next month.

In addition, he underwent major abdominal surgery on July 13, 1985, when a cancerous section of his large intestine was removed.

While hospitalized, Reagan also will undergo a colonoscopy--an examination of the colon that is considered routine after surgery for colon cancer. In previous exams, small polyps have been removed. Reagan also will be given an upper-body CAT scan, in which low-energy waves are passed through the body to help form a picture of the internal organs and, possibly, to locate tumors.

Speakes, referring to the lack of abnormalities found in the August examination, said: “The mild discomfort does not necessarily indicate anything other than what we say--an enlarged prostate which is common in men of his age.”

Although the White House used the word “discomfort” to describe the President’s symptoms, medical experts were less circumspect in discussing them. They said that he may have to urinate more often than usual during the day, as well as several times during the night, and may feel considerable pain.

Speakes, describing the condition for which Reagan will be treated, said: “The extra layers of tissue grown on the outside and inside of the prostate . . . causes a constriction of the urinary tract in the area that it passes through the prostate. And when that happens, then you do the resection, which simply opens up the urinary tract.”

The surgery will be performed by Dr. David C. Utz and Dr. J. R. Beahrs, both urologists with current or former ties to the well-known Mayo Clinic, and will be coordinated by Dr. Oliver Beahrs, J. R. Beahrs’ father. The elder Beahrs, Speakes said, was a friend and associate of the late Dr. Loyal Davis, the stepfather of First Lady Nancy Reagan.

Slight Bleeding

The President’s stay in the hospital will last three to four days if his recovery proceeds normally, Speakes said. The procedure produces slight bleeding for several days. Thus, Reagan will still be hospitalized when Congress returns after its Christmas recess on Jan. 6.

Reagan will enter the hospital two days after returning to Washington from his own annual year-end vacation in California. The colonoscopic examination will be performed Jan. 4, and the prostate surgery will take place Jan. 5.

“If there were urgency, we would do it tomorrow,” Nancy Reagan said of the planned surgery in an interview with wire service reporters on Wednesday.

The prostate operation is the most frequently performed surgery in men older than 65, encompassing 333,000 cases in the United States last year, according to the National Center for Health Statistics.

“It’s a very common operation associated with few risks and a high likelihood of success,” said Dr. Jean deKernion, chairman of the urology department at the UCLA Medical Center.

The prostate gland surrounds the neck of the bladder and the urethra, the tube that carries urine and semen through the penis. Normally, the prostate’s function is to produce fluid and nutrients for the semen.

Often Becomes Enlarged

But the prostate commonly becomes enlarged in men over 50, and the enlarged gland pinches the urethra, narrowing the passage, experts said. When enlarged, the prostate is smaller than a baseball and larger than a golf ball, deKernion said.

Another doctor described enlargement of the prostate as similar to that of a doughnut around a tube: If the doughnut expands, the sides of the tube are pushed in. The operation Reagan faces generally takes one to two hours to complete, depending on the degree of enlargement.

During the surgery, a tubular instrument called a resectoscope is inserted through the penis and up to the urethra. The instrument has an electric loop on the end that cuts out the enlarged tissue and widens the channel.

“It’s like an opening in the center of an apple,” deKernion said. “You whittle away to enlarge the channel.”

The tiny pieces of cut-away prostate tissue are flushed out through the penis, and a catheter is inserted in the bladder to drain out urine for several days in the healing process.

Even if prostate cancer is discovered, it “would be far less ominous than other kinds of cancer,” said Dr. Michael Droller, chairman of the urology department at Mt. Sinai Medical Center in New York City. Prostate cancer can be readily controlled, he said.

Rapid Recovery Likely

In addition, the transurethral resection is less stressful for the body than regular surgery, which involves cutting into the body and produces substantial bleeding. In prostate surgery, however, “since no incision is made through the skin, the patient usually recovers rapidly,” says a report by the National Institute of Aging. In addition, the report says, sexual activity usually is unaffected by the operation.

Doctors said that the normal period of hospitalization is less than a week, with the next two weeks spent in moderate activity. A completely normal schedule, including meetings and travel, is possible in three to four weeks.

The President should be fully able to carry out his job throughout the hospitalization and recovery period. “A person can make decisions all along,” said Dr. Elliot L. Cohen, assistant professor of clinical urology at Mt. Sinai.