What Are The Side Effects
The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .
Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.
What Happens After Radical Prostatectomy
Patients are usually discharged within 24 hours of surgery after radical prostatectomy.
You may have a drain that gets rid of excess fluid from the surgery site. If a drain is placed at the time of surgery, it is typically removed before you leave the hospital.
A urinary catheter continues to drain your urine into a bag. You may need to leave the catheter in place at home for a few days to one week.
Who Should Get A Radical Prostatectomy
Men younger than 75 years old with limited prostate cancer and who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.
Before doing a radical prostatectomy, doctors first try to confirm that the prostate cancer has not spread beyond the prostate. They can figure out the statistical risk of spread by looking at tables comparing the results of a biopsy and PSA levels.
Other tests to check for signs of spread, if needed, can include CT scans, bone scans, MRI scans, ultrasound, PET scans, and bone scans.
If it appears that the prostate cancer hasnât spread, your surgeon may first offer you other options besides surgery. These can include radiation therapy, hormone therapy, or simply watching the prostate cancer over time, since many prostate cancers grow slowly.
Depending on how high your risk of the cancer spreading is, your surgeon may also consider doing an operation called pelvic lymph node dissection.
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Urinary Problems After Surgery
Leaking urine
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.
Difficulty urinating
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch Pauls story for one mans experience of managing urinary problems after surgery below.
Sexual problems after surgery
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After Prostatectomy: What To Expect
At the hospital : You should expect to be in the hospital for one night. At Johns Hopkins, all rooms on the urology floor are private. Here, nurses help patients get moving shortly after surgery to prevent blood clots and other postoperative risks.
First few days at home : After youre sent home, you might find that regular ibuprofen or acetaminophen will be sufficient pain management for the first few days. If over-the-counter medications arent enough, your doctor can help you with alternatives.
One week after surgery : After your surgery site heals, your catheter will be removed. This is usually seven to 10 days after surgery. This can easily be done at your doctors office. Some people decide to take out their catheter at home. If thats the case, ask your doctor for instructions first.
This is also about the time your surgeon will call you with the final pathology results. He or she will discuss what you should know and whether further treatment is necessary.
One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.
- Urinary incontinence
- Erectile dysfunction
Recovery from surgery takes time. These side effects are often temporary. However, if they are affecting your quality of life, ask your doctor about options that can help.
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Things You Should Expect After Prostate Surgery
Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.
In the immediate hours after surgery:
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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How The Surgery Is Done
Different surgical methods may be used to remove the prostate:
- open radical prostatectomy usually done through one long cut in the lower abdomen
- laparoscopic radical prostatectomy small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen for guidance
- robotic-assisted radical prostatectomy laparoscopic surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and move robotic arms that hold the instruments.
Removing Part Of The Bladder
Removing part of the bladder is not a common operation for bladder cancer. It is usually used to treat the very rare type of cancer called adenocarcinoma of the bladder.
After having a partial cystectomy, you can pass urine in the normal way. But your bladder will be smaller so you may need to go to the toilet more often.
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What Happens To A Man When He Has His Prostate Removed
The location of prostate is such that, if the patient experiences BPH then it might lead to urethral compression causing difficulty in urination and leading to LUTS . Unfortunately, BPH is a common problem in adult men and the chances of BPH drastically increases after the age of 60 years. A growth in size of prostate is also a sign of prostatic cancer.
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Changes In Your Sex Life
Most men experience some decline in erectile function after their prostate is removed, but this can be managed. It can take six months or even up to a year for the affected nerves to recover from surgery. But with proper therapy and treatment, most patients can have good erectile function again, says Dr. Fam.
Treatment options include:
Work with your doctor to find a treatment that is right for you.
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Why Is Radical Prostatectomy Done
Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.
For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:
How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again
This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.
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How Is A Prostatectomy Performed
The type of surgical procedure depends on the condition being treated . In both cases, the prostate gland is removed and in the case of cancer, surrounding tissue and some lymph nodes may also be removed. Our surgeons reattach the tube to the bladder and may leave a drain in the abdomen to remove extra fluids after surgery.
The doctors of The Urology Specialists of Maryland will help patients determine what type of prostatectomy is best suited for your conditions.
Caring For The Incision
You will be able to take a shower the second day after your surgery. You may continue to have some discharge at the drain site for three to five days. Once you leave the hospital, the key words on caring for the drain site and incisions are clean and dry. Showering once a day and gently patting the area with a clean towel should be sufficient.
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While In The Hospital
It’s important to your recovery to start moving as soon as possible. Most men are out of bed and walking around the unit on the same day as their surgery. Your nurse will assist you until you can manage on your own. When you first get up, raise the head of your bed, take a couple of deep breaths, and allow your body to adjust to the change in position. Dangle your feet over the side of the bed for a few minutes, then slowly stand up. Be careful because getting up too quickly can make you light-headed.
Get out of bed at least three times each day preferably more. This helps prevent lung infections and blood clots. You may be prescribed an injectable blood thinner to further reduce the risk of blood clots. The more time you spend out of bed, the faster you will recover and the faster your bowel function will return to normal. Your nurse will also give you an oral stool softener and mild laxative to prevent constipation.
In addition to walking, you will be encouraged to do two other things that help prevent complications: Use an incentive spirometer , and wear compression stockings while in bed. Both will be provided and the nurses will instruct you on how to use them.
Removing The Whole Bladder
A radical cystectomy means taking out the whole bladder and the nearby lymph nodes.
You may also have part of your bowel removed. This is so your surgeon can create another way for your body to collect and pass urine. It’s called a recto sigmoid pouch. Your surgeon will discuss this with you beforehand if you’re having this operation.
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Urgent Signs And Symptoms
For emergencies that can’t wait, call 911.
- You have a persistent or recurring temperature greater than 101 F or repeated chills.
- Your catheter stops draining urine despite adequate hydration and no kinks in the tubing.
- Your urine in your Foley catheter is cloudy, foul smelling or persistently bloody .
- You have no bowel movement by day five after surgery.
- You have an unexplained severe pain that you didn’t experience while in the hospital.
- You are nauseated or vomiting.
- You have asymmetrical leg swelling .
- You have worsening redness, swelling or drainage from your incisions.
Loss Of Bladder Control
You may have some light dribbling or trouble controlling your bladder after a radical prostatectomy. This is known as urinary incontinence or urinary leakage. You may need to use a pad to manage urinary leakage for some days or weeks after the operation. Bladder control usually improves in a few weeks but it can take up to a year after the surgery. For about 5% of people, incontinence is ongoing and may need an operation to fix. In rare cases, incontinence may be permanent.
For help managing these problems, see Urinary problems.
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Life After A Radical Prostatectomy: A Real
Reposted from Greater Boston Urology.
In October of 2013, Les Cavicchi underwent a radical prostatectomythe removal of the prostate gland. Les had been diagnosed with prostate cancer a month earlier after undergoing a TRUS biopsy.
Less cancer was localized, meaning it was contained within the prostate gland itself. He didnt need further treatment for prostate cancer after the surgery, only regular monitoring of his PSA.
However, Les did suffer from common side effects associated with radical prostatectomies, specifically urinary incontinence and erectile dysfunction.
Q: So lets get right to it: You were dealing with incontinence after your radical prostatectomy?Les: The thing about any kind of prostate procedure is youve got to deal with incontinence. This was a big issue for me for a while. I had purchased padded undergarmentsa whole case of them, because I didnt know how long this was going to last.
Men wonder why this particular side effect happens. The prostate gland is the primary organ for controlling urinary flow in normal physiology. When you are rising frequently during the night, and/or having difficulty starting urination, these are signs that the prostate is beginning to grow in size and interfere with this specific function. Every mans prostate gets larger with age it does not necessarily have anything to do with having cancer. It is a separate reality.
Women dont have a prostate. What do they use? Kegel muscles!
About Greater Boston Urology
What Types Of Surgery Are There
Radical prostatectomy involves removing the prostate, part of the urethra and the seminal vesicles. After the prostate is removed, the urethra will be rejoined to the bladder and the vas deferens will be sealed.
Some people are able to have nerve-sparing surgery, which aims to avoid damaging the nerves that control erections. Your doctor will discuss whether this is an option for you. Nerve-sparing radical prostatectomy is more suitable for lower-grade cancers and is only possible if the cancer is not in or close to these nerves. It works best for those who had strong erections before diagnosis. Problems with erections are common even if nerve-sparing surgery is performed.
Cancer cells can spread from the prostate to nearby lymph nodes. For intermediate-risk or high-risk prostate cancer, nearby lymph nodes may also be removed .
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Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when it’s half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
When Should I See My Healthcare Provider
Talk to your healthcare provider if you have any of these symptoms after your surgery:
- Bleeding, swelling or drainage from the incisions.
- Inability to have a bowel movement.
- Inability to urinate after catheter removal.
- Increased pain around the incisions.
A note from Cleveland Clinic
Radical prostatectomy is a common surgery to remove the entire prostate gland. This prostate cancer surgery may be robotic surgery or open surgery. Robotic surgery has a shorter recovery time. Full recovery can take weeks, with some side effects lasting for months. Light exercise and medication can help you heal faster.
Last reviewed by a Cleveland Clinic medical professional on 08/03/2021.
References
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What Is A Radical Prostatectomy
Surgery to remove the prostate to treat prostate cancer is called a radical prostatectomy. The aim of surgery is to remove all of the cancer cells.
It is usually done when the cancer is contained in the prostate and has not spread to the surrounding area.
A prostatectomy may sometimes be done to treat locally advanced prostate cancer. But usually, this operation is not possible. This is because the surgeon would not be able to remove all the cancer cells that have spread outside the prostate. Other types of surgery, such as transurethral resection of the prostate , can help with the symptoms of locally advanced prostate cancer.
A prostatectomy is a big operation and may not be suitable for everyone. Your doctor can tell you whether it is suitable or if a different treatment may be best for you.
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