Recovering From Prostate Surgery
To treat prostate cancer, doctors perform tens of thousands of surgeries each year. In recent years, one procedure called a radical prostatectomy has become a fine art, says J. Brantley Thrasher, MD, a professor of urologic surgery at the University of Kansas Medical Center in Kansas City. While side effects like incontinence and impotence are still major concerns, most patients respond well to the surgery, Thrasher says.
In fact, many men respond almost too well. They feel so good after the surgery that they start to push themselves too hard, he says. One of his recent patients went on a two-mile jog while still wearing a catheter. I told him he needed to slow down and rest for a while.
If you have a radical prostatectomy in your future, youll want to know what to expect. Heres a closer look at this procedure. As youll see, your life wont necessarily take a turn for the worse after prostate surgery. In fact, it just might get better.
Why do surgeons perform radical prostatectomies?
According to the Food and Drug Administration, radical prostatectomy is considered to be the most definitive treatment for many men with prostate cancer, a disease that kills about 30,000 American men each year. Depending on their age and the stage of their cancer, however, some men do well with a less invasive treatment.
How should I prepare for surgery?
What happens during a radical prostatectomy?
What will happen during recovery in the hospital?
Risks Of Radical Prostatectomy
Radical prostatectomy has a low risk of serious complications. Death or serious disability caused by radical prostatectomy is extremely rare.
Still, complications from unintended nerve damage can happen after radical prostatectomy. They include:
Urinary incontinence. This means trouble controlling your urine, leaking, or dribbling. If you have incontinence, talk to your doctor about treatments that can help.
Erectile dysfunction . Problems with erections are common after prostatectomy. Still, most men are able to have sex after prostatectomy while using medicines for ED , an external pump, or injectable medications. The younger you are, the higher the chance that youâll be able to get erections after surgery.
Most doctors think you can help yourself regain your ability to get erections if you try to get one as soon as possible once your body has had time to heal â often several weeks after your surgery. This is called âpenile rehabilitation.â Talk to your doctor before you try it.
Much of the skill involved in radical prostatectomy centers on sparing these nerves during the operation. A man undergoing radical prostatectomy by a surgeon at an advanced prostate cancer center has a better chance of keeping their sexual and urinary function.
Other complications of radical prostatectomy include:
- Bleeding after the operation
- Narrowing of the urethra, blocking urine flow
Help Managing Cancer Treatment Side Effects
The team at Compass Oncology is experienced in helping patients treat prostate cancer and manage the side effects of treatment. If you live in the Portland-Vancouver area, have more questions about the side effects of prostate cancer treatment, or need help managing your side effects, request an appointment at one of our locations that’s convenient for you. We’re here with you every step of the way.
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Fast Facts On Bph Surgery:
- Surgery is rarely the first line of treatment for BPH.
- A doctor who specializes in the urinary tract does most TURP surgeries.
- TURP is considered a fairly safe, effective procedure for treating BPH.
According to the American Urological Association, transurethral resection of the prostate or TURP is the most common type of surgery used to treat BPH. Every year, doctors perform it on around 150,000 American men.
Surgeons perform most TURP procedures when the patient is under general anesthesia and unconscious or asleep.
Alternatively, they use spinal anesthesia, where a needle is placed in the spine to stop any sensation below the waist.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Are There Things I Can Do To Help Myself If I Have Erectile Dysfunction
Yes, there are changes you can make in your life that may help with your erectile dysfunction. Remember to speak with your doctor or healthcare team before making any of these changes.
Some changes you may want to consider are:
- Try to exercise on a regular basis.
- Try to eat a healthy diet.
- Drink responsibly. Long-term, heavy drinking lowers your ability to have an erection.
- Try to lower your stress and fatigue . Being diagnosed with prostate cancer and working in all the changes it brings to your life can be stressful. Stress and the tiredness caused by your prostate cancer treatment, can make it difficult for you to get in the mood. Many men going through prostate cancer treatment feel this way. Talking with your partner might help lower your stress. You may also speak to your doctor or healthcare team about how you are feeling. They are there to help you through this time.
- Stop smoking. Research studies show that smoking can harm your ability to have sex. If you need help to stop smoking, speak with your doctor or healthcare team.
- Practice your Kegel exercises. Kegel exercises help strengthen your pelvic floor muscles, which support your bladder and bowel. These muscles also help with erections. For more information, please see the IMPACT booklet, Kegel Exercises for Men.
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.
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Uk Guidelines For Keyhole Surgery
The National Institute for Health and Care Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the prostate but they must:
- tell people having the surgery about the risks and benefits
- monitor people closely
- collect information about any problems people have and report on them
Researchers are looking into whether keyhole surgery is as good as open surgery.
Life After Prostate Cancer Treatment
Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.
Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.
Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.
“It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.
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Incontinence After Prostate Surgery: Everything You Need To Know
Alan was 68 years old when he had a prostatectomy. My doctor thought it was the best way to treat my prostate cancer and I agreed, he said. We talked about the risks involved, how to prepare for the surgery, and what would happen during the surgery, but it was what happened after prostate surgery that I didnt expect. He never told me about the potential for bladder leaks.
I thought it was probably normal to have some incontinence after prostate surgery, but 6 weeks after I had the catheter removed, I was still unable to stand up without leaking urine. Ill never forget the day I had my catheter taken out. I came home, had a beer to celebrate, and immediately it all just rushed out of me when I stood up a half-hour later. I just didnt expect this to happen and was really worried that it was going to become a permanent part of my life.
I went in for a checkup, and thats when my doctor told me that this is a common side effect for some men. He told me that the leaks would likely recover with time, and he went through my options and discussed what I could do to help speed up the recovery process, which was helpful. I just wish he would have told me all this sooner, before the surgery. At least then, I could have known what to expect.
Alans story isnt uncommon. Undergoing a prostatectomy can be difficult. And for many men, finding that they are incontinent post-surgery may come as a shock.
Three Common Prostate Problems
Growing older increases the danger of prostate problems. The three most common problems in the prostate gland are prostatitis, benign prostatic hypertrophy, and prostate cancer.
One change does not prompt another. For instance, having prostatitis or benign prostatic hypertrophy does not raise your risk of prostate cancer. Also, you can have more than one issue simultaneously.
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How Will Prostate Surgery Affect My Sex Life
Experienced robotic surgeons like Dr. David Samadi dont open the endopelvic fascia during surgery, which spares the rick of damage to nerve bundles that control sexual function. The recovery of the function, however, is not immediate and you should not feel discouraged if weeks or even a few months after surgery you experience erectile dysfunction. It is not an indication of long-term damage.
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.
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What Causes Incontinence After Prostate Surgery
Urinary incontinence is a potential side effect of prostate removal surgery. The prostate is located just below the bladder and surrounds the urethra. Removing it , or using radiation to treat it, can sometimes cause damage to the nerves and muscles of the bladder, urethra, and or sphincter, which controls the passage of urine from the bladder. This can result in urinary incontinence. In this instance, men are usually experiencing stress urinary incontinence, which is a type of incontinence that happens when you place increased pressure on the bladder. Things like sneezing, coughing, working out, and even standing up can cause you to leak urine.
Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
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Advantages Of Ralp Over Traditional Surgery Include:
- Small incisions
- Less blood loss than in traditional surgeries
- Less pain than an open incision surgery
- Less risk of infection over other kinds of surgery
- Shorter stay in the hospital
- Faster recovery at home
The magnification system provides your surgeon with a clear view of the tiny blood vessels, nerves, and muscles surrounding your prostate to help minimize side effects after your surgery.
Not every man who needs prostate removal surgery will be a candidate for robotic surgery. Each prostate cancer patients situation is unique, with some patients requiring a different surgical method either traditional open surgery or, less frequently, radical perineal prostatectomy.
If you have recently been diagnosed with prostate cancer and are looking for a second opinion on treatment options before undergoing surgery, consult with one of the prostate cancer specialists at Compass Oncology located throughout the Portland-Vancouver area.
What Necessitates Prostate Removal
Prostate cancer and sometimes benign prostatic hyperplasia can necessitate the removal of prostate gland. However, the most common cause is prostatic cancer as BPH can nowadays be managed with other treatment options. The prostate gland removal surgery is known as prostatectomy. The risks, benefits and side-effects of prostatectomy should be discussed with the patient, before making the decision to get prostate gland removed.
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Surgery To Remove Prostate Cancer
Surgery is one of the main treatments for prostate cancer. You usually have surgery to remove your prostate gland. This is a radical prostatectomy.
A radical prostatectomy is a major operation with some possible side effects. You may not need this type of surgery if you’re an older man with a slow growing prostate cancer. This is because your cancer might grow so slowly that you’re more likely to die of old age or other causes than from prostate cancer.
When You Might Have A Radical Prostatectomy
Your doctor might recommend a radical prostatectomy if:
- your cancer hasn’t spread outside the prostate gland. This is localised prostate cancer
- your cancer has broken through the covering of the prostate and spread to the area just outside the prostate gland. This is locally advanced prostate cancer
- you are well enough to have this operation
The aim of a radical prostatectomy operation is to cure prostate cancer.
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What Are Pelvic Floor Exercises And Can Improve Erection Quality
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
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What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.
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How Can I Improve Incontinence After Prostate Surgery
Want to stop incontinence after prostate surgery? Kegels may be your answer! As mentioned above, Kegels are a common treatment option for incontinence after prostate surgery. Among other things, the pelvic floor muscles help control bladder and bowel function and, like other muscles of the body, if they get weak they are no longer able to do their job effectively. To improve muscle function, Kegels must be done regularly, every day. The good news is that they can be performed pretty much anywhere, anytime, and in a variety of positions . For a complete guide on performing a mens kegel, click here.)
Biofeedback can sometimes be used to determine if you are performing a kegel properly. And, electrical stimulation may also be used to help re-teach the muscles to contract.