After prostate cancer surgery your best chance to recover quickly and without incident is to follow the doctor’s instructions and practice common sense.
- Take the medications your doctor prescribes. These will likely include pain meds and an antibiotic
- Learn how to handle your catheter so you minimize any chance of getting an infection
- Do any exercises your doctor recommends and keep your general health strong by returning to gentle exercise when you get your doctor’s okay.
- Refrain from using your down time to indulge in fatty foods and beer. Instead, eat a healthful diet, based on The Prostate Diet that will help your body repair and heal more quickly. More on prostate cancer prevention
- Listen and watch: if anything seems amiss, such as pain, swelling, blood in your urine, pain upon erection, chafing where the catheter goes into your penis, or anything else that doesn’t seem right, contact your doctor.
- If you haven’t already done so, then start to focus on your lifestyle and making those changes that maximize your future prostate health. Read more on the 6 Pillars of Prostate Health
Having said this, there are risks, side effects, and complications associated with all surgical procedures, and prostate surgery is no exception. Challenges men may encounter when undergoing prostatectomy include the following.
- Hernia: Hernias are a common occurrence after prostatectomy. One study of retropubic prostatectomy placed the incidence of hernia at 21 percent, with 82 percent of them occurring within two years of surgery. (Ichioka) Another study of laparoscopic prostatectomy found an 8.3 percent incidence of hernia. (Yoshimime)
- Bleeding that requires blood transfusion. During a prostatectomy, surgeons need to tie off and cut a large vein near the prostate, and this can result in significant and rapid bleeding. The amount of blood lost tends to be less with both laparoscopic and robotic-assisted prostatectomies compared with retropubic prostatectomy. Some men choose to bank their own blood before surgery in case a transfusion is needed. (More on Questions to Ask about Surgery.) A 2010 study that compared retropubic prostatectomy with laparoscopic prostatectomy found that 56 percent of men who underwent the retropubic procedure required blood transfusions while only 20 percent of those who had the laparoscopic procedure needed transfusions. (Grossi)
- Infection: Infections associated with surgery can include skin infection (cellulitis) at incision sites, an absess under the skin or deep in the pelvis, or a urinary tract infection. Skin infections can usually be treated with an antiobiotic, while abscesses need to be drained. Deep abscesses can be treated by placing a drian through the skin and into the abscess. Urinary tract infections typically are related to use of a catheter, which men need for at least 5 to 7 days after a prostatectomy to drain the bladder. The risk of a urinary tract infection increases the longer the catheter is in place.
- Complications associated with anesthesia: For men who undergo general anesthesia, common side effects may include nausea, vomiting, and scratchy throat. When epidural anesthesia is used, potential side effects include lowered blood pressure and impaired movement of a leg.
- Impotence/erectile dysfunction: The incidence of erectile dysfunction after prostatectomy has been reported to be as high as 88 percent. (Korfage) Other research has found that more than 75 percent of men had problems related to erectile dysfunction as long as 92 months after prostatectomy. (Meyer) More on ED after Prostate Surgery
- Urinary incontinence: Most men experience some urinary incontinence for several weeks or longer after prostatectomy, but then it resolves for many of them within a few months. Study results vary, with one report in Urology noting that only 7 percent of men had not regained urinary continence 18 months after prostatectomy. (Walsh 2000) In a more recent study comparing retropubic versus laparoscopic prostatectomy, 12 months after surgery urinary incontinence was present in 10 percent of men who underwent retropublic prostatectomy compared with 8 percent who had laparoscopic prostatectomy. (Grossi)
- Bladder neck contracture: This complication involves scar tissue that develops where the urethra and bladder are sewn together. It occurs in 3 to 5 percent of prostatectomies. (Ellsworth) Signs and symptoms of bladder neck contracture include straining to urinate and a decreased stream. The stricture can normally be opened in an office procedure. A complication of treatment for bladder neck contracture is urinary incontinence.
- Deep venous thrombosis: A deep venous thrombosis is a blood clot that forms in the veins in the pelvis or leg. This occurs in less than 10 percent of prostatectomy patients. A less common occurrence is when a piece of the clot breaks away and travels to the heart and lungs. This can result in a pulmonary embolus, which can be life-threatening if the clot is big enough. Men who experience acute swelling in the leg, calf pain, or shortness of breath should contact their doctor immediately, as these are indications of deep venous thrombosis and pulmonary embolism.
- Rectal injury: Damage to the rectum occurs in less than 2 percent of retropubic and perineal prostatectomies. In most cases, if the injury is small a physician can close the area and it will heal. If the injury is large, a temporary colostomy may be necessary.
- Sterility: A prostatectomy also typically leaves men sterile because the semen and its sperm cells are not ejaculated through the penis to the outside. However, being sterile is not the same as being impotent or having erectile dysfunction, which is another side effect of a prostatectomy. More on ED and Prostate Cancer Treatment.
- Retrograde ejaculation: Men who have had a prostatectomy have a 40 to 90 percent chance of experiencing retrograde ejaculation after the procedure. Retrograde ejaculation is the result of damage to the muscle at the neck of the bladder. Thus when a man has an orgasm, it is dry because the semen goes into the bladder rather than into the urethra. This also means that men who have had a prostatectomy can expect to see cloudy urine when they urinate after an orgasm, but this is not harmful in any way.
- Penis shrinkage: If the nerves that run along the prostate are damaged during surgery, there can be a small change in the width and/or length of the penis. One clinical study reported that 63 percent of men who did not use a penile vacuum device after prostatectomy experienced penis shrinkage. (Raina). As part of the dicussion around treatment options you should talk to your doctor about a penile rehabilitation program after surgery which may include a number of treatments for ED. More on ED Treatment after Prostate Surgery
- Death: The risk of dying from a prostatectomy is about one half of one percent.