What You Need to Know About Prostate Surgery
About the Prostate
The prostate is a gland that produces some of the fluids that carry sperm. It is located underneath the bladder, in front of the rectum. It produces some of the fluids that carry sperm. It’s an important part of the male reproductive system.
Surgery for partial or complete removal of the prostate is called prostatectomy. Common reasons for the surgery include prostate cancer and enlarged prostate (benign prostatic hyperplasia). Less typical reasons include recurring prostate bleeding and urinary problems.
Traditional Open Surgery
During prostatectomy, the surgeon enters through an abdominal incision (retropubic approach) from the navel to the pubic bone. The prostate is removed and, in the case of prostate cancer, surrounding lymph nodes may also be removed.
If nerves are affected, they may need to be removed, too, although it’s not always possible to preserve function. You may have difficulty achieving erection, but this may not be a permanent problem. If both sides of the nerves are affected, erectile dysfunction (ED) is permanent, but there are methods that may restore function.
If your problem is caused by an obstruction or enlarged prostate, you may be able to avoid abdominal surgery and an external incision. Using a long, flexible tube with a light and lens (endoscope), your doctor can enter through the end of the penis. Part of the prostate gland can be removed using this less invasive method. If you have prostate cancer, it is unlikely your doctor will recommend this method.
Laparoscopic surgery is a minimally invasive approach to prostate surgery. Multiple tiny cuts allow the surgeon to insert small surgical instruments. A thin tube with a camera (laparoscope) allows the surgeon to see. In some hospitals, the surgeon directs a robotic arm in precise movements while viewing a computer monitor. Either with or without the robotic arm, laparoscopic surgery involves less blood loss. It will still take some time to recover, but you’ll probably feel better faster than if you had abdominal surgery.
The space between the rectum and scrotum is called the perineum. If there is no need to remove lymph nodes, your surgeon can enter through an incision in the perineum. This method is faster and usually results in less pain and a shorter recovery time. The perineal approach is a good alternative if you have other medical problems that make abdominal surgery difficult.
Recovering from Prostate Surgery
You’ll be closely monitored following any of these procedures. You’ll probably need a catheter for a week or two. Before you’re released from the hospital, you’ll receive instructions on how to handle your catheter and on how to care for the surgical site.
Whatever method of surgery you had, the incision site will probably be sore for a few days. Follow your doctor’s post-surgical instructions and arrange a follow-up visit. Recovery time will depend on the type of surgery, your overall health, and adherence to post-operation instructions.
General Side Effects of Surgery
All surgical procedures come with some risk. General risks to surgery include reaction to anesthesia, bleeding, and infection of the surgical site. Signs that you may have infection include fever, chills, swelling, or drainage from the incision. Once your catheter is removed, you should be able to urinate on your own. If you can’t, or if you can’t move your bowels, notify your doctor.
Impotence, or ED, is a potential side effect of prostate surgery. If your nerves were spared, you have a better chance of full recovery. If you have ED, it may take a long time to recover, or you may never fully recover. A skilled surgeon can minimize nerve injury. A UCLA study concluded that choosing a doctor who has performed at least 1,000 surgeries increases the chances of post-surgery recovery of erectile function.
A small number of men notice a slight decrease in penis length after prostate surgery.
Immediately after prostate surgery, you may experience involuntary leakage, but it should get better over time. Some men, especially those over age 70, develop urinary incontinence.
It should be noted that removal of the prostate causes sterility. This is because the procedure severs the connection between the testicles and the urethra.
Removal of lymph nodes can cause fluid to accumulate (lymphedema) in the genital area or legs. This can cause pain and swelling, but lymphedema can be improved with treatment.
In the case of prostate cancer, your doctor may recommend radiation therapy. This is usually advised for men who have high risk factors, such as positive margins or rising PSA (prostate-specific antigen) levels. In an effort to kill wayward cancer cells, radiation is beamed to the area where the prostate was. This may not be recommended if your cancer has spread. Radiation therapy can cause urinary difficulties and impotence. It also increases the risk of bladder and rectal cancer.
- Alemozaffar, M. et al. (2012, March 8). Technical Refinement and Learning Curve for Attenuating Neurapraxia During Robotic-Assisted Radical Prostatectomy to Improve Sexual Function. European Urology, 61(6), 1222-1228. Retrieved August 19, 2013, from http://casit.ucla.edu/workfiles/EuropeanUrologyArticle.pdf
- Open vs. Robotic Prostatectomy: What's Right for Me? (2011, October). Beth Israel Deaconess Medical Center. Retrieved August 19, 2013, from http://www.bidmc.org/YourHealth/HealthNotes/ProstateHealth/LatestTreatments/TheFactsonOpenvs,-d-,RoboticProstatectomy.aspx
- Prostate Cancer Treatment Overview. (2013, July 31). National Cancer Institute, National Institutes of Health. Retrieved August 19, 2013, from http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page4
- Prostate Enlargement: Benign Prostatic Hyperplasia. (2012, March 23). National Kidney and Urologic Diseases Information Clearinghouse, National Institutes of Health. Retrieved August 19, 2013, from http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement
- Radiation Therapy Following Prostatectomy. (n.d.). Prostate Cancer Foundation. Retrieved August 19, 2013, from http://www.pcf.org/site/c.leJRIROrEpH/b.5839311/k.13F6/Radiation_Therapy_Following_Prostatectomy.htm
- Radical Prostatectomy. (n.d.). Johns Hopkins Medicine. Retrieved August 16, 2013 from http://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/radical_prostatectomy_92,P09111
- Surgery for Prostate Cancer. (2013, August 15). American Cancer Society. Retrieved August 19, 2013 from http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-surgery