About Your Prostate Surgery
A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body.
A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision , which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.
Open Prostatectomy
In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button . Theyll remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.
Figure 2. Open prostatectomy incisions
Laparoscopic or Robotic-Assisted Prostatectomy
During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen . Theyll insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to help with this procedure.
Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions
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.
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What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
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Does Incontinence Happen If I Treat Prostate Cancer With Radiation
Some men need radiation therapy after prostate removal. During radiation therapy, some of the normal tissues around the urinary sphincter, urethra and bladder may be exposed, causing irritation to occur post therapy, leading to incontinence. This typically subsides within a few months after radiation therapy, however if it persists, additional treatments described below may be helpful.
Urinary Problems After Prostate Cancer Treatment
Many men get urinary problems as a side effect of their treatment. This is because prostate cancer treatment can damage the nerves and muscles that control when you urinate .
If youre starting treatment for prostate cancer, ask your doctor about the possible side effects. Each treatment can cause different urinary problems. Your chances of getting each side effect will depend on the treatment youre having, and on whether or not you had urinary problems before starting treatment.
If youve already had prostate cancer treatment and you have urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes to help manage them.
Depending on the type of problems youre having, ways to manage them can include lifestyle changes, pelvic floor muscle exercises, bladder retraining, medicines or surgery. For practical tips read our How to manage urinary problems guide.
Watch Paul’s story below for one man’s experience of managing urinary problems after prostate cancer treatment.
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Travelling To Radiotherapy Appointments
You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask the therapy radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.
The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. Your radiotherapy doctor would have to agree. This is because it is only for people that would struggle using public transport and have no access to a car.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
What Treatments Are Available To Me If My Incontinence Doesnt Go Away After A Year
While kegels and behavioral therapy work well for most men with mild to moderate leaking, they may not be completely effective for some. Luckily, there are still some options for treating bladder leakage after prostate surgery.
Another surgery is sometimes needed when bladder leaks persist for more than a year after surgery. This may consist of having a urethral sling procedure, or an artificial urinary sphincter.
With a urethral sling procedure, a synthetic mesh tape is implanted to support the urethra. Up to an 80% improvement has been seen with this procedure and some men stop leaking completely.
An artificial urinary sphincter is used in patients who have more severe urinary incontinence that is not improving, or for those patients who may have had a lot of damage to the sphincter muscle after prostate surgery. An artificial urinary sphincter is a mechanical ring that helps close the exit from the bladder.
As will all surgeries, these come with pros and cons and potential complications. Be sure to discuss these options with your doctor.
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Getting Ready For Your Surgery
You and your care team will work together to get ready for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you arent sure.
- I take a blood thinner, such as:
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these complications, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
About smoking
If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling .
About sleep apnea
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device for sleep apnea, bring it with you the day of your surgery.
Ask about medications
Things To Do After Prostate Surgery
After prostate surgery, you will not be allowed to stand up, as a requirement of postoperative care. During this period, a washing solution in the form of serum will be applied to your bladder and it will be continuously drained through a catheter. This solution is intended to prevent coagulation of minor bleeding that can develop after surgery, and keep the urinary tract open.
Your doctor may end this procedure the next day or the same night, depending on his/her preferences. This process will be ended once you stand up and walk. From that moment on, the water you drink and the urine you pass will take over the task of this washing solution, and will protect you from coagulation that can occur after surgery.
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What Changes Do I Need To Make To My Diet
Discuss your post-surgery diet with your doctor as you will probably want to avoid or at least minimize issues such as constipation. The lack of exercise, the medication, even the stress, might affect your bowel functions. Your diet will be focused on eating more vegetables, fruits, grains and avoiding meat, especially the red one, pasta, alcohol, fast-food, sugar and processed desserts.
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Radical Prostatectomy Retropubic Or Suprapubic Approach
You’ll be positioned on the operating table, lying on your back.
An incision will be made from below the navel to the pubic region.
The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.
The prostate gland will be removed.
A drain will be inserted, usually in the right lower area of the incision.
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Ask About Your Medications
You may need to stop taking some of your medications before your procedure. Talk with your healthcare provider about which medications are safe for you to stop taking. Weve included some common examples below.
Anticoagulants
If you take a blood thinner , ask the healthcare provider doing your procedure what to do. They may or may not tell you to stop taking the medication, depending on the reason youre taking it.
Examples of blood thinners include:
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Do not stop taking your blood thinner medication without talking with a member of your care team.
Nonsteroidal anti-inflammatory drugs
Read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E. It has important information about medications you might need to stop taking before your procedure and what medications you can take instead.
Pain medications and antianxiety medications
Tell your healthcare provider if youre taking any pain medications or antianxiety medications. Its important to keep taking these medications on schedule, even during your treatment. You may be able to take them on the morning of your procedure, if needed.
Is Drinking A Lot Of Water Good For Your Prostate
Doctors recommend drinking six to eight glasses of water daily. You may need more water when you exercise or work in a hot environment. Drinking more than the required amount can increase your trips to the bathroom. Hydration is necessary, but do not overdo it.
For prostate problems, limit water intake before going to bed at night. This will keep you from waking up at night to urinate repeatedly.
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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.
Questions To Ask Your Doctor Or Nurse
- Is the treatment Im having for prostate cancer likely to cause any urinary problems?
- What type of urinary problems might I get?
- What should I do if I cant urinate?
- Will my urinary problems get better?
- What treatments are available?
- What are the risks and side effects of treatments for urinary problems?
- What can I do to help myself?
- Where can I get pads and other products?
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Urinary Incontinence After Prostate Surgery
Urinary incontinence and/or inability to urinate are the common side effects after prostate surgery. This side effect usually ends in a short time.
Transient urinary incontinence develops in consequence of disruption or discomfort in the sphincter muscles which control the release of urine. This type of incontinence is generally similar to the stress incontinence that women often experience after vaginal delivery.
After prostate cancer surgery, the goal is basically to recover quickly, have full control over the bladder and become sexually active again.
Is It Possible To Impregnate A Sexual Partner After Prostate Surgery
Prostate surgery does not qualify as a type of birth control.
So, unless your doctor tells you that your surgery results in infertility, you have to assume that the possibility of impregnating a sexual partner with ovaries and a uterus remains.
Prostate surgery doesnt impact sperm, which is the reproductive cell that can fertilize an egg and result in pregnancy. What may be impacted is the amount of seminal fluid produced, which is what transports the sperm to the egg.
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Incontinence After Prostatectomy: Drink Water Enjoy Sex Again
Its a simple health message weve heard all our lives: Drink water to stay healthy.
However – Prostatectomy usually affects bladder control, so you might be thinking:
Surely I should decrease my intake while incontinent to avoid toilet-rushing and pad-overflowing?
In fact, counter-intuitively, drinking MORE water during recovery will speed up your recovery, reduce the need to pee, and give you a better quality of life.
THREE reasons to drink more water during your continence recovery
And some Sex with Incontinence tips at the end!
How Much Water Should I Drink After Turp Surgery
Drink 6 to 8 glasses of water each day. Avoid drinks that contain caffeine, such as coffee, tea, hot chocolate and cola. Caffeine may irritate your bladder. If you have heart or kidney problems, check with your doctor about how much to drink.
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Incontinence After Prostate Surgery Forums
Going through prostate cancer and having your prostate removed can be a physically and emotionally trying time in life. Many men are unprepared for the extent to which they may experience bladder leaks after prostate removal and it can be disheartening to have undergone surgery only to experience a loss of bladder control for a period afterward.
Fortunately, this is usually resolved within a year. During that time though, you may find that you need someone to talk to about your experience. Finding a forum or message board filled with people who can relate can help ease some of the tensions that you may be going through.
The NAFC message boards are a great way to connect with others who may also be experiencing incontinence, due to prostate surgery or other conditions. Theyre free to join and the forum is anonymous so you can speak freely without the worry of feeling embarrassed or ashamed. NAFC is proud of this amazing group of individuals who visit the forums and courageously share their stories, offer support, and provide inspiration to each other. We encourage you to check it out!
What Drinks To Avoid For Your Prostate Problems
You should avoid drinks that increase your urination. These can dehydrate you. These include caffeine-containing drinks such as coffee, green tea, black tea and soft drinks or sodas. Alcohol can also dehydrate you. Hence, limit its intake or consider avoiding it completely. People who avoid alcohol have seen improvements in their prostate problems.
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When To Call The Doctor
- You have pain in your belly that does not go away when you take your pain medicines
- It is hard to breathe
- You have a cough that does not go away
- You cannot drink or eat
- Your temperature is above 100.5°F
- Your surgical cuts are bleeding, red, warm to the touch, or have a thick, yellow, green, or milky drainage
- You have signs of infection
- Your urine stream is not as strong or you cannot pee at all
- You have pain, redness, or swelling in your legs
While you have a urinary catheter, call your provider if:
- You have pain near the catheter
- You are leaking urine
- You notice more blood in your urine
- Your catheter seems blocked
- You notice grit or stones in your urine
- Your urine smells bad, or it is cloudy or a different color
- Your catheter has fallen out
Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
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What Can Help With Urinary Frequency And Urgency
There are treatments that can help with urinary frequency and urgency, as well as things you can do yourself.
Bladder retraining
If you need to urinate more often than usual or sometimes leak before reaching the toilet, you could try a technique called bladder retraining. This can help you control when you urinate, and help you hold on for longer. Speak to your specialist continence nurse or physiotherapist for more information.
Medicines
Drugs called anti-cholinergics can help to reduce frequency, urgency and leaks. If you can’t have anto-cholinergics, you may be offered mirabegron tablets.
Percutaneous posterior tibial nerve stimulation
This treatment may help some men to urinate and leak urine less often. A needle is placed under the skin just above your ankle. A low electrical current is passed through the needle to affect the nerves that control urination. This can help stop the bladder from emptying before its full.
Youll normally have PTNS once a week for 12 weeks. Each treatment lasts about half an hour. PTNS has no serious side effects, although the area where the needle enters the skin may feel a little sore afterwards.
Sacral nerve stimulation
This is sometimes called Sacral Neuromodulation . A small wire is surgically placed against the sacral nerve in your lower back. The other end of the wire is connected to a small box . The SNS device makes mild electrical pulses that stimulate the sacral nerve to help you regain control of your bladder.
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