What Happens After Prostate Removal

Urgent Signs And Symptoms

Prostate Surgery Side Effects

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.

What Is An Artificial Urinary Sphincter And How Does It Help With Urinary Incontinence

An artificial urinary sphincter can help men who have moderate to severe urinary incontinence due to poorly functioning muscle or sphincter valve after prostate cancer surgery.

The AUS has three parts:

An inflatable cuff that is placed around the upper urethra. The cuff closes off the urethra to prevent leakage of urine.
A pump that is inserted into the scrotum. It’s completely on the inside and not visible, and the pump controls the opening and closing of the cuff.
A small pressure-regulating balloon that is placed in the abdomen, under the muscles. The balloon maintains fluid under pressure within the urethral cuff to pressurize the system and hold urine back.

If you have this surgery, youll press on the pump when you feel the need to pee. This opens the cuff to allow urine to pass. When youre done peeing, the cuff automatically closes again on its own.

The AUS procedure provides a very good and satisfactory result in 90% of cases. Risks are uncommon and include:

Failure of the device .
Erosion of the cuff into the urethra.
Infection.

All of these would require additional surgery.

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.

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Immediately After A Prostatectomy

You will stay in hospital for two to five days.
Nurses will monitor your vital signs.
Your pain will be managed with medication.
You may be given antibiotics to reduce the risk of infection.
You may have a drip inserted into your arm or hand for a few days.
You will most likely have a drain tube out of your abdomen that will be removed in the first day or two after the surgery.
In most cases, you will have to go home still wearing the catheter. You will be taught how to care for it.

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After surgery, youll stay in the hospital for a day or two. You may feel sore, but nurses will encourage you to get up as soon as possible. Walking helps your body start to recover from the surgery and function normally again.

Your doctor may prescribe pain medicine for a few days immediately following surgery. After that, youll switch to over-the-counter pain meds.

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What Happens During Surgery

Your surgeon will put a small needle just below your belly button, into your abdominal cavity. The needle is connected to a small tube that passes carbon dioxide into the belly. This lifts the abdominal wall to give the surgeon a better view once the laparoscope is in place.

Next, a small cut will be made near your belly button. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.

Before the surgery, the surgeon will take a thorough look at your abdominal cavity to make sure the laparoscopy procedure will be safe for you. If the surgeon sees scar tissue, infection, or abdominal disease, the procedure will not be continued.

If the surgeon decides the surgery can be safely performed, more small cuts will be made, giving them access to the abdominal cavity. If necessary, one of these small incisions may be enlarged to remove the pelvic lymph nodes.

What Happens Before Radical Prostatectomy

Before radical prostatectomy, your provider will ask you about your health history. Youll also need to tell your provider what drugs and vitamins you take. You may need to stop taking some of your medications a few days before your surgery, especially drugs that cause blood thinning.

Your hospital will give you specific instructions, including how long before your surgery to stop eating and drinking.

To check your health before your procedure, you also may need:

Blood tests.
Prostate ultrasound and biopsy.

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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:

Blue clamp
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:

Wash your hands with soap and water.

Remove the tape at the joint of the catheter tube and bag.

Swab all connecting areas with alcohol pads.

Remove the blue clamp.

Open Radical Prostatectomy Vs Minimally Invasive Radical Prostatectomy

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In 2003, only 9.2% of radical prostatectomies were done using a minimally invasive procedure. By 2007, that number had jumped to 43.2%. In 2009, researchers in Boston reported on a study that compared outcomes, benefits, and complications of open surgery vs. minimally invasive surgery:

No difference was found in deaths or in the need for additional cancer therapy between the two approaches.
The median hospital stay was two days for minimally invasive surgery and three days for open surgery.
2.7% of men having laparoscopic surgery required a blood transfusion compared with 20.8% of men having open surgery.
There was more anastomotic stricture narrowing of the suture where internal body parts are rejoined for open surgery than for minimally invasive surgery .
There were fewer respiratory complications with minimally invasive surgery than with open surgery .
There were lower rates of incontinence and erectile dysfunction with open surgery. The overall rate was 4.7% for laparoscopic surgery and 2.1% for open surgery.

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Day Before Your Surgery

Follow a light diet

Follow a light diet, such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink, and avoid fried foods and foods with a lot of seasoning.

Note the time of your surgery

A staff member from the Admitting Office will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, theyll call you the Friday before. If you do not get a call by 7 p.m., call .

The staff member will tell you what time to arrive at the hospital for your surgery. Theyll also remind you where to go.

Do your bowel preparation

The night before your surgery, use a saline enema as instructed on the box.

Shower with a 4% CHG solution antiseptic skin cleanser

The night before your surgery, shower with a 4% CHG solution antiseptic skin cleanser.

Wash your hair with your usual shampoo and conditioner. Rinse your head well.

Wash your face and genital area with your usual soap. Rinse your body well with warm water.

Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.

Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Do not put it on your face or genital area.

Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.

Dry yourself off with a clean towel.

Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Sleep

Go to bed early and get a full nights sleep.

Side Effects From Hormone Therapy

Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.

The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.

Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.

Side Effects From Radiation

Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.

Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

Treatment Options For Prostate Stones

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Most men with prostate stones will not require any treatment, again due to lack of symptoms. Also, sometimes, prostate stones may pass on their own in a mans urine. However, if they do become infected and are causing prostate or urinary tract problems, then they may require antibiotics. In more severe cases, they can be removed surgically. Prostatic calculi can be easily removed with a transurethral electro-resection loop or holmium laser if they cause difficulty in urination or chronic pain.

Any man, having urinary symptoms or pain in the lower pelvic region, needs to see his doctor right away for a thorough examination and diagnosis of what the problem may be.

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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.

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After Prostate Cancer Surgery

After your operation, you will wake up in the recovery room. Once its safe to do so, you usually go back to the ward. Recovery rooms and wards are busy and often noisy places that some people find strange and disorienting. You’ll feel drowsy because of the anaesthetic and painkillers.

It takes a few weeks for you to recover after your operation. You will need to spend a few days in the hospital and then give yourself time to recover once you are home. Most people can go back to normal activities between 6 to 8 weeks after surgery.

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Additional Treatment After Surgery

Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.

Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:

Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.

Getting Ready For Surgery

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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 youre not sure.

I take a blood thinner, such as:

I smoke or use an electronic smoking device, such as a vape pen, e-cigarette, or Juul®.

I use recreational drugs.

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 problems, we can prescribe medications to help keep them from happening.
If you drink alcohol regularly, you may be at risk for other problems 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:

Be honest with your healthcare providers about how much alcohol you drink.
Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
Get a headache.

For information about being a health care agent, read How to Be a Health Care Agent.
If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

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Exercise

For caregivers

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

the type and size of the cancer
what grade it is

How Is Urinary Incontinence After Prostate Surgery Treated

If you find youre having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medications or physical therapy exercises for the pelvic floor muscles. These treatments may also cut down on the number of times that you have to get up each night to pee.

These methods can sometimes help men who have mild to moderate leakage. Men who have persistent leakage or a more severe problem may need surgery if they do not want to continue to use pads.