Surgical Procedures: Prostatectomy

What is a prostatectomy and how is it done?

A prostatectomy is a surgery to remove the prostate gland. The main surgery used to remove the prostate gland is called a “radical prostatectomy.” During a radical prostatectomy, the surgeon removes your prostate, some of the tissue around it, and the seminal vesicles (the glands that make most of the fluid for semen). There are two ways a radical prostatectomy can be done:

• Retropubic Prostatectomy: An incision (cut) is made in the belly (abdominal wall) to remove the prostate. Lymph nodes may also be removed.
• Perineal Prostatectomy: The prostate is removed through an incision (cut) made in the perineum. The perineum is the space in between the scrotum and anus. An incision in the belly may be needed if lymph nodes are removed.

A prostatectomy can be done in 3 different ways. The type of technique used will depend on many factors and you will talk to your surgeon about your options. Each type of surgery has its own risks and benefits and your surgeon will explain these to you.

The 3 techniques are:

• Open incision (large cut).
• Laparoscopic (many small incisions).
• Robotic approach.

Surgery to treat prostate cancer can lead to nerve damage. This can stop you from being able to have an erection. Nerve-sparing surgery may be an option for some patients. Your surgeon will talk to you about your surgery and options for nerve-sparing.

What are the risks of prostate surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Bleeding, which may or may not require blood transfusions.
• Blood in the urine.
• Infection.
• Injury to the surrounding organs.
• Lymphocele (a collection of fluid).
• Lymphedema (swelling that can happen after lymph nodes have been removed).
• Being unable to have or maintain an erection.
• Changes in orgasm (can be “dry,” meaning no semen released).
• Changes in your ability to father a child.
• Inability to hold your urine and/or stool.
• The penis becoming shorter by about 1-2 cm.
• Inguinal hernia (when tissue pushes through muscle. It looks like a lump and can be painful to the touch).

What is recovery like?

Recovery from a prostatectomy may include a stay in the hospital for several days. Your entire recovery can take up to 4 weeks. You will have a temporary urinary catheter to drain urine from your bladder. You may also have drains in the belly to remove any extra fluid buildup. You will be given instructions on how to care for any catheters and drains before leaving the hospital.

Your medical team will teach you about the medications you will be taking, such as those to prevent pain, blood clots, infection, and constipation or other conditions.

Your provider will talk to you about any activities you should avoid, depending on the surgery you have had. Often these include:

• Take prescribed medications as instructed.
• No heavy lifting for 6 weeks after surgery. Your provider will tell you when you can go back to normal activities.
• Walk often to prevent blood clots, pneumonia, constipation and to help maintain muscle strength.
• Do not drive until the catheter is removed and/or while taking narcotic pain medications.
• Avoid straining to have a bowel movement.
• Shower as instructed. Do not tub bathe until your provider tells you that you can.
• Avoid sexual activity until advised by your healthcare team.

Call your healthcare provider if you have:

• Fever. Ask your provider how high your fever should be before calling them.
• Bleeding, redness, warmth or drainage at your incision.
• Chills, nausea and/or vomiting, burning with urination, being unable to eat or drink.
• Cough that won’t go away.
• Any new or worsening pain.
• Heavy bleeding with or without large blood clots.
• Shortness of breath, chest pain and/or swollen tender legs.
• No urine in catheter bag or if you are having difficulty urinating.
• Leaking urine while the catheter is in.
• Any changes to your urine such as blood in the urine, gritty material or stones in the catheter bag, abnormal urine color or foul-smelling urine.
• Problems with your catheter, or if it falls out.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.