Surgical Procedures: Prostatectomy
What is a prostatectomy and how is it performed?
Prostatectomy is removal of the prostate gland. There are different types of prostatectomy and the type used will depend on your situation. The types include:
Radical Prostatectomy: Removal of the prostate, surrounding tissue and seminal vesicles. There are two ways this is 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.
Your surgeon will talk to you about the best type of surgery for you. They can include using an open (large incision), laparoscopic (many small incisions) or robotic approach. Each type of surgery has its own risks and benefits and your surgeon should explain them to you.
Surgery to treat prostate cancer can lead to nerve damage that can stop a man from being able to have an erection. Nerve sparing surgery may be an option for some men. Your surgeon will talk to you about your surgery and options for nerve sparing.
What are the risks associated with 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.
- Injury to the surrounding organs.
- Lymphocele. (A collection of fluid.)
- Lymphedema. (Swelling that can happen after lymph nodes have been removed.)
- Inability to have or maintain an erection.
- Changes in orgasm (can be “dry”, meaning no semen released).
- Changes in the ability to father a child.
- Inability to hold your urine and/or stool.
- The penis becoming shorter by about 1-2 cm.
- Inguinal hernia. (This is 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 excess fluids. You will given instructions on catheter care when leaving the hospital.
Your medical team will talk to 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 activity restrictions, 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 with:
- 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, inability 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 you 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.
- Catheter 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.
American Cancer Society. Surgery for Prostate Cancer. 2016. Found at: https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html
Healthline. What you need to know about prostate surgery. Found at: https://www.healthline.com/health/prostate-surgery#recovery
Mayo Clinic. Prostatectomy. 2018. Found at: https://www.mayoclinic.org/tests-procedures/prostatectomy/about/pac-20385198