What to Expect After Prostate Cancer Surgery

Incontinence and impotence among the major concerns

Prostate surgery comes with a unique set of issues, concerns which are not present with most surgical procedures. This is because the prostate is closely linked with two important functions in the human body: the ability to urinate and the ability to have sexual intercourse.

While the risk of complications associated with urinary function and sexual function has decreased dramatically in recent years, they are both still issues we need to monitor once is the surgery is complete and recovery begins.

early morning man sitting flush toilet
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Possible Complications of Prostate Surgery

In addition to the general risks of surgery and anesthesia, men who undergo prostate surgery may face specific postoperative complications. These can vary based on the amount of the prostate gland removed and the method used to remove prostate tissue.

Some of the more common complications include:

  • Difficulty urinating
  • Bleeding
  • Incontinence
  • Erectile dysfunction
  • Impotence
  • Change in penis size
  • Retrograde ejaculation (ejaculation into the bladder rather than out of the penis)
  • Urethral stricture (the narrowing of the urethra)
  • TURP syndrome (a consequence of the surgical procedure which can lead a potentially severe drop in sodium level)

Post-Operative Care

During the first few days following prostate surgery, it's normal to experience some blood or small clots in the urine. A Foley catheter will remain in place until your surgeon thinks it should be removed. Typically, the catheter will stay in place for 24 hours for procedures that shrink the prostate and up to two weeks for surgeries that remove the prostate tissue.

Most patients can return to full activity within four weeks of the procedure. For outpatient procedures, the recovery is much faster and often means full activity within a week of the surgery.

If your procedure requiring incisions, good incision care is essential to your recovery. Preventing infection will help reduce any scars you may have and will significantly decrease your risk of complications in the weeks following surgery.

Problems With Following Prostate Surgery

Incontinence is a common problem for men after prostate surgery and typically occurs once your catheter is removed.

There are different types of incontinence. Stress incontinence happens when pressure on the bladder is increased, such as when you sneeze, cough, or lift something heavy. This is the most common type following surgery. Urge incontinence happens when the urge to urinate is accompanied by urination. Mixed incontinence is the term for experiencing both urge and stress incontinence.

For most men, even a small amount of urine leakage can be distressing. And while most will experience some form of incontinence following surgery, it's a condition that tends to improve considerably after the first month. After a year, only a small percentage of men will require incontinence pads to prevent leakage.

If faced with incontinence following prostate surgery, there are few techniques that may help:

  • Using the restroom as soon as the urge strikes and not holding it
  • Kegel exercises performed to strengthen pelvic floor muscles
  • Urinating frequently even before the urge is felt
  • Urinating before going to bed at night

Erectile Dysfunction After Prostate Surgery

The risk of erectile dysfunction and impotence remains a major concern following prostate surgery and is probably the main reason why so many men fear the procedure.

There are a number of factors that determine the likelihood of impotence following surgery, including the man's sexual function prior to the procedure and the type of procedure performed. While some studies have suggested that robotic procedures have a lower risk of long-term impotence, others have shown that the type of surgery is less important than the skill of the surgeon involved.

Ideally, the right procedure performed by the right surgeon will offer the best opportunity for sexual function following a prostate procedure.

In faced with erectile dysfunction, open communication with your partner is key to maintaining a sexual relationship. While intercourse is important, it is not the only way to experience sexual pleasure for men or women. Intimacy can be maintained, but it may require more effort than in the past.

The Bottom Line

Incontinence and erectile dysfunction are common after prostate procedures, but the good news is that both tend to improve over time. If you experience either of these problems after surgery, speak candidly with your surgeon so that you can explore ways to treat them or lessen their impact.

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Article Sources
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  1. American Cancer Society. Surgery for Prostate Cancer.

  2. Seattle Cancer Care Alliance. What to expect after prostate cancer.

  3. Cleveland Clinic. Urinary Incontinence After Prostate Cancer.

  4. John Hopkins Medicine. Erectile Dysfunction After Prostate Cancer.

Additional Reading