Recovering After Prostate Surgery
During the first few days after prostate surgery it is normal to experience some blood or small clots in the urine. A foley catheter will remain in place until your surgeon believes 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 4 weeks of the procedure. For outpatient procedures, the recovery is much faster and often means full activity within a week of the procedure.
If your procedure requires 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.
Incontinence After Prostate Surgery
Incontinence is a very common problem for men after having prostate surgery. In the first week after surgery, it is common to have a catheter in place, which drains the bladder continuously. After the catheter is removed, it is likely that incontinence will be present.
There are two types of incontinence, stress incontinence and urge incontinence. Stress incontinence happens when pressure on the bladder is increased, such as when the patient sneezes, coughs or lifts. Urge incontinence happens when the urge to urinate is accompanied by urination. Mixed incontinence is the term for experiencing both urge and stress incontinence. Stress incontinence is most common after prostate surgery.
There is a significant risk of incontinence after surgery. One study showed that 4% to 87% of men have incontinence issues in the first month following surgery. This enormous gap in percentages is caused by different definitions for the term incontinence. Some studies included men who had even tiny amounts of uncontrolled "dribbling" as incontinent, while others only included men who required more than one pad per day to contain the urine.
For patients, even a small amount of urine leakage can be disturbing to their social life and self-esteem, so it is important to understand that most men will have mild to severe incontinence for the first month after surgery, but more than one third of patients will still require incontinence pads for urine control one year after surgery.
The same study showed that nerve sparing surgical techniques decreased the chances of experiencing incontinence after surgery, but patient age also had an impact, with men of 70 years of age being at higher risk for incontinence.
Incontinence may be improved using a few simple techniques:
- Using the restroom as soon as the urge strikes, not "holding it"
- Kegel exercises
- Urinate frequently, even before the urge is felt
- Urinate prior to going to bed at night
Sex After Prostate Surgery
Sex after surgery is a very important topic for patients with prostate problems. The risk of erectile dysfunction and impotence after surgery is significant, especially in the time immediately following surgery.
Recent studies indicate that most men experience impotence after having surgery that removes part or all of the prostate. 59.9% of men reported impotence 18 months after a radical prostatectomy, however, 24 months after surgery 41.9% reported that sexual function was a "moderate to big problem".
While some studies say that robotic procedures have a lower risk of long term impotence, there are other studies that show that the type of surgery is less important than the skill of the surgeon and the number of surgeries the surgeon has performed. Ideally, the right procedure, performed by the right surgeon will offer the greatest opportunity for sexual function after surgery.
Open communication with your partner is imperative to maintaining a sexual relationship after surgery. 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.
In the end, it is important to balance the risk of impotence with the risks of not having surgery when making a decision. In some cases, organ damage or even death is a real possibility without surgery. The threat of death or kidney failure should outweigh the potential for erectile dysfunction.
After Prostate Surgery: Long Term
Incontinence and erectile dysfunction are common after prostate procedures. Some conditions, such as diabetes and hypertension, can make erectile dysfunction more likely.
Both incontinence and erectile dysfunction tend to improve over time. Exercises, medication and other treatments can improve both. If you are experiencing either after your procedure it is important to be candid with your surgeon.
Incontinence After Prostate Surgery. Global Robotics Institute at Florida Hospital. https://www.globalroboticsinstitute.com/en/urology-robotic-prostatectomy/incontinence-after-prostate-surgery
Laparoscopic Robotic Assisted Prostatectomy. University of Michigan Health System. Accessed May 2010. http://www.med.umich.edu/1libr/urology/lapRP.htm
Transurethral Electro-Resection of the Prostate. Cedars-Sinai. Accessed May 2010.
Urinary Incontinence Following Prostate Cancer Treatment: Incidence and Clinical Presentation. From the Service d'Urologie at the Hôpital Charles Nicolle, Rouen, France (PG), and the Genitourinary Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida. Medscape Today.