Prostatectomy, the surgical removal of the prostate gland, often presents a trade-off between cancer control and quality of life.
What Happens After the Prostate Is Taken Out?
Complications and Recovery
Incontinence and erectile dysfunction (ED) are common after prostatectomy, with rates varying depending on nerve-sparing status, pre-surgical erectile function, and age. Early intervention with physiotherapy and medication can aid recovery.
Life Without a Prostate
Sexual Function and Climax
Post-prostatectomy, men experience non-ejaculatory orgasms, which, for most, do not diminish the pleasure of climax. However, ED remains a concern, with up to 90% experiencing some level initially. Men who are younger than 64 years of age, in good health and good erection prior to surgery and have undergone nerve-sparing surgery tend to get back their erections. Treatments such as PDE5 inhibitors, vacuum erection devices, or penile implants can aid in regaining sexual function.
Longevity Post-Prostatectomy
Survival and Prognosis
After prostatectomy, localised prostate cancer has a 10-year survival rate of 98%, which varies with cancer stage and health factors, emphasizing the importance of personalised treatment plans.
Life Changes Post-Surgery
Catheterisation and Long-Term Use
Postoperative care often involves short-term catheterisation. This is around 7 to 10 days. Long-term use is uncommon but may be necessary due to specific complications, like leakage of urine, emphasising the importance of a tailored postoperative care plan.
Managing Incontinence Long-Term Effects
Chronic incontinence is rare, affecting up to 10% of men. Stress urinary incontinence that is leakage when coughing, lifting or sneezing can happen in up to 20%.
A multimodal rehabilitation strategy with investment in pelvic floor muscle training can help men return to baseline function. Pelvic floor muscle training post-surgery can lead to a 40-60% improvement in incontinence symptoms, a crucial component of postoperative care.
If by one year you are still completely wet you need to seek medical attention and consider an artificial urinary sphincter.
In my practice, 70% of patients are dry on the removal of the catheter, and the absolute majority of my patients should be dry or wear one pad as a reassurance by 6 months. So typically by 6 months if you are not dry I refer patients earlier to the reconstructive/ incontinence surgeon.
Erectile Function After Prostatectomy
Recovery and Interventions
Nerve-sparing techniques have improved the prognosis for post-surgery erectile function, with about 50% regaining sufficient function for intercourse. The erections may not be as strong or as hard or else may not last as long as before.
Pharmacological aids remain a cornerstone of postoperative sexual health management. Do not hesitate to ask for assistance.
Supporting Men Post-Prostate Surgery
Psychological Impact and Support
The psychological impact post-surgery is significant. Counselling and support groups are essential, as they can improve the emotional well-being of over 70% of patients. Ask your department for help. A proper prostate cancer unit should have this service.
Prostatectomy Magnitude
Surgical Advances
The rise of robotic-assisted prostatectomy has led to shorter hospital stays and less blood loss, marking a significant improvement in the surgical management of prostate cancer.
Nowadays I started performing this procedure as a day case. That is my morning two patients go home in the evening.
What happens to the sperm after my prostate is taken out?
Sperm production continues but is reabsorbed, which can be an essential consideration for men looking at fertility post-surgery.
Pain Management Post-Surgery
Analgesic Use after removal of the prostate
Effective pain management is critical, with most men experiencing manageable pain levels post-surgery. Most of my patients are on paracetamol and non steroidals.
Chronic pain is rare, affecting a small percentage. About 10% to 40% of patients may complain of pelvic pain after pelvic surgery this is temporary and may last up to 6 months.
Post-Surgery Lifestyle
Activity and Health
Patients are encouraged to gradually resume physical activity, which has been shown to reduce postoperative complications and aid in overall recovery. Walking is the best exercise to be done initially. After 6 to 8 weeks you can start light activities. By 3 months you can lift and exercise normally.
Weight Changes After Prostate removal
Weight Management after removing the prostate
Post-surgery weight changes are more influenced by lifestyle factors rather than the surgery itself, highlighting the role of diet and exercise in postoperative recovery. Invest in healthy eating and exercise in a sensible way.
Alcohol Consumption Post-Surgery
Alcohol consumption should be moderated, particularly for patients on postoperative medications, to avoid interactions.
Radiotherapy or Surgery for Prostate Removal which would have been the best?
The choice between surgery and radiotherapy is complex, with each having similar long-term effects on urinary and erectile function. Factors influencing the decision include patient age, cancer stage, and personal preferences.
Typically for young patients removal of the prostate is preferred. Even though you can remove the prostate after radiotherapy the complications are higher. Whilst after removing the prostate you can have radiotherapy if needed so many patients opt for surgery as it gives them another opportunity to access treatment. The other advantage there is about surgery is that the prostate can be analysed completely and like that you know the extent of your disease.
