If you’ve been diagnosed with prostate cancer, your doctor (usually a urologist) may have spoken to you about the various treatment options available, such as chemotherapy, hormone therapy, and radiation therapy. For some people with prostate cancer, a prostatectomy is one treatment that may be recommended.
A prostatectomy is a surgical procedure to remove all or part of the prostate, a male reproductive gland that produces fluid necessary for the functioning and survival of sperm cells. It’s about the size of a walnut and sits just beneath the urinary bladder in men, in front of the rectum.
There are two main types of prostatectomy: radical and simple.
Radical Prostatectomy
During a radical prostatectomy, your surgeon will remove the entire prostate gland along with some surrounding tissues and the seminal vesicles (glands that help make the fluid for semen). Sometimes nearby lymph nodes may also be removed.
Simple Prostatectomy
A simple prostatectomy, on the other hand, involves removing only a part of the prostate gland. Specifically, the inner portion is removed, leaving the outer portion of your prostate intact.
There are two surgical approaches for both radical and simple prostatectomy.
Open Surgery
During open surgery, your surgeon will operate and access your prostate through a single large incision between your belly button and pubic bone, or in the perineal area between your scrotum and anus.
Laparoscopic Surgery
During laparoscopic surgery, or laparoscopy, your surgeon will instead create two to four small incisions and insert a laparoscope (a thin tube with a light and camera) and long, thin surgical tools to cut and remove tissue. Some surgeons perform the procedure using a robotic system, and it’s called robot-assisted prostatectomy or robotic prostatectomy.
Laparoscopy is less invasive and reduces scarring and recovery time.
Single-Port Radical Prostatectomy
More recently, surgeons have begun using a procedure called single-port radical prostatectomy. This newer alternative to traditional laparoscopic prostatectomy and robotic radical prostatectomy involves a single incision for the laparoscopic tools instead of multiple cuts. Research suggests this procedure is safe and effective, and may reduce hospital stay time.
Transurethral Resection of the Prostate
In rare cases, your healthcare provider may recommend a transurethral resection of the prostate, or TURP. During this procedure, your surgeon will insert a laparoscope-like device called a resectoscope in the opening of the penis and through your urethra (the tube that carries urine from your bladder) to access and remove prostate tissue. You may be a candidate for this procedure if you:
Have a tumor that is only present in the prostate and you cannot have a radical prostatectomy
Have advanced prostate cancer and need relief from symptoms, such as trouble urinating
Days to Weeks Before Surgery: Pre-op Assessments
A few days to weeks before your operation, you will have a pre-op assessment with your doctor, who will discuss the surgery you will be getting. They will explain the procedure and risks, and answer any questions you have. They may also discuss the type of anesthesia that will be used.
Your doctor will conduct a medical evaluation to assess your overall health and identify any potential risks you might have. This may include taking your vital signs (such as temperature and blood pressure) and ordering blood tests, imaging studies, prostate biopsy, and other diagnostic procedures to better understand the extent of your disease (you may not need these if you had them when you were diagnosed).
At this time, it’s important to let your doctor and the healthcare team know about the following:
All medications you are taking, including over-the-counter drugs and herbal supplements
If you’re sensitive or have an allergy to any medications, latex, iodine, tape, contrast dyes, or anesthetics
If you have a history of bleeding problems
If you smoke
You will receive specific instructions on how to prepare for the surgery. You may be asked to stop taking any blood thinning medications, including aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn), one week before surgery. Stopping smoking for even just a few days before your surgery will help you recover better and avoid breathing problems during surgery.
The Day Before Surgery
You may be asked to begin a “bowel prep” the day before your surgery, which will probably involve drinking a liquid solution or using an enema to empty your colon.
You will also be instructed to only drink clear liquids 24 hours before surgery, and to avoid eating or drinking anything at all after midnight the night before your surgery. If you have medications you need to take, you will have to take them with just a small sip of water.
Don’t forget to make arrangements for transportation to and from the hospital.
The Day of Surgery
Before heading to the hospital on the day of your surgery, remember to:
Wear comfortable, loose-fitting clothing and glasses instead of contacts, if necessary.
Leave any metallic objects you wear (including body piercings) at home, along with other valuable items.
Avoid using any products on your skin, such as lotions, deodorant, makeup, or cologne.
Pack loose-fitting clothing, brief-style underwear one to two sizes larger than what you normally wear, and sneakers that lace up (so they can be loosened if you have swelling).
Bring your breathing device if you have sleep apnea, as well as something to hold your personal items like hearing aids, toothbrush, dentures, and eyeglasses.
You may also want to bring entertainment for your hospital stay, such as headphones for music, a book or magazine, or a tablet.
After you check in to the hospital on the day of surgery, you’ll be given a hospital gown to wear. You’ll also be asked to remove any jewelry and go to the bathroom to empty your bladder before the procedure.
Before your surgery begins, nurses will help position you on the operating bed and attach monitoring devices to measure your vital signs. An intravenous (IV) line will be started on your hand or arm. If there is excessive hair at the surgical site, it may be clipped off, and the area will be cleaned with an antiseptic.
An anesthesiologist will administer anesthesia through your IV that makes you fall asleep, and will continuously monitor your vital signs during surgery. If you are receiving general anesthesia, you will be given a breathing tube and ventilator. You will also receive a urinary catheter to drain urine from your bladder.
Your surgeon will then perform the operation. Depending on the type of prostatectomy chosen, they will make the necessary incisions to access your prostate. A drain may be inserted at the surgery site, depending on the type of surgery.
After the prostatectomy, your surgeon will close the incisions with stitches, surgical tape, or surgical glue, and apply a sterile bandage or dressing. The urinary catheter will be left in to drain urine while you heal. You will then be transferred to a bed in a recovery area.
You may wake up in the recovery area with an oxygen mask on, compression boots on your lower legs to help with blood circulation, and a urinary catheter. You’ll be provided with pain medications as needed to ensure comfort during the recovery period.
Your care team will encourage you to walk as soon as you feel able to help reduce the risk of blood clots and pneumonia, and to stimulate your bowels. They will also teach you deep breathing exercises and how to use an incentive spirometer (a disposable device that encourages deep breathing). You will also learn leg exercises to help with blood flow and Kegel exercises to help you control your urine.
If you have a urinary catheter, your care team will instruct you on catheter care, which includes emptying and cleaning the catheter bag and monitoring for any signs of infection.
You may be allowed to leave the hospital a few hours after your procedure if you had a single-port radical prostatectomy. Otherwise, you will probably stay in the hospital for one to four days after your surgery.
Once you’re home, you may have some post-surgery pain:
From gas
Around your incisions
In your back, shoulders, or other areas of your body
In your rectum, or a feeling of pressure like you need to have a bowel movement
The pain is typically manageable with over-the-counter pain medications, or as recommended by your doctor. You’ll need to maintain a liquid diet one to two days after your surgery. This will give your body time to recover and heal.
Most people feel better about a week after surgery, but you might still feel tired for several weeks after the procedure and should avoid strenuous activity to allow your body to heal. Many patients take time off work for three to four weeks to heal. You may be ready to resume normal activities about a month after surgery.
Expect regular follow-up appointments with your provider, who will want to monitor your recovery.
Call your healthcare provider immediately if you experience:
Heavy bleeding or discolored drainage from your incisions
A fever of 100 degrees F (38 degrees C) or higher
Infection or odor at the surgical site
Skin separation at your stitches
Increased pain
Urinary incontinence (leaking urine or the inability to control urine) and erectile dysfunction are common side effects of prostatectomy, especially after radical prostatectomy.
But these are often temporary.
Urinary Incontinence
There are several types of urinary incontinence, including:
Stress incontinence, when urine leaks during coughing, sneezing, laughing, or exercise
Urge incontinence, a sudden and uncontrollable need to urinate
Orgasmic incontinence, the leakage of pee during sexual excitement or orgasm
Bladder control usually improves slowly over several weeks or months. The following strategies may help recover bladder control:
Bladder training, by assigning specific times throughout the day to urinate
Medications
Most people have good urinary control around 6 to 12 weeks after surgery. Until then, you may want to avoid caffeinated beverages and carry incontinence pads.
Erectile Dysfunction
After a radical prostatectomy, most men experience some erectile dysfunction, or loss of their ability to have an erection — even with nerve-sparing surgery. The ability to have an erection often returns slowly, and may take several months. It may take up to two years to go back to the same quality of erections and sexual function as before surgery.
In the first few months after surgery, you will probably not be able to have a spontaneous erection without medicine or other treatments. However, you may still be able to experience normal sensation and an orgasm with little-to-no semen (also called a dry orgasm).
Medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) will only work if the nerves that control erections have not been damaged or removed. Another medication, alprostadil, is available as an injection or a pellet that’s inserted into the urinary opening, and may help with erections.
Vacuum devices and penile implants are other options to treat erectile dysfunction after a prostatectomy.
Change in penis length (typically a loss of 1 to 2 centimeters), which generally resolves on its own after about a year
Bladder spasms, or sudden and intense cramping pains in the lower abdomen and penis, which improve with time
Infertility (some men choose to use a sperm bank before their procedure if they plan on having children)
Narrowing of the urethra, which may be treated with dilation procedures or surgery
Lymphedema, or localized swelling due to the removal of lymph nodes, which can be treated with physical therapy
Common risks that are associated with any type of surgery include:
Reactions to anesthesia or other medications
Infection
Bleeding
Blood clots in the legs or lungs
There may be other risks depending on your health and the type of surgery you will be getting. Discuss all your concerns with your doctor before your scheduled surgery.
