Survivorship: Life After Prostatectomy

Prostatectomy (surgical removal of the prostate) can result in long-term effects due to damage to nerves in the area. This can cause incontinence and erectile dysfunction. Your risk may be higher if you also had radiation therapy (external beam or brachytherapy).

Incontinence and Issues with Urination

Incontinence (not able to hold your urine) can be difficult to deal with physically and emotionally. There are different degrees of incontinence, and a treatment plan will be specific to your situation. These can include:

• Exercise can help strengthen the pelvic floor muscles to better control urine flow. These can be taught by a pelvic floor specialist (physical therapist).
• Medications can be used to help with certain types of incontinence.
• There are devices that can be used to open and close urine flow. These are put in your body using a surgical procedure. Talk with your urologist about these devices.
• Incontinence products, such as pads worn in your underwear and adult briefs and undergarments, can help absorb urine if you have incontinence.

There are some things you can do to help manage incontinence:

• Empty your bladder before bedtime, before leaving the house, or before strenuous activity.
• Try not to drink fluid before bedtime or when you know you will need to be out of the house for an extended period of time.
• Avoid fluids that contain caffeine or alcohol because they can make you have to urinate (pee) more often.

Talk to your healthcare provider if you are having incontinence. Coping with incontinence can cause fear, anxiety, embarrassment, and anger. A good plan to manage incontinence can help you live life more fully.

Occasionally, men can develop a narrowing, or stricture, of the urethra (the tube that drains the bladder through the penis and out of the body). This can lead to trouble passing urine and can increase the risk of urinary tract infection. If you have trouble passing urine, see blood in your urine, or have pain or burning with urination, contact your care team.

Changes to Sexual Function

Most men have some degree of erectile dysfunction (ED) after surgery. It can take several months to years to regain erectile function, if at all. Your urologist may suggest taking medications for ED, sometimes as soon as 6 weeks after surgery. This can help prevent muscle wasting (the penis is a muscle) and improve the chances of regaining the ability to have erections. You should discuss the options available to you so that you can return to a normal sex life as soon as possible. A urologist can help with these issues.

When you can have an erection, the sensation of orgasm should be pleasurable, but most likely there will be decreased or no ejaculation of semen. The orgasm will be "dry" because during surgery the glands that make most of the fluid were removed. You may also have climacturia. This is the involuntary loss of urine during orgasm. Empty your bladder before sex to help manage this side effect. Your urologist may have other suggestions for treatments to help with climacturia as well.

If you have had a radical prostatectomy, you will not be able to father a child naturally. This is because the connection to where the sperm is produced is cut during the surgery. Sperm can be collected and used for in-vitro fertilization.

Your penis may be a bit shorter after prostatectomy or have a curvature after this procedure. This shape/size of your penis should return to normal in the first 1-2 years after the procedure.

Lymphedema

If lymph nodes were removed during your surgery you may be at risk for lymphedema. Lymphedema is a build-up of fluid in your legs or genital area, causing swelling and/or discomfort. Lymphedema can be treated. It is very important to report any swelling or discomfort to your care provider right away to get early treatment.

Osteoporosis

You may be at a higher risk of developing osteoporosis (thinning of the bones). If you received hormone therapy or had an orchiectomy (removal of testes), you are at greater risk. Ask your provider if you should be taking calcium and Vitamin D supplements to strengthen your bones. A DEXA or bone density scan can determine if you have signs of osteoporosis.