Surgical Procedures: Prostatectomy

What is a prostatectomy and how is it done?

A prostatectomy is surgery that removes the prostate gland. The most common surgery used to remove the prostate gland is called a “radical prostatectomy.” During a radical prostatectomy, the surgeon removes your prostate, some of the tissue around it, and the seminal vesicles (the glands that make most of the fluid for semen). There are two ways a radical prostatectomy can be done:

• Retropubic Prostatectomy: An incision (cut) is made in the abdomen (belly) to remove the prostate. Lymph nodes may also be removed.
• Perineal Prostatectomy: The prostate is removed through an incision made in the perineum. The perineum is the space between the scrotum and anus. An incision in the abdomen (belly) may be needed if lymph nodes are removed.

A prostatectomy can be done in 3 different ways. Your provider will talk with you about the type of surgery you may need. Each surgery has its risks and benefits.

The 3 types of surgery are:

• Open incision (large cut).
• Laparoscopic (many small incisions).
• Robotic surgery (special tools are used).

Surgery to treat prostate cancer can cause nerve damage, making you unable to have an erection. Nerve-sparing surgery may be an option for some patients. Your surgeon will talk to you about your surgery and options.

What are the risks of prostate surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to help with pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Bleeding, which may or may not require blood transfusions.
• Blood in your urine.
• Infection.
• Injury to surrounding organs.
• Lymphocele (a collection of fluid).
• Lymphedema (swelling that can happen after lymph nodes have been removed).
• Being unable to have or maintain an erection.
• Changes in orgasm (can be “dry,” meaning no semen is released).
• Changes in your ability to father a child.
• Inability to hold your urine and/or stool.
• The penis becoming shorter by about 1-2 centimeters (cm).
• Inguinal hernia. This is when tissue pushes through muscle in your lower belly. It looks like a lump and can be painful to the touch.

What is recovery like?

After a prostatectomy, you may need to stay in the hospital for a few days. Your full recovery may take up to 4 weeks. You will have a temporary (short-term) urinary catheter, which is a thin tube that helps drain urine from your bladder. You may also have drains in your belly to remove extra fluid. You will be told how to care for any catheters and drains before leaving the hospital.

Your provider will talk to you about anything you should avoid based on the surgery you have had. They will also tell you what medications you will be taking to prevent side effects. You should:

• Take prescribed medications as told to do so by your care team.
• Not lift anything heavy for 6 weeks after surgery. Your provider will tell you when you can go back to normal activities.
• Walk often to prevent blood clots, pneumonia, and constipation and to help keep your muscles strong.
• Not drive until the catheter is removed and/or while taking narcotic pain medications.
• Avoid straining to have a bowel movement.
• Shower as told to do so. Do not tub bathe until your provider tells you that you can.
• Avoid sexual activity until advised by your healthcare team.

Call your healthcare provider if you have:

• Fever. Your care team will tell you at what temperature you should call them.
• Bleeding, redness, warmth, or drainage at your incision.
• Chills, nausea and/or vomiting, burning while urinating, being unable to eat or drink.
• Cough that won’t go away.
• Any new or worsening pain.
• Heavy bleeding with or without large blood clots.
• Shortness of breath, chest pain and/or swollen tender legs.
• No urine in catheter bag or if you are having a hard time urinating.
• Leaking urine while the catheter is in.
• Any changes to your urine, such as blood, gritty material or stones in the catheter bag, abnormal  color, or foul-smelling urine.
• Problems with your catheter, or if it falls out.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.