Prostate surgery is the last resort approach to the management of problems affecting this gland.
Doctors usually recommend prostate surgery when other treatment options are ineffective.
However, the most common causes for surgery of the prostate are prostate cancer and benign prostatic hyperplasia (BPH) or enlarged prostate.
Patients considering surgery may have concerns about the procedure.
You may also have tons of questions on your mind. This article aims to provide answers to your questions.
Scroll down to learn about prostate surgery recovery and other things you need to know.
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Types of prostate surgery
The main goal of prostate surgery depends on a patient’s condition and severity of symptoms. For instance, the main objective of surgery for prostate cancer is to remove cancerous tissue.
On the flip side, BPH surgery intends to remove prostate tissue in order to restore normal urine flow.
There are different types of prostate surgery. We’re going to discuss them below.
Open prostatectomy is a traditional open surgery or an open approach. The term open surgery means a surgeon accesses the prostate through a standard surgical incision. In most cases, the incision is four to five inches long.
The primary objective of prostatectomy procedures is prostate removal. Although open prostatectomy, and other prostatectomy approaches, is mainly used for prostate cancer, they can also work for other conditions.
For cancer treatment, there are two types of this surgery:
This involves making an incision from the belly button to the pubic bone. The surgeon aims to remove the prostate only and remove some lymph nodes for testing if they suspect cancer has spread. In cases cancer has spread, a surgeon may decide not to continue with the operation.
Radical perineal prostatectomy
This involves an incision between the rectum and scrotum. This approach is performed when certain conditions would complicate retropubic surgery. During this procedure, a surgeon can’t remove lymph nodes. The approach primarily helps with localized prostate cancer. It is relatively faster than retropubic surgery but carries a higher risk of erectile dysfunction.
In patients with prostate cancer, the goal is to remove tissue to eliminate cancer but minimize damage to the surrounding structures. These surrounding structures are the seminal vesicle, nerves that enable erectile function, and muscles that control urinary continence.
Less commonly, some surgeons may recommend simple prostatectomy for men with severe urinary symptoms and very enlarged prostate glands.
Open prostatectomy requires general or spinal anesthesia. Usually, a surgeon makes an incision through the lower abdomen. Additionally, the surgeon may place a catheter in the bladder through the lower abdomen to flush the bladder, known as postoperative bladder irrigation. Another catheter comes out of the penis to drain the urine.
The term laparoscopic surgery refers to minimally invasive surgery where a surgeon makes small incisions. It is also known as keyhole surgery.
Unlike traditional surgery with large incisions, the laparoscopic operation is less invasive and may result in less pain and scarring after the procedure.
Laparoscopic surgeries also have a shorter recovery time and lower risk of infection. Nowadays, the laparoscopic approach has become common for men with prostate cancer.
This approach can be categorized into two different procedures.
Laparoscopic radical prostatectomy (LRP)
To remove the prostate, a surgeon inserts long instruments through several small incisions in the abdominal wall. The camera, on one of the instruments, allows a surgeon to see inside of the body. Compared to open radical prostatectomy, laparoscopic prostatectomy involves less pain and blood loss, shorter hospital stays, faster recovery time, and the urinary catheter remains in the bladder less time.
Robotic-assisted laparoscopic radical prostatectomy (RALRP)
This is also known as robotic prostatectomy. The surgeon relies on a robotic system to perform the robotic-assisted prostatectomy. Sitting at a control panel in the operating room, a surgeon moves robotic arms to perform the surgery through small incisions in the abdomen. Compared to other procedures, robotic-assisted surgery is more precise. Also, patients who undergo robotic surgery may experience faster recovery incontinence.
Other types of prostate surgery
Besides the above-mentioned procedures, other surgeries on the prostate gland include:
- Prostate laser surgery – treats BPH primarily without making incisions. To perform the surgery, a doctor inserts a fiber-optic scope into the urethra through the tip of the penis. Then, they remove prostate tissue that obstructs urine flow.
- Endoscopic surgery – doesn’t require incisions. The surgeon uses a long and flexible tube with a light and a lens to remove portions of the prostate. They insert the tube through the tip of the penis.
- Transurethral resection of the prostate (TURP) – standard procedure for enlarged prostate. It aims to widen the urethra. But it may also work in some cases of prostate cancer. A urologist uses a wire loop to cut pieces of the enlarged prostate tissue. These pieces go into the bladder and are flushed out at the end of the procedure.
- Transurethral incision of the prostate (TUIP) – requires several small incisions in the prostate and bladder neck to widen the urethra and improve urine flow. It may have a lower risk of adverse reactions than TURP.
Postoperative care and recovery
The doctor recommends surgery when other forms of therapy are ineffective for prostate conditions. For men with prostate cancer, surgery is the standard treatment approach, besides radiation therapy.
The exact type of surgery depends on the severity of your symptoms. The doctor recommends the most suitable surgery for your condition.
At the same time, the healthcare provider explains all about the procedure. They will inform you about the purpose, process, and what to expect right after. You, as a patient, have the opportunity to ask questions regarding your procedure and recovery.
Before a patient wakes up from the operation, the surgeon inserts a catheter into the penis. The purpose of the catheter is to drain the bladder. In most cases, the catheter stays in a patient’s body for one to two weeks. You may have bladder spasms or cramps while the catheter is in the bladder.
The length of hospital stay varies from one patient to another. Always bear in mind every man is different, so their prostate condition and its symptoms may differ.
In some cases, a patient needs to spend a few days in the hospital. However, most patients leave the hospital within 24 hours, especially after minimally invasive procedures.
Before you leave the hospital, you will receive proper care for the surgical incisions and catheter. Make sure to adhere to these instructions religiously. That way, you can have a successful and faster recovery.
Your doctor will inform you when to come for a checkup. If everything seems okay, they will remove the catheter. Once the catheter is removed, you will be able to urinate on your own.
Every surgery is different, as seen above. Some require larger incisions, whereas others need smaller ones. Some surgeries are open approach, and others minimally invasive.
Regardless of the surgery, it’s normal to experience some soreness and discomfort for a few days.
Other possible side effects
- Inflammation of the prostate
- Blood in urine
- Urinary tract infection
- Urinary irritation
- Difficulty holding urine
The abovementioned symptoms are normal and generally are not a cause for concern. If you are worried or they become severe, you need to contact your doctor.
General side effects after surgery
First, it’s important to clarify all surgeries come with certain risks. These risks are not bound to happen.
Not all patients experience side effects, but some may have them. The risk of adverse reactions is lower in minimally invasive procedures.
Some side effects include:
- Reaction to anesthetic
- Blood clots
- Damage to the organs
- Infection of the surgical site
If you have an infection, you may experience the following symptoms
- Drainage from the incision
Dealing with urinary issues after surgery
Inform your doctor about the side effects you’re experiencing, especially if urine is blocked. You should also call your doctor if the blood in the urine is thick.
Other, more specific, and serious side effects may also occur. This is particularly the case with radical prostatectomy. The most common adverse reactions here are urinary incontinence and erectile dysfunction.
A man with urinary incontinence may not be able to control urine. Or he may experience leakage or dribbling. Not all cases of urinary incontinence are the same. They may include stress incontinence, overflow incontinence, urge incontinence, and continuous incontinence.
It’s useful to remember bladder control may return within several weeks or months post-op. The recovery in urinary control develops gradually. A doctor can’t really predict how long this is going to last.
Generally speaking, older patients experience more incontinence problems than younger men. Healthcare professionals will explain how to manage incontinence. Management strategy may include pelvic floor exercises. They strengthen pelvic floor muscle and may improve bladder control.
Dealing with Erectile Dysfunction after surgery
On the other hand, a man with erectile dysfunction cannot achieve and maintain an erection for sexual penetration. Two tiny bundles of nerves on the sides of prostate control erections.
If a patient has erections before surgery, the surgeon will attempt not to injure those nerves. In other words, they will use a nerve-sparing technique. However, if cancer affects areas close to the nerves or is growing into them, the surgeon will have to remove those nerves as well.
Upon removal of both nerves, a man is unable to achieve a spontaneous erection. That doesn’t mean they will never have an erection, though. Today, several aides can help a man achieve an erection.
It’s useful to mention a patient may have erections when nerves on one side of the prostate are removed only. In case a surgeon doesn’t remove any nerves, you have a good chance of restoring healthy erectile function. Keep in mind this may take a while.
Restoring erectile function
A patient’s ability to achieve an erection after prostate surgery depends on a few factors. These factors include the age, type of surgery, erectile function before the surgery, and whether the nerves were cut and removed during the operation.
There is no specific timeframe here. It can take anywhere from a few months to two years to improve erectile function after prostatectomy.
Younger patients are more likely to restore their erectile function.
A surgeon’s experience and expertise also play a role in impotence risk. Patients of surgeons who perform prostatectomy frequently are less likely to develop ED than their counterparts whose surgeries were performed by surgeons who don’t do these operations often.
Some doctors recommend penile rehabilitation. They believe regaining potency will yield better results if a man tries to get an erection as soon as the body starts to heal. This is usually a few weeks after the procedure.
To help men regain erectile function, a doctor may prescribe medications, including PDE5 inhibitors, alprostadil, vacuum devices, and penile implants.
Side effects of prostate surgery
- Changes in orgasm (no ejaculation of semen)
- Loss of fertility
- Lymphedema (accumulation of fluids in the legs or genital region that cause swelling and pain. Rare but possible complication)
- Change in penis length (decreased penis)
- Inguinal hernia (groin hernia)
Post-surgery care guidelines
After surgery, you will get detailed instructions to follow at home. For example, you will need to keep the surgical wound clean. You will also have to avoid driving for at least a week and engaging in vigorous activities for six weeks.
After surgery, you will need to be careful with stairs – you should only climb the stairs when necessary.
Changing sitting positions is important for your recovery. You should not spend more than 45 minutes in one position. While you’re healing, you should avoid soaking in bathtubs, hot tubs, and swimming pools.
Since pain and discomfort are common after surgery, you will need to take medications to alleviate these symptoms.
Although it may seem like you can do everything on your own, you should allow someone to help you until your catheter is removed. That way, you won’t put too much pressure on your prostate and catheter or injure them accidentally.
Within a day or two, you will need to have bowel movements. To make that happen, if you have constipation, you will have to take a fiber-rich diet, drink fluid, or take laxatives.
Some men may notice their scrotum started swelling. You can manage that problem by rolling a towel to create a sling.
To reduce the swelling, you need to place the towel under the scrotum while sitting or lying down. Then, loop the ends as if you’re using a donut cushion, but make sure the ends go over your legs. In other words, you’re in the middle of that donut. That way, you will get more support. If the swelling doesn’t go away within a week, consult your doctor.
Expected recovery time after prostate surgery
Your incisions may be sore one to two weeks after the procedure. You will also have a catheter inserted during this time. Within four weeks, you will be able to return to normal activity with minor restrictions. For most men, it may take about six weeks to return to normal.
The exact recovery time depends on the type of condition, the severity of symptoms, and the surgical approach. Some men may take longer than six weeks to recover and heal.
Prostate surgery is often performed for cancer, but in some cases, for management of other problems such as BPH. Several surgeries and approaches are available.
Doctors today prefer minimally invasive approaches due to quicker recovery and lower risk of side effects.