Coping With Side Effects From Prostate Cancer Surgery: What To Expect

One important caveat to keep in mind is that surgical techniques have improved a great deal over time. This leads to better recovery times and less long-term issues. Still the weeks and months immediately after surgery are likely to pose a few challenges. Here, we asked Dr. Akshay Bhandari, director of robotic surgery at Mount Sinai Medical Center in Miami, to share some realistic guidance about what men should expect.

What To Expect After Surgery

Generally, a catheter — a thin, flexible tube — is placed during a urological procedure to allow for a proper and safe healing process. The catheter helps facilitate urine flow immediately after surgery.

“In order to heal, we leave that catheter, which is essentially a tube that is letting the urine flow while the healing happens,” Dr. Bhandari explains.

This catheter is placed through the penis into the bladder. Most men keep this catheter for about one to two weeks. Your nurse will show you how to empty the bag, keep the area clean, and move around safely while it is in place.

The day the catheter is removed is an important milestone, but don’t be surprised by urine leakage. The sphincter muscles and nerves that normally keep urine in have been resting and may be weak due to a lack of usage. Light leaking, especially when you cough or stand up, is expected during the first days and weeks.

“Sometimes it may take a while for that other muscle to make up for the function of the lost muscle. So, typically we tell people that it may take up to six weeks before you start seeing improvement, and typically most people should recover their control between three to six months,” says Dr. Bhandari.

Thankfully, only a very small portion of patients experience long-term leakage.“Rarely it drags on to a year. I’d say about 90 plus percent of the people are continent after this procedure to the point where either you have very minimal incontinence or no incontinence,” he adds.

For patients who deal with ongoing bladder issues, Kegel exercises — short squeezes of the pelvic-floor muscles — are the single best home strategy to speed continence recovery. Your care team can refer you to a pelvic-floor physical therapist who will teach proper technique and, if needed, biofeedback. Aim for three short Kegel sessions a day (for example, 10 quick squeezes each time).

Erectile Dysfunction After Surgery

Because the erection-controlling nerves run like delicate, thin strands alongside the prostate, it is expected to have weaker or absent erections right after surgery. About four in ten men report some degree of erectile dysfunction overall, and the number is higher in older men. Other factors such as age, diabetes, excess weight, smoking, heart or kidney disease, and already-impaired erections before surgery make recovery tougher.

“The nerves that supply the penis that cause erections run very close to the prostate. So when we do the surgery, we try and spare those nerves, which we call the nerve-sparing prostatectomy,” Dr. Bhandari emphasizes.

Whenever it is safe, surgeons try to “spare” one or both nerve bundles. Nerve-sparing does not guarantee immediate potency, but it improves long-term results. Even with perfect nerve preservation, it is normal to have little or no erections for several months; gradual improvement often starts around six months and can continue up to two years.

“Even with the best efforts in sparing them, there will be people who will have long-term issues with erections because there’s just more to sparing the nerves — there could be injury to the nerves just from the traction of doing the surgery and the healing may not happen,” Dr. Bhandari explains.

Men who are older, have medical conditions that affect blood vessels, or had weak erections beforehand are more likely to need medications or devices (such as pills, vacuum pumps, or injections) to achieve an erection after surgery. Penile-rehabilitation programs that start soon after catheter removal — combining daily low-dose pills with regular stimulation — may shorten recovery. Full recovery, when it happens, typically occurs 12 to 24 months after surgery.

“Obviously, if someone’s younger, someone’s healthy, doesn’t have diabetes, high blood pressure, heart disease — they will recover. The likelihood of them improving or recovering their erections is much higher than someone who’s in their later age, like the seventies, or has diabetes that is poorly controlled, or hypertension, or coronary artery disease,” Dr. Bhandari adds.

Questions To Ask Your Doctor

• How long do you expect I will need the catheter, and who should I call if it stops draining?
• When should I start pelvic-floor exercises, and can you refer me to a therapist?
• Based on my age and health, what is my personal chance of incontinence lasting longer than six months?
• Was nerve-sparing possible in my surgery? If so, on one or both sides?
• How will we track my progress over the next year?

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