Prostate removal surgery, also known as a radical prostatectomy, is a major surgery that requires careful consideration of the risks and benefits. For men with localized prostate cancer or an enlarged prostate causing urinary symptoms, removal of the prostate may potentially cure cancer or provide relief from lower urinary tract symptoms. However, prostate removal is not without risks. Understanding the details of the procedure, recovery, and potential side effects can help men determine if prostate removal is the right choice for their condition.
What is a radical prostatectomy?
A radical prostatectomy is the surgical removal of the entire prostate gland plus some surrounding tissue. It is most commonly performed for the treatment of prostate cancer. Less frequently, it can be done to relieve urinary symptoms caused by an enlarged prostate (benign prostatic hyperplasia or BPH).
There are several approaches that can be used to remove the prostate:
- Open radical prostatectomy – The surgeon makes an incision in the lower abdomen to access the prostate. This is the most invasive option with the longest recovery time.
- Laparoscopic radical prostatectomy – The surgeon makes several small incisions in the abdomen and uses a camera and instruments to remove the prostate. This is less invasive than open surgery.
- Robotic-assisted laparoscopic prostatectomy – Similar to laparoscopic but uses a robotic interface to control the surgical instruments. This provides enhanced vision and precision.
Of these options, robotic prostatectomy has become the most common technique in the United States, allowing surgeons to operate with enhanced vision, precision, and control.
Why would the prostate need to be removed?
There are two main reasons a radical prostatectomy may be recommended:
Prostate cancer treatment
If prostate cancer is localized and has not spread beyond the prostate gland, complete removal of the prostate can potentially eliminate the cancer. Additional treatment like radiation therapy or hormone therapy may be recommended after surgery depending on the risk profile.
According to American Cancer Society estimates, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. For those with early stage prostate cancer, radical prostatectomy is a standard treatment option. The decision whether or not to get prostate cancer treatment can depend on multiple factors like age, overall health, expected longevity, and tumor characteristics.
Relief of urinary symptoms
For men with very enlarged prostates causing significant urinary symptoms, medications may not provide adequate relief. Removing the enlarged prostate tissue by prostatectomy can improve urinary flow and other lower urinary tract symptoms.
This type of prostate removal surgery is much less common than for prostate cancer treatment. Medications to shrink the prostate and minimally invasive procedures like transurethral resection of the prostate (TURP) are usually tried first. If medications and other procedures fail to provide enough symptom relief, prostatectomy may be an option.
What are the risks of prostate removal surgery?
While a radical prostatectomy is an effective treatment for the right patients, it carries substantial risks that should be carefully weighed:
Erectile dysfunction
After prostate removal, most men will experience erectile dysfunction due to damage to the nerves and blood vessels that control erections. In a recent study looking at quality of life after various prostate cancer treatments, loss of erectile function was highest after prostatectomy compared to external radiation or brachytherapy. Rates of erectile dysfunction after surgery range from 20-90% depending on age and other factors. Treatments like medications, pumps, or penile implants may help restore erectile function to some degree.
Urinary incontinence
Temporary or long-term urinary leakage is another common side effect after radical prostatectomy. The sphincter muscle that controls urine flow can be damaged during surgery. With time, control typically improves but some degree of incontinence can persist long-term. Pelvic floor physical therapy can help retrain the sphincter muscles. Severe cases may require surgery to insert an artificial urinary sphincter.
Other risks
Other potential risks and side effects of a prostatectomy include:
- Pain or infection at incision sites
- Bleeding requiring transfusion
- Lymphedema or leg swelling if lymph nodes are removed
- Damage to rectum or other pelvic structures
- Adverse reaction to anesthesia
- Need for additional cancer treatment if positive margins or spread is found
As with any major surgery, heart or lung complications are also possible. The likelihood of risks and side effects depends on the surgical approach, patient health profile, surgeon experience, and other factors.
What is the prostatectomy procedure like?
The specifics of the surgery may vary slightly depending on whether an open, laparoscopic, or robotic technique is utilized. But the basic steps of the procedure are:
Patient preparation
Prior to surgery, blood work, medical exam, cardiac tests and imaging studies may be done to evaluate overall health status. Certain medications may need to be adjusted or stopped. The patient will be told to discontinue eating and drinking for a period of time before the operation. A urine catheter will be inserted.
Anesthesia
General anesthesia is used so the patient is fully unconscious during the operation. In some cases, an epidural is also placed for post-surgical pain management.
Incisions
For an open radical prostatectomy, a 5-7 inch incision is made in the lower abdomen below the navel. For a laparoscopic or robotic-assisted approach, small 0.5-1 cm incisions are made.
Accessing the prostate
The surgeon separates tissues and accesses the prostate gland. Nearby structures like the urethra, bladder neck, and seminal vesicles may be removed as well. Lymph nodes may also be extracted and biopsied.
Removing the prostate
The prostate is freed from surrounding connective tissue and carefully excised. The removed tissue is sent for pathological analysis.
Reconnecting urethra/bladder
The bladder neck and urethra are reattached to ensure continued function of the lower urinary tract. A catheter remains in place post-surgery.
Inserting drainage tube
A narrow tube is placed temporarily in the pelvis to allow drainage of fluid and bleeding.
Closing incisions
Incisions are closed with sutures or surgical glue. Bandages or dressings are applied.
The operation typically takes 2-4 hours depending on the technique used. Robotic prostatectomy generally takes longer but allows greater precision.
How is recovery after prostate removal surgery?
Patients usually stay 1-2 nights in the hospital after their prostate is removed. Recovery typically involves:
Hospital stay
After surgery, patients are monitored in a recovery room for a few hours before being transferred to a hospital room. IV fluids, antibiotics, pain medications are administered. Doctors monitor for bleeding and other complications.
Catheter
The urinary catheter remains in place during the hospital stay to allow drainage while the urethra heals. This is typically removed prior to discharge.
Drainage tube
The pelvic drainage tube stays in for 1-2 days until bleeding and fluid output decreases adequately. This prevents fluid accumulation and infection.
Activity
Walking short distances is encouraged soon after surgery to prevent blood clots and stimulate recovery. Strenuous activity should be avoided for 4-6 weeks.
Diet
A clear liquid diet progresses to regular foods over 2-3 days. Avoiding straining with bowel movements is important. Stool softeners are used.
Incision care
Incision sites will have some drainage and should be kept clean and dry. Dressings are changed.
Medications
Antibiotics, pain medications, and other drugs are prescribed for home use during recovery.
Follow-up appointment
An appointment with the surgeon is scheduled for 1-2 weeks after discharge to monitor progress, check pathology results, and remove any sutures or staples.
Continued improvements
Gradual improvements in pain, fatigue, strength, and urinary control may continue over the next few months. Erectile dysfunction can persist long-term.
What is the typical hospital stay after a prostatectomy?
The typical hospital stay after a radical prostatectomy is:
| Prostatectomy Type | Typical Hospital Stay |
|---|---|
| Open Radical Prostatectomy | 2-5 days |
| Laparoscopic Prostatectomy | 1-3 days |
| Robotic Laparoscopic Prostatectomy | 1-2 days |
Minimally invasive prostatectomy techniques allow for faster recovery and shorter hospitalization compared to open surgery. However, an individual patient’s condition and recovery pace may require a slightly longer or shorter hospital stay.
Factors that could lead to a longer hospital stay include:
– Older age
– Poor health status
– Obesity
– Extensive bleeding
– Large prostate size
– Intraoperative complications
– Slow recovery of urinary function
– Uncontrolled pain
Enhanced recovery protocols aim to get patients functioning well and home as soon as reasonably possible. Private rooms, early walking, and rapid return to eating facilitate quicker discharge. Follow-up rehabilitation and monitoring continue on an outpatient basis.
What are the home recovery recommendations after prostate removal?
Once discharged from the hospital, recovery continues at home for several weeks. Typical home recovery recommendations after a radical prostatectomy include:
Rest and increase activity gradually – Fatigue is common so adequate rest is important. Light activity can be increased over several weeks. Lifting heavy objects should be avoided for 4-6 weeks.
Take care of incisions – Incision sites should be kept clean and dry. Look for signs of infection like redness, swelling, oozing. Avoid soaking the area.
Manage pain and discomfort – Over-the-counter pain relievers, ice packs, and sitting on a doughnut pillow may provide comfort as healing progresses.
Avoid straining for bowel movements – Anesthesia and bed rest can lead to constipation. Stool softeners, laxatives, fiber, and drinking plenty of fluids can help prevent excessive pushing and discomfort.
Pelvic floor exercises – Starting Kegel exercises soon after surgery can help regain urinary control by strengthening pelvic floor muscles.
Use urinary pads as needed – Leakage of urine is common initially after catheter removal. Protective pads can manage occasional dribbling until control improves.
Eat a balanced diet – Nutritious foods support the healing process. Stay hydrated and avoid straining from constipation.
Contact provider for concerning symptoms – Fever, heavy bleeding, new pain or symptoms should be evaluated promptly to check for potential complications.
Following discharge instructions carefully makes recovery at home smoother and safer. Be sure to attend scheduled follow-up appointments with the surgical team.
What is the recovery timeline after prostate removal surgery?
The typical recovery timeline after a radical prostatectomy is:
1 week
– Incision pain improving
– Transitioning to regular diet
– Beginning light activity
2 weeks
– Much of incision pain resolved
– Good mobility around house
– Driving may be permitted
4 weeks
– Resume light household chores
– Walking up to 1 mile daily
– Only light lifting permitted
6 weeks
– Exercise restrictions lifted
– Moderate activity allowed
– Strength and endurance improving
3 months
– Most urinary control regained
– Erectile function may start improving
– Feel 80-90% recovered
6-12 months
– Continued improvements in urinary and erectile function
– Typically cleared for full physical activities
– Long-term side effects persist for some
The actual timeline can be shorter or longer than these general guidelines depending on the individual. Younger, healthier men tend to recover their continence and sexual function faster. Open prostatectomy typically doubles recovery times compared to minimally invasive techniques.
What are the chances of regaining urinary continence after prostatectomy?
Urinary incontinence is common after prostate removal but most men regain control over time. On average, studies show the chances of regaining urinary continence as:
| Time after Surgery | Chance of Urinary Continence |
|---|---|
| 1 month | 25% |
| 3 months | 60% |
| 6 months | 80% |
| 12 months | 90%+ |
Younger men have higher chances of regaining bladder control than older patients. Other factors that increase continence rates include:
– Good preoperative urinary function
– Less invasive surgical technique
– Skill and experience of surgeon
– Pelvic floor rehabilitation therapy
– No radiotherapy
With dedication to pelvic floor exercises, use of incontinence products, and sometimes medications, the majority of men recover reasonable urinary function within one year of prostate removal surgery.
What are the chances of regaining erectile function after prostatectomy?
Regaining erectile function after prostate removal can be challenging since the required dissection and removal of the prostate damages the nerves and blood vessels involved in generating erections. Statistics on recovery of erectile function include:
| Time after Surgery | Chance of Erectile Function |
|---|---|
| 6 weeks | 15% |
| 3 months | 30% |
| 6 months | 50% |
| 12 months | 60-70% |
| 2 years | 70-80% |
Younger age, localized cancer, nerve-sparing surgical technique, and use of erectile rehabilitation all improve the chances of recovering erectile function. Still, many prostatectomy patients continue to experience erectile dysfunction long-term even with treatment. Satisfying sex life after prostate removal may require medications, devices, counseling, or other interventions.
Should I have my prostate removed?
Deciding whether to undergo prostate removal is an individual choice that depends on multiple factors:
– Age and health status – Older, medically complex patients have higher surgical risks.
– Severity of urinary or cancer symptoms – Worse symptoms warrant more aggressive treatment. Mild issues may not require surgery.
– Cancer characteristics – Advanced disease requires a different approach.
– Willingness to accept side effect risks – Men’s concerns about urinary, erectile, and fertility issues vary.
– Opinions of doctor(s) – Providers weigh pros and cons to recommend best options.
– Available resources – Costs, insurance coverage, and access to quality care are considerations.
– Personal preferences – Individual situations, values, and priorities differ.
For some men with urinary obstruction or early prostate cancer, the potential benefits of prostate removal may outweigh the risks. Those with advanced cancer, limited life expectancy, or certain health concerns might avoid major surgery.
Completing a thorough evaluation, getting specialist input, understanding possible outcomes, and carefully weighing your priorities with your providers’ guidance can determine if prostatectomy is the most appropriate choice for you.
Conclusion
Radical prostate removal is a major surgery that requires significant recovery. For the right patients, it can eliminte prostate cancer or dramatically improve urinary symptoms when other treatments fail. However, possible permanent side effects like erectile dysfunction and urinary incontinence make the risks substantial. Working closely with your urologists and cancer care team is imperative to determine if you are a candidate for prostate removal. For those who undergo a prostatectomy, commitment to the rehabilitation process can help optimize outcomes. While a challenging procedure, prostate removal provides the only chance for definitive treatment for some men facing this common disease.