Understanding prostate surgery and its aftermath

 

The effects of prostate surgery

 

There are a number of reasons why men have prostate surgery but all result in the likelihood of similar after effects including incontinence and erectile dysfunction. When the nerves in that area of the body are disturbed it means that normal bodily functions are also disturbed. How serious the effects are and how long they last vary depending on what sort of surgery you’ve had and from person to person.

 

Surgery for prostate cancer

 

Many men with prostate cancer have their prostate gland removed surgically with the aim of curing the cancer.

There are several types of prostate cancer surgery and your urologist will discuss with you which is best for you. They all involve an operation in an operating theatre and a general anaesthetic.

Your surgeon will decide which type would be best for you by considering the following:

  • The stage of your cancer – that is how big it is and whether it’s spread to other parts of your body. You can find out more about staging on the Cancer Research UK website.
  • The grade of your cancer – which is also known as the Gleason score. You can find out more about grading on the Cancer Research UK website.
  • What they think your prognosis is – that is what the outlook is for your cancer and its treatment.
  • What your general health is like.
  • What symptoms you have.

 

Open surgery (radical prostatectomy)

 

Your surgeon does this through an incision in your abdomen (a retropubic prostatectomy) or in the perineum – the area between your testicles and rectum (a perineal prostatectomy).

They will take out your prostate gland and some tissue around it so that they leave what they call a clear margin.

They will also take out the local lymph nodes and seminal vesicles – the tubes which carry semen. You will be offered the opportunity to preserve some semen if you might want to father children in the future.

 

 

laparoscopic surgery

 

Keyhole surgery (laparoscopic prostatectomy)

 

Often the prostate can be removed using keyhole (laparoscopic) surgery. Your surgeon uses a tube with a light and eyepiece to look inside your body. They fill your abdomen with carbon dioxide gas so they can see your prostate clearly. A tiny video camera gives a magnified view of your prostate gland on a video screen. Your surgeon cuts away your prostate gland from the surrounding tissues and puts it in a small bag before removing it through one of the incisions in your abdomen. The main difference with this surgery is that you won’t have a large wound in your abdomen afterwards. Instead you’ll have several small incisions.

Most studies have shown that laparoscopic surgery is as good at treating prostate cancer as open surgery. Men also lose less blood, experience less pain and spend less time in hospital. Most men also recover and go back to normal activities more quickly than with open radical prostatectomy surgery.

Two of the most common side effects of prostatectomy are incontinence and erectile dysfunction (impotence). There doesn’t seem to be any difference in the number of men who have these side effects after open prostatectomy or after laparoscopic prostatectomy – or after other procedures on the prostate not involving surgery.

There can be risks with laparoscopic surgery though and these include heavy bleeding for some men and damage to healthy tissue close to the prostate. These complications are uncommon when the operation is carried out by a surgeon with specialist training and experience in laparoscopic techniques.

 

prostate surgery types

 

Robotic surgery

 

Robotic assisted prostatectomy (also called da Vinci surgery) is another type of keyhole surgery for prostate cancer where the surgeon uses a robot machine to help with the operation. It helps the surgeon to make small delicate moves and cuts. Surgeons have only been using it since 2000 so it’s too early to say whether it’s better than other types of surgery for prostate cancer.

Just as with other types of surgery your surgeon carries out robotic assisted surgery in an operating theatre and you’ll have a general anaesthetic. Next to the operating table is a machine with arms which hold the camera your surgeon uses to see inside you and the surgical instruments.

Your surgeon sits at a control panel watching what’s happening on a screen where everything is magnified 10-12 times.

Your surgeon uses the robotic arms to make five incisions in your abdomen through which they put the camera and surgical instruments.

 

Advantages of laparoscopic surgery can be:

 

  • You’ll have less bleeding.
  • You’ll have smaller scars.
  • You’ll be able to go home earlier.
  • You’ll recover more quickly.
  • It’s possible that you’ll suffer from incontinence and erectile dysfunction for a shorter time.

 
 
 
nerve sparing surgery
 
 

Nerve sparing surgery

 

Surgeons have developed a technique to try to prevent erectile dysfunction after prostate surgery. This is called a nerve sparing prostatectomy. Two bundles of nerves run alongside the prostate. These nerves help control erections. During nerve sparing prostatectomy, your surgeon cuts prostate tissue carefully away from the nerve bundles without damaging them. If your surgeon can remove the prostate without harming the nerves it is much more likely that you’ll still be able to have erections afterwards. But with nerve sparing surgery there is a higher risk of some cancer cells being left behind.

Nerve sparing surgery is only suitable for men with very early prostate cancers. The cancer must be completely inside your prostate. And it must be as far away from the bundles of nerves as possible. If your cancer is growing too close to or into the nerve bundles then they have to be removed. If your surgeon leaves them behind the cancer won’t be cured by the operation.

If your biopsies show that the cancer is only on one side of your prostate gland you may be able to have the nerve bundle on the other side left untouched. This may still cause some difficulty with erections but drugs can sometimes help some men.

If you are interested in nerve sparing surgery you can ask your surgeon if it is likely to be suitable for you.

 

Side effects of prostate surgery

 

Erectile dysfunction/impotence

 

Erection problems occur in up to 7 out of 10 men (70%). Impotence means you can’t have an erection. This is more likely to happen if you’re older. Your doctor will explain this to you and offer you the chance to store sperm before the operation if you wish to have children in the future.

Your doctor or specialist nurse can also refer you to a sexual dysfunction clinic for specialist help.

There’s more information about erectile dysfunction here.

 

Incontinence

 

Prostate surgery can also cause problems with incontinence. For many men this is a temporary problem although it can take months to get back to normal. If the incontinence persists you may be referred to a specialist clinic for exercises and medication and for a few men surgery is necessary. There’s more information about incontinence here.

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