When your doctor first said the words, “radical prostatectomy,” to you, your first instinct was probably to be afraid.
However, this is a completely routine, standard treatment for men with localized prostate cancer. In fact, 15-year survival rates for men with localized disease after surgery can be as high as 97%, according to a study by the Mayo Clinic.
And, only about 5-6% of patients experience a recurrence of their cancer over time.
If your doctor has recommended a radical prostatectomy, read on to discover what to expect from the procedure, common side effects and ways to prepare yourself mentally and physically for the surgery.
What is a Radical Prostatectomy?
A radical prostatectomy is surgery to remove the prostate gland and some of the surrounding tissue.
Source: Katelaris Urology
It can be performed one of three ways: regular surgery, robotically-assisted surgery or a laparoscopic surgery. Laparoscopic surgery means small incisions are made, then the surgery is done via tools and a camera inserted inside the body. This means no large or open incisions need to be made, and often shortens recovery time.
Radical prostatectomies are the standard of care for localized (non-metastasized) cases of prostate cancer. Localized means that your cancer has not spread to the lymph nodes or other organs.
This is a routine surgery performed by urologists, and approximately 138,000 prostatectomies are completed every year in the United States.
Again, it sounds very scary, but you are in good hands! Radical prostatectomies have been performed since the early 1900s and have been refined many times since then to further minimize the risk of complications.
How to Prepare for Your Surgery
Your urologist or doctor will give you specific instructions to prepare for your surgery. Typically, they will want to send you for a few diagnostic tests, like blood draws or X-rays, to verify your general health prior to surgery. Your doctor will also advise if you need to stop taking any of your normal medications.
Don’t make any sudden changes without first consulting your doctor. However, there are several easy lifestyle changes you can start doing right now to help your surgery go smoothly and speed up your recovery time.
1. Male Kegel Exercises
You may have heard of kegel exercises before but thought they were only something women did during and after pregnancy. Kegels work to strengthen the pelvic floor muscles, something both men and women have!
The male version of the exercise is a bit different, but the effect is the same. Doing regular kegel exercises can help avoid urinary incontinence issues after surgery by strengthening the muscles that control urine flow.
Here’s how to do a male kegel exercise:
- First, tighten your rectum. Pull it inward toward your body, like you are trying to prevent passing gas. Don’t engage your thigh, buttock or abdominal muscles when doing this. Only your rectum should move.
- You will feel a pulling and tightening feeling, going upward into your body.
- If you’re not sure you have the right muscle group, urinate and then attempt to stop the flow of urine mid-stream. These are the muscles you want to be controlling.
- Once you’ve found the right muscles, tighten them and hold for 3-5 seconds (or as long as you can at first), then rest for 3-5 seconds, and repeat.
Aim for 3 sets of 7 reps at first, which you can do throughout the day instead of all at once. As your muscles get stronger, advance to 4 sets of 15 reps each time.
To keep up with daily practice, download a kegel training app on your phone. You can set reminders throughout the day to train. You can even do them while watching TV or sitting at your desk at work.
Source: Apple App Store
You should continue these exercises after surgery, as soon as your doctor advises it’s okay to start again.
2. General Cardiovascular Fitness
Being active is always good for your health and preparing for surgery is no exception.
Continue the activities you regularly enjoy if you already exercise. If not, try and find at least one form of cardio exercise you like, whether it’s walking, jogging, cycling, swimming or something else.
Remember: never do nothing!
Both your mental and physical well-being can be dramatically improved by a regular exercise program. Pair cardio with an upper body exercise, such as weightlifting, for an even greater benefit.
To keep yourself accountable, consider buying an exercise tracker, like a Garmin or Fitbit, to log your daily activity. It’s easy to keep track of your workouts and will motivate you to stay active.
3. Organize Your Medications
After surgery, you’ll be recovering in the hospital for 1-2 days. Pack a bag with comfortable clothing, your phone, a book or any other comforts from home you’d like, and don’t forget your medications.
Ensure you bring all your medications in their original, labelled containers. This is so the hospital staff can be sure of what you’re taking and how often you’re supposed to take it. If you have any medication restrictions, your urologist will let you know.
Be sure to bring your CPAP machine if you require one for sleep apnea, as many hospitals do not provide this.
Lastly, keep a file on your computer (or in a journal) with your full medical history and a list of all medications you’re currently taking. Update this file frequently, including right before your prostatectomy, and bring it with you to the hospital.
It’s always a good idea to have it on hand to show medical staff if they have any questions about your history.
What to Expect After Surgery
Just like before surgery, your urologist will provide any specific guidelines or instructions for recovering from your surgery.
Generally speaking, here’s what you can expect in the weeks following your procedure.
You will be discharged from the hospital within 24 to 48 hours. Arrange for someone to drive you home, as you may still be in some discomfort and shouldn’t drive yourself.
You will have a urinary catheter when you go home, and for 1-3 weeks after surgery. Instructions for taking care of your catheter will be provided by the hospital. Don’t worry, it is completely painless while you have it in!
Source: Memorial Sloan Kettering
You can continue showering as normal with your catheter and it will come with Velcro straps to connect to your leg during the day, allowing you to conceal it under a pair of pants. It is not the most pleasant thing in the world to deal with, but it is necessary, and you will not feel it inside your body.
You will have a follow-up appointment with your urologist scheduled for a week or two after your procedure, to check your healing progress. Typically, this will be when the catheter is removed as well.
Recovery Tips After Surgery
Once you get home, take it easy for at least 6 weeks following your surgery. While this is a routine procedure, it’s still surgery and your body needs time and rest to recover.
You probably won’t feel like going out too much at first anyway, but avoid driving for at least the first week. Have your partner, a family member or friend stay with you to help you prepare meals, do household chores and run errands for you during these first few weeks of recovery.
You should not be in much pain, and many patients report none at all. However, mild discomfort can be controlled with over-the-counter Tylenol. If you are having sharp or severe pain, contact your doctor right away.
You may be prescribed an antibiotic to prevent infection. Your urologist will let you know if you need one, and if you should stop taking any other medication while you’re on it.
Whether you’re on antibiotics or not, avoid drinking alcohol during your recovery period as it can irritate the bladder and slow your healing.
It’s a great idea to buy a “donut cushion” to sit on for the first few weeks, as you may be a bit tender. This will lessen the pressure on your pelvic region when sitting down. You can find one at a medical supply store, or most large stores like Walmart.
Your doctor will also want to continue to monitor your PSA levels after your surgery. This ensures your surgery was successful in removing all traces of your prostate cancer.
If necessary, radiotherapy can be used to treat any recurrence of cancer, though it’s rare to need additional treatment.
Common Side Effects of a Radical Prostatectomy
These side effects are common after surgery, but if you’re experiencing them, consult your doctor right away. There are many treatments available to help manage or eliminate these side effects.
1. Urinary Incontinence
Incontinence is common after removal of your post-surgery catheter and can continue afterwards. Many patients experience incontinence for approximately 2 months after surgery as the body finishes healing.
In more severe cases, most improve within 6 months to 1 year after surgery, though about 11% of patients still experience some degree of mild to severe incontinence after that period.
Mild incontinence is defined as occasional leaking, moderate is constant leaking, and severe is excessive or continuous leaking that requires a high number of pads to control.
This can be incredibly frustrating to deal with, but remember that most post-surgical cases improve with time.
Luckily, there’s more you can use to help than just pads. When you are healed enough, your urologist may recommend using the Pacey Cuff™ to assist in relieving your incontinence while your sphincter control is recovering.
It’s fully adjustable, comfortable and designed to let you live your life just like you did pre-surgery. The Pacey Cuff™ is now available in Canada, the United States and many other countries worldwide.
2. Erectile Dysfunction
This is another common side effect most men experience directly following surgery, and it can be very frustrating. Try to remember that you just underwent surgery and it will take time for your body to recover fully, and that there are many treatment options available.
During a radical prostatectomy, the vas deferens and seminal vesicles are removed. This does not affect sexual function or the ability to have an erection, but it does mean you will no longer be able to father children.
Source: Urology Group Virginia
Recovering your normal erectile function can take from 6 to as long as 18 months after surgery, and for some men, even longer.
But that does not mean you need to suffer for that length of time! Many treatment options are available to take within a few weeks of your surgery, including oral medications or vacuum devices.
Always check with your doctor before undergoing a treatment for erectile dysfunction, but know that help is out there and that you will most likely recover fully with time.
Don’t Fear Your Surgery
Having to undergo any type of surgery can be stressful, but try not to worry. Radical prostatectomies are routine for a reason: they work!
Surgical or radiation treatment is the most effective way to remove your prostate cancer and give you the best chance of survival.
It’s important to feel comfortable with your urologist and be able to communicate openly and honestly with them about your concerns and any questions you have. A good urologist will take the time to answer your questions and reassure your fears to help you have a stress-free surgery and recovery period.
Most of all, remember that while there are some temporary side effects after surgery, leaking urine after your recovery period is never normal and can be treated.
You do not need to give up your favourite activities due to incontinence!
If you’re experiencing urinary incontinence after a radical prostatectomy, check out the Pacey Cuff™ for an affordable and eco-friendly solution.
It doesn’t force you to wear heavy pads or adult diapers, which can be uncomfortable, and let’s face it, no one wants to have to wear those. Get your life back with the Pacey Cuff™ instead!