The condition you had prostate surgery to fix, most commonly prostate cancer or an enlarged prostate that is causing urinary issues, is usually resolved after your procedure. People who go through this type of surgery frequently experience complications like urinary incontinence and erectile dysfunction after the procedure, which may be temporary or permanent. There are different ways to minimize the impact these issues may have on someone’s life after prostate surgery.
Benefits of Surgery
The goal of prostate surgery is to resolve problems caused by your prostate gland. The prostate gland is a walnut-sized gland of the reproductive gland that is located behind the scrotum in men. Issues of the prostate are usually a result of an enlarged prostate gland, which can wrap around the urethra and obstruct the flow of urine.
Prostate enlargement is common in men as they age. This type of prostate enlargement is called benign prostatic hyperplasia (BPH). It only becomes a problem when it obstructs the urethra and impairs the flow of urine. Prostate enlargement can also be caused by cancerous cells. When prostate gland enlargement is cause by cancer, the question then becomes whether or not the cancerous cells—or tumor—are limited to the prostate gland or whether it has spread to other parts of the body. When a tumor is confined only to the prostate gland, the tumor itself can be removed with prostate surgery.
In cases where an enlarged prostate causes urinary obstruction, prostate surgery is performed to remove the entire or a part of the prostate gland, which can help resolve symptoms, including hesitancy (difficulty starting urine stream), urinary frequency, bladder retention (unable to completely empty the bladder), and incontinence.
With cancer, your doctor will remove the cancerous cells through prostate surgery to prevent the cancer from spreading beyond the prostate. The success rate for this type of prostate surgery is very high if all the cancer is removed. Surgery also provides your doctor with information about the exact size and state of your tumor.
Possible Future Surgeries
A prostatectomy itself is usually enough to resolve prostate cancer or issues associated with an enlarged prostate gland. A radical prostatectomy can usually cure prostate cancer when it is limited to the prostate gland. If your cancer has already spread, you may need ongoing cancer treatment, such as chemotherapy or radiation.
When prostate surgery is used to address non-cancer problems like BPH, additional surgeries may be needed. Some men will require a second surgery after their prostatectomy for BPH or other issues with an enlarged prostate if:
- Not enough of the prostate gland was removed the first time
- Prostate enlargement continues after surgery
- Scar tissue forms after prostatectomy and blocks the urethra
The goal of prostate surgery is to resolve problems related to prostate enlargement that could cause serious health problems. This doesn’t mean prostate surgery doesn’t come with its own complications. There are a number of side effects that are likely to occur after prostate surgery and will require adjustment, including:
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time. The types of incontinence that are common after prostate surgery include:
- Stress incontinence: Leakage occurs during coughing, laughing, sneezing, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder (the bladder sphincter). Prostate cancer treatments can damage this valve or the nerves that keep the valve working
- Overflow incontinence: Trouble with emptying the bladder, and taking a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue
- Urge incontinence: A sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine
- Continuous incontinence: Losing all ability to control their urine
In general, older men tend to have more incontinence problems than younger men. Large cancer centers, where prostate surgery is done often and surgeons have a lot of experience, generally report fewer problems with incontinence. Incontinence can be treated in most cases. Even if your incontinence can’t be corrected completely, it can still be helped.
How to Manage Incontinence
There are multiple ways to manage incontinence:
- Pelvic floor muscle strengthening: Pelvic floor muscle exercises can help muscle strength and bladder control get better by doing exercises that tighten and relax muscles that control the flow of urine
- Bladder training: This can help manage how often you need to urinate throughout the day by assigning certain time intervals to empty your bladder
- Medicines: Some medications can help the muscles of the bladder and the muscles that control urine flow. Most of these drugs affect either the muscles or the nerves that control them. They work best for urge incontinence
- Surgery: This may be used to correct long-term incontinence. It can remove blockage. Material such as collagen might be recommended and injected to tighten the muscle that controls urine flow. A small device called a urethral sling can also be implanted to press the urethra against the pubic bone. An artificial muscle controlled by a scrotal pump may be an option for men, and it’s implanted to squeeze the urethra
- Incontinence products: They can help keep you active and comfortable. Adult briefs and undergarments are bulkier than pads worn under your clothing, but provide more protection. Bed pads or absorbent mattress covers can also be used to protect the bed linens and mattress
In terms of sexual health, erections can be impaired after prostatectomy between a few months and up to two years. There are a number of delicate nerves surrounding the prostate gland that are important to erectile function, and lasting effects may result if any damage to these nerves happened during your surgery.
Your ability to have an erection after surgery depends on your age, your ability to get an erection before the operation, and whether the nerves were cut. All men can expect some decrease in their ability to have an erection, but the younger you are, the more likely it is that you will keep this ability.
The recovery of this function after surgery will be slow. Most doctors feel that regaining this function is helped along by trying to get an erection as soon as possible once the body has had a chance to heal, usually several weeks after the operation.
In cases where erectile dysfunction is permanent, several medications are now available to help treat erectile dysfunction after prostate surgery, including:
Some men also experience loss of sensation or pain during orgasm after prostate surgery. Men who are interested in preserving their fertility may want to have sperm collected and stored before their surgery.
Prostatectomy can also put you at a higher risk of developing an inguinal hernia, or swollen lymph nodes in the groin. Physical therapy like pelvic floor exercises and a good bowel regimen to reduce straining after surgery can help. Make sure you get specific advice for your situation when you talk to you doctor about follow-up care.
Before you have prostate surgery, your doctor will monitor your enlarged prostate by screening for cancer. This screening is most often done using a blood test called a prostate-specific antigen (PSA) test. The PSA is used for both cancer screening and monitoring for recurrence of cancer that has already been treated. PSA levels increase with age, and higher levels are associated with a higher risk of prostate cancer. After a prostatectomy, PSAs should not be present in your blood sample.
If you have had a radical prostatectomy, your doctor will schedule follow-up visits to continue to monitor you for recurrence. Typical screenings after surgery include:
- An initial PSA level three months after your surgery
- Checking PSA levels every three to four months for the first year after your surgery
- Checking your PSA level twice a year in the second year after your surgery
- After the second year, your doctor should continue to check your PSA level once each year
If your cancer returns or has spread after a prostatectomy, a second prostate surgery is unlikely. Medical management with radiation, chemotherapy, immunotherapy, or hormone therapy are typically recommended.
When it becomes clear that cancer has spread beyond the prostate, targeted treatment for those areas—will be used. Surgeries in other parts of the body can also be a possibility.
If you are going to have a prostatectomy related to a cancer diagnosis, discuss your care with a team of surgeons and oncologists.
A Word From Verywell
Prostate surgery can improve quality of life and chances of survival in the case of prostate cancer, but it comes with its own set of complications, which can be temporary or permanent. impotence and incontinence are the most common concerns after prostate surgery. Even if these problems are not completely resolved, there are different ways to cope with them in the long run. If you are feeling overwhelmed because of these concerns, talk to a loved one or seek out a support group to find others who understand what you are going through.
It’s important to remember that prostate surgery is not necessary unless prostate enlargement is causing health problems or is a result of cancer. Talk with your doctor about your risks versus the benefits of surgery for your individual diagnosis before you have prostate surgery.