Is prostate removal a big operation?

A radical prostatectomy is a major operation, and as with all major surgery there are some risks involved. These include: bleeding during or soon after the operation and possibly needing a blood transfusion - this is very unlikely if you have keyhole surgery (fewer than 1 in every 100 men)

prostatecanceruk.org - Surgery: radical prostatectomy - Prostate Cancer UK

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What does surgery involve?

Before the operation

A week or more before your operation you will have tests at the hospital to make sure you are fit enough for surgery. This is called a pre-op assessment. Tests can include blood and urine tests, an electrocardiograph (ECG) to check how well your heart is working, a physical examination, and scans such as a chest X-ray. Your nurse will also ask you about any allergies you have, and you’ll need to bring a list of any medicines you’re taking. You might need to stop taking some drugs, such as warfarin. Doing pelvic floor muscle exercises for a few weeks before your operation may help you recover more quickly from urinary problems caused by surgery.

Getting organised at home

Before your operation, it helps to get organised at home to make life easier when you leave hospital. You won’t be able to lift heavy things for a while and you will need to rest. You could:

fill your freezer with food so you don’t need to cook

do your shopping online

if possible, arrange to have a friend or relative with you for the first couple of days after you go home in case you need any help

arrange for people to help with things like cleaning

if you have pets, put pet food into small containers so you don’t have to lift heavy bags

get a list of useful phone numbers ready

have some absorbent (incontinence) pads ready

make sure you have some comfortable, loose clothes to wear while any soreness settles down.

During the operation

You will go into hospital on the day of your operation or possibly the day before. You won’t be allowed to eat for about six hours before the operation, although you may be able to drink water or certain other drinks until two hours before. This will be explained to you. You may be given an enema (liquid medicine) or a suppository (a pellet) to clear your bowels. These are put inside your back passage (rectum). A nurse will prepare you for your operation. They will put elasticated knee length stockings on your legs – you might hear these called TEDs. They reduce the chance of blood clots forming in your legs. You will keep these on until you are moving around normally again. You will have a general anaesthetic so that you’re asleep during the operation and you won’t feel anything. The operation usually takes two to four hours but can sometimes take longer.

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As well as the prostate, your surgeon will also take out the seminal vesicles. These are two glands that are connected to the prostate and sit just behind it. They store some of the fluid in semen (the fluid that carries sperm). There are two bundles of nerves attached to the prostate that help you get erections. Your surgeon will try to save these nerves if it’s possible. This is called nerve-sparing surgery. If your surgeon thinks your cancer may have spread to the nerves, they may need to remove one or both of these bundles. This will cause problems getting an erection without medical help. Even if the nerves are saved, it can still take some time for your erections to recover. Although these nerves are involved in erections, they don’t control feeling in the penis. So even if they are affected or removed you won’t lose any feeling and you should still be able to have orgasms.

After the operation

You will wake up in the recovery room. You will have an oxygen mask on, as you will be breathing more slowly than usual while the anaesthetic wears off. You will have a drip in your arm to give you fluids and pain relief, and you will have a catheter in place to drain urine from your bladder. You may also have a thin tube in your lower abdomen to drain fluid from the area where your prostate used to be. This is usually removed 24 to 48 hours after the operation.

Catheter

You’ll have a thin, flexible tube (called a catheter) passed up your penis to drain urine from your bladder while the area heals. It will be put in place during the operation, while you’re asleep. It may feel strange or uncomfortable at first and you may feel like you need to urinate all the time. But the catheter should drain all the urine without you needing to do anything, and this feeling usually passes after a few hours. Most men go home with the catheter in. Your nurse will show you how to look after it, and it will be removed at the hospital one to three weeks later.

Pain

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You will be given pain-relieving drugs after the operation if you need them. These should control any pain you have, but tell your doctor or nurse if you are in any pain. The drugs are usually given into a vein in your arm or hand through a drip (intravenous infusion). You might have a pump so that you can give yourself pain relief without having to wait for someone to bring it to you. There is a limit on the pump so that you can't give yourself too much medicine by mistake. After keyhole surgery, you may have some pain in the tip of your shoulder for a few days. This is caused by the carbon dioxide used during surgery. The gas irritates the nerves, and this can cause pain. Your stomach may also feel bloated, and you might feel some cramping and tightness. It’s usually quite mild and goes away over time.

Swelling

You may have some bruising and swelling in and around your testicles and penis. This can make it uncomfortable to sit on hard surfaces. It shouldn’t last more than a few weeks. If you have a lot of swelling, or if it’s getting worse, tell your doctor. When you go home, you may find underpants (briefs) give you more support and are more comfortable than loose boxer shorts. You can also buy supportive underwear, such as a jock strap or testicle support. If you had lymph nodes removed during the operation, this can very occasionally cause swelling in the scrotum (the skin containing your testicles) and one or both legs (lymphoedema). You will be given compression stockings to help encourage the fluid to drain from your legs if you need them.

Eating and drinking

Your team will let you know when it’s safe to start eating and drinking. You will usually start with sips of water.

Getting out of bed

You will be encouraged to get out of bed and start moving around as soon as you can to lower the risk of blood clots. You may also be prescribed injections to reduce the risk of blood clots. You will go home one to five days after your operation, depending on your recovery and your doctor’s advice.

prostatecanceruk.org - Surgery: radical prostatectomy - Prostate Cancer UK

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