Symptoms of Radical Prostatectomy

Radical prostatectomy is a common surgical procedure used to treat prostate cancer, especially when it is confined to the prostate gland. This operation involves the complete removal of the prostate gland along with some surrounding tissues. While it can be life saving, the recovery process and the symptoms following the surgery can significantly impact a patient’s quality of life. Understanding these symptoms can help patients prepare both physically and emotionally for the journey ahead.

Understanding the symptoms of radical prostatectomy is crucial for any man considering or recovering from the procedure. These symptoms are not signs of surgical failure but rather a natural part of the healing process as the body adjusts to changes caused by the removal of the prostate gland. From urinary incontinence and erectile dysfunction to emotional and psychological effects, patients may face both physical and mental challenges during recovery.

What Is Radical Prostatectomy?

Radical prostatectomy is a major surgery most often performed to treat localized prostate cancer. The goal is to remove all cancerous tissue, and depending on the stage of the cancer, nearby lymph nodes may also be removed. This surgery can be performed through different approaches open surgery, laparoscopic surgery, or robot-assisted laparoscopic surgery. Regardless of the method used, certain symptoms and side effects are common post-surgery and can range from short term discomfort to longer-term complications.

Immediate Post Surgical Symptoms

After undergoing radical prostatectomy, patients typically spend one to two days in the hospital. During this time, the most noticeable symptoms are related to the surgery itself. These include pain around the surgical site, abdominal discomfort, fatigue, and a feeling of general weakness. Pain is usually well managed with medications prescribed by the healthcare team. Mild swelling or bruising near the incision is also expected and should gradually improve over time.

A urinary catheter is usually placed during the surgery and remains for about a week to help drain urine while the urethra heals. The presence of the catheter can cause a feeling of urgency or discomfort, especially during movement, but this is temporary and typically resolves after the catheter is removed.

1. Urinary Incontinence :- One of the most common and distressing symptoms after radical prostatectomy is urinary incontinence. This refers to the involuntary leakage of urine and occurs because the prostate gland plays a role in urinary control. After surgery, it may take time for the body to adjust and regain full control of the bladder.

   There are different types of urinary incontinence observed post surgery

   • Stress incontinence, where leakage occurs during activities like coughing, sneezing, or lifting.

   • Urge incontinence, where there is a sudden and strong urge to urinate followed by leakage.

   For many patients, incontinence gradually improves over weeks or months. Pelvic floor exercises, such as Kegel exercises, are often recommended to strengthen the muscles involved in bladder control. In rare cases, if symptoms persist, further medical or surgical interventions may be needed.

2. Erectile Dysfunction :- Erectile dysfunction (ED) is another significant symptom that can follow radical prostatectomy. The nerves and blood vessels responsible for erections run very close to the prostate gland. Even with nerve-sparing surgical techniques, these structures may be affected during surgery, resulting in temporary or permanent erectile difficulties.

   The likelihood and severity of ED depend on various factors such as the patient’s age, sexual function before surgery, and whether the nerves could be preserved during the operation. Some men recover erectile function within a year, while others may require medications, vacuum erection devices, or even penile implants to manage this condition.

   Early intervention with medications such as phosphodiesterase inhibitors (e.g., sildenafil) may be prescribed post-operatively to promote penile rehabilitation and improve outcomes.

3. Changes in Orgasm and Ejaculation :- Although orgasm is still possible after radical prostatectomy, it may feel different than before. Since the prostate gland and seminal vesicles are removed during surgery, patients will no longer ejaculate semen a condition called dry orgasm. While this change does not affect the sensation of orgasm for all men, some may find the experience less intense or emotionally different.

   Additionally, some men experience orgasm-associated urinary leakage, particularly during the early recovery phase. This is generally temporary but can be distressing. Open communication with a urologist or sexual health counselor can help manage these concerns effectively.

4. Bowel Symptoms :- Though less common, some patients may notice temporary changes in bowel habits following radical prostatectomy. These may include mild constipation or bloating, especially if pain medications or reduced physical activity are factors. Staying hydrated, eating a high-fiber diet, and using stool softeners if recommended by a doctor can help alleviate these symptoms.

5. Emotional and Psychological Impact :- The emotional symptoms after radical prostatectomy can be just as significant as the physical ones. Men often face a wide range of feelings including anxiety, depression, body image concerns, and worry about sexual performance or incontinence. These emotional reactions are completely normal but should not be ignored.

   Support from loved ones, counseling, and prostate cancer support groups can offer much-needed relief and reassurance. Many men find that talking openly about their experiences helps them cope better and adjust to life after surgery.

6. Long Term Recovery and Monitoring :- Recovery from radical prostatectomy varies from person to person, but many patients resume most of their normal activities within six to eight weeks. However, certain symptoms like urinary leakage or erectile dysfunction may take longer to resolve.

   Regular follow-ups with your urologist are crucial for monitoring PSA (Prostate-Specific Antigen) levels. Since the prostate is removed, PSA levels should drop to nearly undetectable levels. A rising PSA may indicate a recurrence of prostate cancer and will prompt further investigation.

Lifestyle Adjustments and Rehabilitation

Rehabilitation after radical prostatectomy is a vital part of recovery. A combination of pelvic floor physiotherapy, healthy eating, weight management, and regular low impact physical activity such as walking can enhance healing and minimize long term complications. Avoiding heavy lifting and strenuous exercise during the early weeks is essential to prevent stress on the surgical area.

Men are also encouraged to engage in discussions with their doctors about fertility, as prostate removal results in infertility. Those planning to have children in the future may consider sperm banking before surgery.

When to Seek Medical Attention?

While most symptoms after radical prostatectomy are manageable and improve over time, certain signs should not be ignored. Contact your doctor if you experience

1. Persistent or severe pain not controlled with medication

2. Fever, chills, or signs of infection around the incision or catheter site

3. Heavy bleeding or blood clots in urine

4. Inability to urinate after catheter removal

5. Swelling in the legs or shortness of breath (which may indicate blood clots)

Prompt medical attention ensures complications are caught and treated early, leading to a smoother recovery.

Conclusion

Radical prostatectomy can be a highly effective treatment for prostate cancer, but it comes with a variety of symptoms and side effects that patients should be prepared for. From urinary incontinence and erectile dysfunction to emotional challenges, the journey after surgery requires patience, support, and proper medical guidance.