Q&A: What to expect if you’re having a prostatectomy

Q: I’m having a prostatectomy. What should I expect?

A: Located deep in the pelvis area, the prostate sits below the bladder and surrounds the urethra. The prostate assists with sexual function and contributes fluids that support the sperm for fertility purposes.

Surgeons typically perform a prostatectomy, or prostate removal, to treat prostate cancer. A prostatectomy provides patients long-term cancer control through a minimally invasive, targeted procedure. Robotic assistance allows a surgeon to preserve nerve function and take a more controlled approach for such a deeply located organ.

There are two types of prostatectomies: simple and radical. In simple prostatectomies, surgeons treat benign enlargement of the prostate by removing obstructing tissue to help improve urine flow. Radical prostatectomies are performed for removal of prostate cancer within both the prostate gland and associated seminal vesicles and are often accompanied by a pelvic lymph node dissection with the goal of complete cancer removal.

Common side effects of a prostatectomy include urinary incontinence and erectile dysfunction. Most prostatectomy patients experience urine leakage postsurgery; however, pelvic strengthening exercises and careful surgical dissection can help control urinary incontinence. Leakage often improves over time — up to 18 months after surgery, but in some cases can be lifelong.

Although a prostatectomy does not directly affect sperm production, patients may experience a decrease in ejaculate fluid that supports the sperm as well as difficulty generating spontaneous erection. To assist with erectile function, treatment options such as medication therapy can facilitate blood flow to the penile tissue during recovery. Most patients will notice improved erectile function between several weeks to 18 months after surgery.

Not all diagnosed prostate cancers will require surgical treatment. For example, doctors may recommend active surveillance for those with low-grade prostate cancer. If your family history indicates a predisposition to prostate cancer, contact your health-care provider to discuss early detection and treatment options.

Dean Laganosky is a urologic surgeon who specializes in minimally invasive surgery at Nazareth Hospital.