A prostatectomy is the surgical procedure involving the removal of the prostate gland, primarily performed as a treatment for localized prostate cancer. The recovery process is phased, moving from immediate post-operative care to the long-term management of urinary function, sexual health, and cancer surveillance.
Immediate Post-Operative Recovery
Most patients undergoing a radical prostatectomy, often using a minimally invasive approach, spend a short time in the hospital, typically one night. The acute recovery phase involves managing discomfort and limiting physical exertion. Pain medication is prescribed for soreness at the incision sites, which usually subsides within the first two weeks.
A urinary catheter is placed during the procedure to drain urine and allow the connection between the bladder and urethra to heal. The catheter usually remains in place for one to two weeks. Patients are taught how to manage it, including cleaning and switching between a leg bag for daytime use and a larger bag for nighttime. Medication can help manage bladder spasms or minor urine leakage around the catheter.
Fatigue is common in the initial weeks. Patients are encouraged to rest but also to engage in light activity, such as walking, to promote circulation and speed recovery. Avoid strenuous activities, including lifting anything over 10 pounds, for the first three to five weeks to prevent strain on the healing area. Most individuals can return to work and normal activities within three to five weeks, depending on their job and the surgical approach.
Managing Urinary Function
The most common functional change after a prostatectomy is urinary incontinence, which occurs because the surgery affects the natural sphincter mechanism controlling urine flow. For many men, this issue is temporary; significant improvement is often seen within the first three months, though full recovery can take up to a year. Incontinence is divided into two main types: stress urinary incontinence (SUI) and urge urinary incontinence (UUI).
Types of Incontinence
Stress incontinence is the involuntary loss of urine caused by physical activity that puts pressure on the bladder, such as coughing, sneezing, or lifting. This is the most prevalent type after prostate removal and is managed through strengthening the remaining pelvic floor muscles. Urge incontinence involves a sudden, intense need to urinate that results in leakage when the bladder muscle contracts too frequently.
Pelvic Floor Exercises
Pelvic floor muscle exercises, often called Kegels, are the cornerstone of conservative management for post-prostatectomy incontinence. Patients are typically advised to begin Kegels as soon as the urinary catheter is removed, or sometimes before surgery, under guidance. Correct technique is important, focusing on contracting the muscles used to stop the flow of urine without engaging the abdominal or buttock muscles.
While the muscles heal, absorbent products like pads or clamps can be used to manage leakage. If incontinence persists beyond twelve months, further management options may be considered. These include prescription medications for urge symptoms or surgical procedures like a male sling or an artificial urinary sphincter.
Restoring Sexual Health
A primary concern is the recovery of erectile function, as the nerves responsible for erections run very close to the prostate gland. Almost all men experience some degree of erectile dysfunction immediately after the procedure due to surgical trauma. Recovery rates and timelines vary widely.
The ability to spare the delicate neurovascular bundles during surgery, known as nerve-sparing technique, is a major factor influencing the eventual return of function. Even with successful nerve-sparing, the nerves are often stunned and require time to recover, which can take many months or up to two years.
Penile Rehabilitation
Penile rehabilitation is a proactive strategy recommended to support the return of natural erections and preserve the health of the penile tissues. This approach aims to maintain blood flow and oxygenation to prevent tissue changes. A common component involves the use of Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil or tadalafil, taken either daily or on-demand.
These medications promote blood flow to the penis, which helps reduce tissue scarring and maintain the health of the erectile chambers. Vacuum erection devices (VEDs) may also be used early in recovery, often combined with PDE5 inhibitors, to mechanically draw blood into the penis. If oral medications and VEDs are insufficient, other options exist, including alprostadil suppositories or penile injections, which provide a more direct erection. Consistent adherence to a rehabilitation protocol offers the best chance for optimal long-term sexual health.
Long-Term Follow-up and Wellness
After a prostatectomy, long-term follow-up focuses on cancer surveillance and overall wellness. The primary tool for monitoring for any recurrence is the Prostate-Specific Antigen (PSA) blood test. Since the prostate gland has been removed, the expectation is that the PSA level will fall to an undetectable level, typically defined as less than 0.2 ng/mL, within two months of surgery.
The frequency of PSA testing is often every three to six months for the first few years, and then annually thereafter. An undetectable PSA confirms the cancer has been successfully treated. If the PSA level begins to rise and becomes detectable, it is referred to as biochemical recurrence, which prompts further evaluation.
Most recurrences happen within the first five years, but surveillance is often recommended for decades, especially for men with a longer life expectancy. For individuals with a persistently undetectable PSA for ten years or more, the need for continued annual testing may be safely reduced or stopped altogether.
Beyond cancer surveillance, the long-term phase involves returning to a healthy lifestyle, including regular exercise and a balanced diet. Recovering from a cancer diagnosis and major surgery can involve emotional and psychological adjustment, and patients should be encouraged to seek support for any distress or anxiety.