A prostatectomy, the surgical removal of the entire prostate gland, is a common treatment option, primarily for localized prostate cancer. This procedure involves detaching the prostate from the urethra and the bladder neck, and then reconnecting the bladder directly to the urethra. Understanding the physical and emotional steps of recovery can help manage expectations and prepare for the changes ahead. This guide outlines the typical phases of healing and the rehabilitation protocols involved in restoring function and quality of life.
Immediate Post-Operative Recovery
Hospital stays are typically one to two nights, especially after a robotic-assisted laparoscopic prostatectomy. Nurses encourage sitting up and walking shortly after the procedure to prevent complications like blood clots and promote faster bowel function return.
Pain management is handled effectively with prescribed oral medications, though some discomfort at the incision sites is expected. A temporary urinary catheter is inserted during surgery to drain the bladder and allow the connection between the bladder and urethra to heal properly. This catheter usually remains in place for about one to three weeks post-surgery.
Physical restrictions are enforced to protect the internal surgical site. Patients must avoid strenuous activity, including lifting anything heavier than 10 to 12 pounds for approximately four to six weeks. Driving is typically restricted for a couple of weeks, and the return to non-strenuous work generally occurs within two to four weeks.
Managing Urinary Function Changes
The prostate’s removal temporarily disrupts the function of the urinary sphincter muscles responsible for continence. Experiencing some degree of urinary leakage, known as incontinence, is nearly universal immediately after the catheter is removed. This temporary incontinence is most often stress incontinence, meaning leakage occurs with movements that put pressure on the bladder, such as coughing, sneezing, laughing, or lifting.
The cornerstone of managing and recovering urinary control is performing pelvic floor muscle exercises, commonly known as Kegels. These exercises strengthen the muscles that form a sling supporting the bladder and urethra. Patients are often advised to begin or resume Kegel exercises soon after the catheter is removed, after receiving proper instruction on the correct technique.
Correct technique involves contracting the muscles used to stop the flow of urine or prevent passing gas, while ensuring the abdominal, thigh, and buttock muscles remain relaxed. Significant recovery can take several months, with improvement continuing for up to a year. While recovery is ongoing, many men rely on protective aids like absorbent pads or specialized clamps to manage leakage.
Addressing Sexual Function Changes
A major consequence of prostate removal can be erectile dysfunction (ED), as the nerves responsible for facilitating an erection run closely alongside the prostate gland. Even with advanced surgical techniques, these delicate neurovascular bundles can be stretched or injured during the procedure, leading to a temporary loss of function. The prognosis for sexual recovery is heavily influenced by whether the surgeon was able to perform a “nerve-sparing” procedure, which attempts to preserve these bundles.
Despite nerve-sparing efforts, most men experience temporary ED because of nerve stunning or injury. The return of natural erectile function is a slow process, often requiring 12 to 24 months, as the nerves slowly heal. Age and the quality of erections before surgery are also significant predictors of the final outcome.
To support the recovery process and prevent tissue changes in the penis, a regimen known as penile rehabilitation is often recommended. This protocol typically begins shortly after surgery and focuses on improving blood flow to the erectile tissues. Initial steps often involve the daily use of oral phosphodiesterase-5 (PDE5) inhibitors, like sildenafil or tadalafil, which help relax the smooth muscle in the penis.
If oral medications are insufficient, other therapeutic options are introduced, including vacuum erection devices (VEDs) or intracavernosal injections. The goal of this rehabilitation is to maintain tissue health and oxygenation during the long period of nerve recovery. Patients should maintain realistic expectations, as full sexual function may not return for up to two years, and some may require continued assistance to achieve satisfactory erections.
Long-Term Monitoring and Lifestyle Adjustments
Long-term monitoring focuses primarily on the regular testing of the Prostate-Specific Antigen (PSA) level in the blood. Since the prostate is removed, the PSA level should fall to an undetectable range within six to eight weeks post-surgery.
The follow-up schedule typically involves PSA testing every three to six months for the first few years, and then annually thereafter. A rising or persistently detectable PSA level (often defined as 0.2 nanograms per milliliter or higher) can indicate a recurrence of cancer cells.
Integrating regular physical activity back into the daily routine is encouraged, though heavy lifting and strenuous core exercises should be avoided until cleared by the surgeon. Maintaining a healthy weight and following a balanced diet can also support overall health and potentially lower the risk of cancer recurrence.
The emotional and psychological impact of the procedure and its resulting functional changes can be significant. Feelings of anxiety, particularly related to the PSA test results—known as PSA anxiety—or distress over changes in sexual function are common. Recognizing these feelings and seeking support from a counselor, support group, or mental health professional is a necessary part of the long-term adjustment process.