The prostatectomy is an invasive
surgery that carries surgical risks. Though valuable
as a prostate cancer treatment, a few patients (one
half of 1 percent) have died as a result of this procedure.
Deep venous thrombosis is a serious side effect of prostatectomy.
Deep venous thrombosis occurs when the blood moves very
slowly through the veins in the legs and begins to clot.
Fortunately, the occurrence of blood clots is less than
10 percent and this number continues to fall if patients
begin to move as soon as they are alert. Movement will
encourage the blood to continually move through the
legs. In addition, some patients use pnuematic stockings
and others use blood-thinning medications. A clot that
breaks off and travels through the body can cause pulmonary embolism, heart attack, or stroke by lodging in the
lungs, heart, or brain. Because of these risks, surgeons
usually recommend prostatectomy only for young patients
in good health.
For six weeks after the surgery,
patients should not try to lift anything over ten pounds.
Lifting and straining could cause a hernia at the site
of the incision. More importantly, lifting could damage
the anastomosis, the new connection between the urethra
and bladder. Damaging this connection could lead to
long term complications. Patients should also avoid
bicycling, horseback riding, motorcycle riding, and
any other activities that could be tiring or even dangerous
for the patient.
Patients also run the risk of infection
at either the site of the incision or the exit of the
catheter from the penis. Patients can keep the incision
site clean by using a solution of hydrogen peroxide
and water. Several times a day, especially after bowel
movements, patients should clean the penis and rectum
with soap and water.
Side Effects of Prostatectomy
Impotence and incontinence are the most common side
effects of the radical prostatectomy. When the doctor
removes the catheter two to three weeks after the surgery,
patients will notice leakage. Many researchers dispute
the exact number of patients who experience incontinence.
Some believe that less than 5 percent of patience experience
total incontinence, which is having no control over
one’s urine flow. Most men will experience some
incontinence, which will improve after the prostatectomy.
Incontinence can range from leakage to stress incontinence,
and can be treated with various techniques and incontinence products such as
pads or specially-designed underwear.
Many patients are most concerned
with sexual potency and their ability to have sex after
their prostate cancer treatment. The nerve sparing-technique
has been helpful in restoring potency in men with localized
prostate cancer with low tumor features. There are two
types of nerve-sparing techniques: unilateral and bilateral.
The unilateral prostatectomy can spare only neurovascular nerve bundle; the bilateral technique spares both. The
return of the erectile function occurs in about 68 percent
of patients who undergo the bilateral technique, and
13 to 48 percent of men who undergo unilateral technique.
Prostatectomy can also impair the erectile function
by altering the flow of blood to the penis.
The occurrence of impotence after
prostate surgery is also determined by the patient’s
age and his sexual potency before the prostatectomy.
Many men do regain their ability to have spontaneous,
unaided erections, but the ability will take time, perhaps
as long as a year, to develop. Doctors can prescribe
medications such as sildenafil, which are oral medications
that stimulate erections. Penile injections and vacuum
pumps can also stimulate erections satisfactory for
sexual intercourse. Impotence refers only the inability
to have erections rigid enough for intercourse, not
the inability to feel sensation, experience sexual pleasure,
or to have an orgasm. Men who experience orgasms after
prostatectomy are likely to experience dry orgasms,
which is the absence of ejaculatory fluid. The prostatectomy
removes the seminal vesicles and prostate gland which
are responsible for producing ejaculatory fluid.