Radical prostatectomy: risks and side-effects

Side effects from a radical prostatectomy can range from standard wound infections to erectile dysfunction. However, if at any point you need this procedure done, there are fortunately a range of treatment options to ensure you’re as fully functioning as possible in the penile area.

We spoke with Mr Neil Haldar, a leading urologist, to find out what exactly are the risks of a radical prostatectomy, side effects from the surgery and some of the treatment options available.

 

What are the potential risks of a radical prostatectomy?
 

The risks associated with radical prostatectomy include those that may occur with any major surgery. These include:
 

• An allergic reaction to the general or local anaesthesia
• Blood loss during the surgery may necessitate a blood transfusion.
• Deep vein thrombosis
• Wound infections
• Internal injury to the rectum. This could lead to an abdomen infection or a urine fistula and might require further surgery to repair.
• A rectal injury is rare but more frequent with the laparoscopic and robotic techniques than with the traditional open approach.
• A bladder neck contracture can occur due to scarring at the join of the urethra to the bladder neck. This can cause obstruction with difficulty urinating and may necessitate a further procedure to open up the scar tissue.
• If the lymph nodes are removed as part of the procedure, a collection of lymph fluid, called a lymphocele can form and may need to be drained.
• A prostatectomy increases a man's chances of developing an inguinal (groin) hernia in the future.
   

Radical prostatectomy side-effects

The main side effects of radical prostatectomy are urinary incontinence and erectile dysfunction (impotence). There is no real evidence so far that any particular method of radical prostatectomy significantly reduces this risk. There is evidence that the experience and skill of the surgeon has an effect.

Urinary incontinence after radical prostatectomy

Urinary incontinence occurs due to problems with the valve that keeps urine in the bladder, the urinary sphincter. Surgery disrupts this valve as well as the nerves that supply the valve. Men with stress incontinence after radical prostatectomy may leak urine when they cough, laugh, sneeze, or exercise. They typically leak more standing, moving, and straining, and less when lying down and sleeping.
 

Immediately after the urinary catheter is removed, most men will have difficulty with urinary control. Patients usually have to wear absorbent incontinence pads for a while until urinary control returns. The length of time to regain control can be unpredictable. Some men regain control in a few days, and some take a few months. In general, older men tend to take longer than younger men.

There is good evidence that performing regular pelvic floor or Kegel exercises before surgery and after removal of the catheter can speed up the return of urinary control.

Occasionally urinary control will be unsatisfactory even after a year. Although rarely needed, there are techniques for restoring control, such as placement of an artificial urinary sphincter.

A few men may find it difficult to urinate a few weeks or months after surgery. This is caused by scarring around the join of the bladder to the urethra, termed bladder neck contracture. This often requires a secondary procedure to dilate open the join.
 

Watch these helpful and informative video on managing incontinence after radical prostatectomy:

Erectile dysfunction after radical prostatectomy

Most men, after radical prostatectomy, can expect some decrease in the ability to have an erection. Erectile dysfunction is this inability to achieve an erection sufficient for sexual penetration. Men who have had nerve-sparing operations are more likely to recover their erectile function, but there's no guarantee. If the ability to have erections does return after surgery, it often returns slowly and can take from a few months to up to two years. Erectile function is more likely to return for men younger than 60, and or men who had good function before surgery. And even if unassisted erections don't return, these same men are also the ones more likely to respond to medication.

 

There a number of treatment options for erectile dysfunction after radical prostatectomy:

Drugs such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) known as Phosphodiesterase-5 (PDE5) inhibitors are pills can help with erections by opening up the blood vessels to the penis. Side effects of these drugs include headaches, facial flushing, upset stomach, light sensitivity, and runny or stuffy nose.

The drug Alprostadil is a synthetic version of the naturally occurring substance prostaglandin E1 produces erections by dilating the penile blood vessels. It can be injected into the penis with a small needle 5 to 10 minutes before intercourse or placed as a pellet into the urethra of the penis.

Vacuum devices are mechanical pumps placed over the penis, which draws blood into the penis to produce an erection. A rubber band placed towards the base of the penis maintains the erection until removed after sex. Some men find the lack of blood flow to be uncomfortable.

Penile implants restore your ability to have erections mechanically. There are different types of penile implants, including malleable silicone rods and inflatable devices that are inserted surgically.

Some urologists feel that regaining spontaneous erectile function is aided by using some of these treatment options as soon as possible after surgery. This is called penile rehabilitation. Evidence as to its efficacy remains limited.

After surgery, there is no ejaculation of semen even though the sensation of orgasm should still be pleasurable. This ''dry'' orgasm occurs because the glands that make the fluid for semen, the seminal vesicles are removed during the prostatectomy. For some men, orgasm becomes less intense or goes away completely after surgery. Less often, men report painful orgasms.

Radical prostatectomy also cuts the vas deferens, which carry sperm from the testicles meaning men can no longer conceive naturally. Usually, this is not an issue, as men with prostate cancer tend to be older. But younger patients may wish to consider "banking" their sperm before the operation.

Another possible effect of surgery is a small decrease in overall penile length, which occurs due removal of the portion of the urethra that passes through the prostate.
 

If you’re suffering from prostate cancer, erectile dysfunction or any other urological condition, it is recommended you speak with a specialist such as Mr Neil Haldar . Make sure you’re in the best of hands and book an appointment today via his Top Doctors profile.