What to Expect After Radical Prostatectomy

Surgery to remove the prostate lasts from 1.5 to 4 hours. After the prostate and other structures are removed, your surgeon reattaches the remaining urethra to your bladder. While you’re still sleeping, your doctor will place a small tube for draining urine, called a catheter, in your penis. It will stay in place for a few weeks.

Usually, you’ll be in the hospital for about 3 days. You may have to stay away from work for up to 5 weeks. Here’s an overview of how you might feel after surgery.

• For the first few days, you’re likely to have pain from the cuts, called the incisions. Your pain can be controlled with medicine. You may have an epidural catheter inserted into your lower back so that it’s easier to give you pain medication. Or you may have a patient-controlled analgesia pump. This is an intravenous form of pain medication that you control by pressing a button. The pump is removed before you leave the hospital. Talk with your doctor or nurse about your options for pain relief. Some people are hesitant to take pain medication, but doing so can actually help your healing. If you don’t control pain well, for example, you may not want to cough or turn over often, which you need to do as you recover from surgery.

• You may have a small drain in your lower abdomen. This will likely be removed before you leave the hospital.

• You’ll leave the hospital with a urinary catheter, called a Foley catheter, in place. Your urine will drain through this catheter into a bag. You’ll have it for 2 to 4 weeks. When your catheter is removed, you’ll be taught Kegel exercises. These are pelvic muscle-strengthening exercises that help you control urination. Most men regain full control of their urination within 1 month after the catheter is removed.

• You may not be able to control your bladder. This condition is called incontinence. Usually it only lasts a few weeks. However, some men have some level of incontinence years after their surgery.

• You may feel tired or weak for a while. The amount of time it takes to recover from an operation is different for each person.

• For the first 3 to 12 months after your surgery, you may not be able to have an erection. This condition is called erectile dysfunction. The younger you are, the more likely you are to recover from this side effect. You can also ask your doctor about medications or treatments that may help.

• You may have constipation from using narcotic painkillers, from not moving much, or from not eating much. Talk with your doctor or nurse about how to keep your bowels moving.

You’ll also need follow-up care after surgery. Four to 6 weeks after your surgery, your doctor will check your PSA level. It should decrease to an undetectable level within a month or so after the surgery if no prostate cancer cells are present. If your PSA remains undetectable for a year, your urologist may order PSA testing every 6 months for another year, and then yearly tests after that.

Keep in mind that after a radical prostatectomy, you may still have an orgasm, but it will be dry. That is, you won’t have any ejaculate fluid. That’s because the sources of the fluid—the prostate and seminal vesicles—have been removed and the vas deferens has been tied off.