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Potential side effects of a radical prostatectomy

This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor.

A radical prostatectomy is one of the most common surgical approaches to treating prostate cancer in men. This option for treatment removes all or part of the prostate gland and is commonly chosen when the cancer is believed to be confined to just the prostate. As with all options, there is a level of risk associated with a prostatectomy. There are also a number of potential side effects that can range from mild to severe.

Risks

The primary risk of a radical prostatectomy, as with any other major surgery, is of a complication during the operation. Issues that may occur during or immediately following the procedure include infection or bleeding at surgery site, reaction to anesthesia, blood clots in legs or lungs and damage to nearby organs. The American Cancer Society (ACS) also reported on the rare instance of intestinal damage during the surgery. Accidentally injuring part of the intestine is more likely to occur during laparoscopic or robotic surgeries, than with the open approach. Injury to this organ may result in infection in the abdomen and in some cases require a second surgery to remedy.

Each case is unique and factors contributing to the level of risk include the stage and grade of the cancer, the age and overall health of the patient and the level of expertise by the surgeon.

The most common side effects

Among patients who opt for the surgical approach to treating prostate cancer, there are two major side effects to be aware of. The inability to control urine, urinary incontinence, and trouble getting and keeping an erection, erectile dysfunction (ED) are the most common complications that can occur post-op.

ED can be one of the most distressing side effects of a prostatectomy.

1. Erectile dysfunction
Running along the sides of the prostate are two small bundles of nerves, responsible for controlling erections and blood flow to the penis, according to the Urology Care Foundation (UCF). Due to their proximity to the prostate gland, there is the potential for damage to occur during the procedure, thus hindering a patient’s ability to maintain an erection. If a man’s ability to do so is fully intact prior to the surgery, a nerve-sparing approach is followed and the surgeon will do his best to avoid damaging the nerves. In some cases, if the cancer has spread very close to these nerves, they may need to be removed altogether.

The rate of risk for ED depends on a number of factors. The younger the patient, the more likely he is to be able to maintain control of his erection following surgery, according to the ACS. When both nerves are removed, the likelihood of immediate function is very low. If just one nerve bundle is removed or damaged, there is slightly less risk of ED and if neither nerve bundles are injured or cut, it’s likely that the patient will regain the ability to have normal erections after the operation. Also known as impotence, erectile dysfunction may take anywhere from several months to two years after the procedure to go away.

Treatment options: According to the ACS, some doctors advise penile rehabilitation for patients experiencing ED. This method of treatment follows the belief that encouraging men to get an erection as soon after recovery as possible will help to regain potency. Several drugs known to help with erections include Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). However, these drugs will not work if both nerve bundles were removed and, several side effects may occur.

Another option is alprostadil, a man-created version of the substance naturally made in the body that can produce erections called prostaglandin E1. Several minutes before sexual intercourse, it can be seamlessly injected into the tip of the penis, according to the ACS. Penile implants and vacuum devices are additional options that may help to remedy ED.

2. Urinary incontinence
The Prostate Cancer Foundation (PCF) reported that urinary incontinence – the leakage of or the inability to control the flow of urine – is the main urinary side effect experienced by patients who undergo a prostatectomy. Though 30 to 50 percent of men with normal baseline function will report an increase in urinary incontinence after the surgery, this is generally reduced when the nerve-sparing method is used. After six months, about one-fourth of men report regular leakage and a need to use absorbent pads, according to the source. However, three years after treatment, less than 10 percent of men report the need to use pads.

“Less than 10% of patients require pads 3 years post-surgery.”

There are different levels of incontinence that exist. Most common following a prostatectomy is stress incontinence, the urine leakage or dribbling that can occur from coughing, laughing, sneezing or exercising, according to the UCF. This is typically caused by an issue with the the bladder sphincter, the valve that controls urine flow. Men who experience overflow incontinence have difficulty producing a powerful stream and emptying the bladder completely. An overly sensitive bladder causing frequent need to use the bathroom even when the bladder is not full can also occur. This is known as urge incontinence, or an overactive bladder. According to the ACS it is very rare for men to experience continuous incontinence, the complete loss of control of urinating.

Treatment options: By several weeks or months after surgery, most men will slowly regain total control of their bladder. However, the effects can still take a toll physically, as well as socially and emotionally. The good news is that there are treatment options.

Many doctors will first suggest kegel exercises to help regain strength of the bladder muscles that may have been lost during the surgery. Though pads are an option for staying comfortable, they are often not a patient’s first choice. According to Harvard Prostate Knowledge, improving continence relies on not just the strength, but proper action of the pelvic floor muscles and repeating these exercises multiple times, several times a day can help regain control. Catheters that collect urine and compression devices that prevent urine from coming out may be used. Sometimes, men will opt for surgery if they are experiencing long-term incontinence. Surgical options include artificial sphincters, bulking agents or bulbourethral sling surgery, according to Harvard Prostate Knowledge. The best option depends on the individual’s circumstance and is best decided upon with a doctor.

Additional side effects

Most men will regain adequate continence and control of erections following surgery.Most men will regain adequate continence and control of erections following surgery.

Patients who undergo a prostatectomy are also at risk for developing Peyronie’s disease, which causes the penis to curve, reported the UCF. Scarring from ED treatment injections in the same spot over and over are one cause of Peyronie’s disease, but it can also occur from the buckling of the penis during intercourse if there is not a strong enough erection. Though an orgasm is still possible – and pleasurable – after the procedure, it will be dry. There will be no ejaculation because most of the semen-producing glands will have been cut during the surgery. Occasionally, orgasms become less enjoyable or fade away completely, according to the ACS.

A loss of fertility will also occur after surgery because the vas deferens, the roadways that deliver the sperm to the urethra, will have been cut during the prostatectomy. Though sperm is still produced, it will not be able to leave the body during ejaculation. For men who are concerned about fertility, they should speak to their doctor about banking their sperm prior to undergoing the surgery.

Each of the risk factors and side effects can be daunting to understand and manage, and many complications may be difficult or embarrassing to talk about. However, the best way to find the solution is through open and honest discussion with a trusted doctor and care team.

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