Prostatectomy is the surgical removal of the prostate gland, the seminal vesicles, and surrounding tissue and lymph nodes. Surgery may be done using an incision between the scrotum and the anus called a perineal prostatectomy, with an abdominal incision called a retropubic approach or laproscopically using several small incisions and a camera. The surgeon may also use a robot to assist in laproscopic procedures. Complications can occur with any surgery method, according to the American Urological Association.
Urinary Incontinence
Surgery may result in an inability to control the flow of urin,e resulting in a condition called urinary incontinence, according to the American Cancer Society. Leakage and dribbling of urine may also occur. Incontinence may go away over weeks or months, but may also continue indefinitely. Stress incontinence means that urine leaks with coughing, laughing, sneezing or exercising and is the most common type of incontinence after surgery. Urge incontinence requires a sudden trip to the bathroom and happens when the bladder is too sensitive as it fills with urine. If the bladder can not be emptied completely, overflow incontinence can occur. It is caused by scar tissue or the growth of cancer and results in a weak urine stream. In rare cases, continuous incontinence occurs and pads or condom catheters may be required to capture leaking urine. Doctors cannot predict who will have incontinence after surgery, but the surgeon’s skill may improve the chance that incontinence will not occur long term.
Impotence
Erectile dysfunction or impotence means that a man is unable to get an erection sufficient for sexual relations. With prostate surgery, the nerves involved in getting an erection may be damaged or removed depending at the site of the tumor. It may take several years before sexual function returns, and in some cases, impotence may be permanent. Taking medications or other treatments such as penile implants may restore sexual function. Some men do not become impotent as a result of surgery, but will not have an ejaculation of semen. The glands that make semen and the pathways used by sperm are often removed or cut during prostate surgery.
Sterility and Penis Length
Prostate surgery cuts the channel between the testicles where sperm is produced and the urethra where urine and sperm leave the body. When the sperm is unable to leave the body by natural means, a man can no longer father a child unless sperm has been stored prior to the surgery. Younger men may want to discuss sperm banking with their doctor prior to surgery. According to the American Cancer Society, it is possible that the length of the penis could decrease after surgery.
Lymphedema
Lymph nodes around the prostate are removed as part of the surgical procedure to be sure the cancer has not spread outside the gland. The lymph nodes are connected to each other and move lymph fluid around the body. If this flow is interrupted by removing a lymph node, fluid may collect in the legs or genital region causing pain and swelling. This condition is known as lymphedema and physical therapy treatment may manage the treatment, but will not cure it.
General Surgical Risks
Complications from prostate surgery are similar to any major surgery and include risks from anesthesia, as well as the possibility of infection, stroke, and blood clots in the legs that may break loose and go to the lungs. Bleeding during and after surgery may occur. Doctors will discuss all surgical risks prior to surgery.
