The most common complications of prostate surgery are urinary incontinence and erectile dysfunction. For otherwise healthy men with cancer confined to the prostate gland, a radical prostatectomy, or removal of the entire prostate, seminal vesicles and surrounding tissues, may be curative. Abdominal surgery to remove the prostate is rarely done for benign prostatic hyperplasia. For most men with serious prostate enlargement and severe lower urinary tract symptoms that do not respond to medication, transurethral resection of the prostate, or TURP, may provide years of relief. Both procedures are invasive and have risks of complications.
Urinary Incontinence
Depending on the procedure, an indwelling catheter may be needed for a few days to several weeks following surgery. According to an August 2010 New York Times article on prostate cancer, leaking urine for days after the catheter is removed is common, and regaining full control may take up to 18 months. Some men continue to have urine leakage when lifting or during sexual activity. Others may have to urinate more often, or have a sudden and strong urge, with large volume accidents as a result of not getting to the bathroom in time. Symptoms of incontinence that persist may respond to treatment with medications or surgery. The New York Times reported, in a related article on enlarged prostate, that some men are left with urinary incontinence following the TURP procedure and that 5 to 10 percent develop urinary tract infections.
Erectile Dysfunction
The degree of erectile dysfunction, or ED, generally depends on the extent of operative nerve damage. In radical prostatectomy for cancer, the location, size and proximity of tumors to nerves may be a determining factor. The New York Times advises one or two years may be needed for sexual recovery after prostate surgery, and that men who are sexually active and in a committed relationship before surgery generally have the best outcomes. The risk of ED is higher for radical prostatectomy than for TURP, although both procedures can result in retrograde ejaculation, or dry ejaculation, either because semen goes into the bladder or because the seminal vesicles were removed. Results of The Prostate Outcomes Study published in the January 2000 "Journal of the American Medical Association" found that of 1,291 subjects aged 39 to 79 who underwent radical prostatectomy, more than 40 men still had complaints of sexual dysfunction 18 months after surgery.
Bleeding
Other risks inherent in surgery are complications of anesthesia, infection and blood loss. The February 2009 "British Journal of Urology International" published a study conducted in Greece of 995 men over seven years who underwent radical prostatectomy. The goal of the study was to classify short- and long-term complications. Fifty-three subjects experienced blood loss that required a transfusion. The New York Times reports that 4 percent of men who have a TURP procedure also experience this complication.
References
- The New York Times: Prostate Cancer
- The New York Times: Enlarged Prostate
- "JAMA": Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study
- "BJU International": Short- and long-term complications of open radical prostatectomy according to the Clavien classification system
