When undergoing the surgical procedure to determine what happens after the prostate is removed, you’ll be placed under anesthesia. At this time, your skilled surgeon will opt for either several meticulous small incisions or a single more significant incision in the lower abdominal region to meticulously remove your prostate gland. Following this removal, a notable change will be the cessation of semen or ejaculate production from the prostate, marking an irreversible alteration in your body’s functionality. However, with modern medical advancements and the assistance of urinary health supplements, many of the side effects stemming from this change can be effectively managed and mitigated.
Anesthesia
Before an operation, you’ll be given both a sedative and general anesthetic in either injection form or tablets, usually both combined together. The anesthetic enters your bloodstream via small capillaries in the lungs and acts on certain centers in your brain to induce unconsciousness. A breathing tube may be inserted into your throat for assistance while connected to a machine which controls breathing during the procedure.
At surgery, an upside-down U-shaped incision will be created in your perineum to accommodate an upside-down U-shaped incision that aims to avoid disturbing nerve bundles that control your prostate gland and seminal vesicles (pouche-like glands located either side of your prostate that secrete semen and promote sperm movement). After this procedure has taken place, any abnormal-appearing tissue as well as your prostate are removed as well as some or all lymph nodes draining your prostate; the amount removed will depend upon its severity.
Following surgery, you’ll be taken to a recovery room where health care providers will monitor and treat any discomfort. They may prescribe painkillers; follow their instructions regarding dosage and schedule before you can leave hospital, typically by noon the day after.
Incisions
An incision (incision) will be made in your lower abdomen to access the prostate gland and surrounding tissue. When performing laparoscopic prostatectomy, surgeons make two to four small incisions in your belly that will allow them to insert a thin rod with video camera at one end (laparoscope) into one incision and use other incisions for surgical tools insertion.
If your cancer is limited in scope, a surgeon may only need to remove the prostate gland itself; otherwise more tissue may need to be taken. Furthermore, pelvic lymph node dissection may also be performed if there’s a chance they contain cancer cells.
As with any surgery, there may be potential side effects such as urinary incontinence and erectile dysfunction (ED), although their treatment depends on whether or not nerve bundles regulating erections were preserved during surgery – if nerve bundles were cut during operation, ED won’t improve over time.
In some instances, your doctor may also recommend surgery to remove the vas deferens, the pathways between testicles (where sperm are produced) and urethra (through which sperm leave your body during sexual encounter), which can reduce fertility as it interferes with sperm production and causes low or no semen in ejaculate. It’s essential that any potential infertility issues with your doctor before proceeding with such procedure.
Drains
Your doctor may leave an additional tube in place after your surgical procedure to drain fluids that accumulate. Typically this tube will be removed when you leave hospital; be careful not to disconnect, puncture or kink it! Keeping tabs on its output and milking the tube periodically are key components of proper care – should it stop draining, contact your physician immediately!
Surgeons may choose between active or passive drainage. Active drains use a plastic bulb resembling a miniature grenade to fill with fluid throughout the day, and must be emptied at least twice or three times every day to remain effective. Passive drains employ gravity; usually being small tubes such as penroses that create passage from wounds into open air spaces (2).
Common side effects of prostate removal may include urinary tract infections, incontinence and erectile dysfunction. Your doctor can treat these problems by administering pelvic floor exercises and bladder training to strengthen pelvic muscles and increase bladder control as well as medications to ease symptoms. Furthermore, prostate specific antigen (PSA) testing will monitor for any recurrences of cancer or evaluate treatment efficacy.
Recovery
As part of your recovery period after open or robotic prostatectomy surgery, nurses will change and clean your wounds regularly while also giving painkillers to take home with instructions about when and how often they should take them. You should typically remain in hospital for one or two days after open or robotic prostatectomy surgery before leaving; for simple prostatectomy or TURP procedures however a catheter will remain for several days until removed by your nurse at home.
Urinary incontinence usually resolves within several weeks of surgery. You may also experience temporary difficulty controlling your urine (urinary incontinence). This should resolve itself over time. You may become impotent even with nerve-sparing surgery due to loss of two tiny bundles of nerves controlling erectile function and sensations (the two tiny nerve bundles control impotence); your surgeon will strive not to damage them during their procedure but cancer sometimes grows into or close to them and needs cutting out; typically these nerves recover within six months to one year, though treatments such as medicines or implants can provide assistance.
