Side Effects

The side-effects of a radical prostatectomy include the short-term usual operative or postoperative risks: heart or lung problems, clots, blood loss, infections, bowel injury, and post-operative wound discomfort.  In modern surgical practice in Australian hospitals these are not commonly serious problems.

In the long term the bladder control returns in most men, and all of the immediate post-operative problems fade.  Lower urinary tract symptoms (LUTS) are often improved after radical prostatectomy in men where an enlarged prostate has caused urinary tract obstruction.

Urinary continence can be affected by radical prostatectomy and have a significant impact on quality of life (QOL).  In expert surgical hands the rate of urinary incontinence is minimal: 1-2% might have severe incontinence requiring pads and further surgical treatment to try to fix.  5-10% of men might have mild stress incontinence during physical exertion, usually not requiring surgical treatment but may need a pad for tennis, golf, jogging.  90-99% will experience no incontinence and won’t need pads.

Impotence occurs in most men after a radical prostatectomy.  Male sexual function after radical prostatectomy depends on both physical and psychological recovery.  Physical recovery of erectile function is linked to preservation of the Neurovascular bundles (NVB) (in which the nerves of erection are located adjacent to the prostate).  Nerve sparing radical prostatectomy is a technique used to preserve the NVBs during surgery, and improve the potency and QOL for men after surgery.

Positive predictors for preservation of erectile function are: younger age and potency at time of radical prostatectomy and preservation of both NVBs during surgery.  Potency after radical prostatectomy may take 12 months to fully recover and require treatment with “PDE–5 inhibitors” such as Viagra, Cialis, or Levitra .

Penile shortening is reported by some men after radical prostatectomy, and is believed due to retraction of the penis under the pubic bone.

Ejaculation is not possible after radical prostatectomy as the ejaculatory glands (prostate and seminal vesicles) have been removed.  Hence infertility is also present for the same reason.  Sexual orgasm is usually normal after surgery, despite the absence of ejaculatory, and can even occur without an erection.

Testosterone levels are normal after radical prostatectomy, as the sex hormone testosterone is produced by the testicles and continues to be produced.  Sexual libido is usually temporarily affected, and is related more to the psychological impact of surgery on general well-being and sexual function.

Surgical experience and technique accounts for the best outcome after radical prostatectomy.  Centres of excellence performing high numbers of radical prostatectomy using best practice surgical and nursing techniques have the best outcomes in terms of patient long term cancer survival and quality of life.

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