Problems after prostate cancer surgery

There is a risk of problems or complications after any operation. Many problems are minor but some complications can be more serious. Treating them as soon as possible is important.

Possible problems after prostate cancer surgery include difficulty getting an erection and leaking urine. 

General risks after an operation

After any major operation there is a risk of:

• infection
• blood clots
• bleeding
• chest and breathing problems

Infection

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You will have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection.

These include:

• a high temperature

• shivering

• feeling hot and cold

• feeling generally unwell

• cough

• feeling sick

• swelling or redness around your wound and your wound might feel hot

• a strong smell or liquid oozing from your wound

• loss of appetite

Rarely for an infection in your wound, you may need another operation.

Blood clots

Blood clots are also called a deep vein thrombosis or DVT. They are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs. This causes a blockage called a pulmonary embolism. Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. And to move around as much as possible. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. They will make sure you are comfortable doing them. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Once you are home, you should spend as much time as possible out of bed. For example, you can go for frequent, gentle short walks.

Bleeding

There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. 

The treatment you need depends on what is causing the bleeding and how much blood you lose. You might need a blood transfusion. Rarely, you might need another operation. 

Bruising after surgery is very common. This might be around your wounds. Or on the sides of your body (flanks), groin or scrotum . If you have a lot of bruising or it spreads, tell your healthcare team.

Chest and breathing problems

Chest infections, including pneumonia, can be serious. 

You can lower your risk by:

• stopping smoking before your operation
• getting up and moving as soon as possible after your operation
• doing any breathing exercises your physiotherapist teaches you

If you get an infection, you have antibiotics to treat it. 

Problems after prostate cancer surgery

Difficulty getting an erection

Radical prostatectomy often affects the nerves you need to get an erection. Almost all men have problems getting an erection after surgery. This is called impotence or erectile dysfunction. Erectile dysfunction may recover over time for some men. But for others, it may be permanent.

Nerve sparing surgery can improve your chance of recovering erections. Nerve sparing surgery means that your surgeon removes the cancer without removing the nerves. But not everyone is suitable for this type of surgery. If your cancer is growing close to the nerves, they will have to remove them. Speak to your doctor before you have surgery to get an idea of your chance of recovering erections afterwards.

Some men will be able to get erections again after surgery. But this can take time and some men will need help to get an erection for the rest of their lives. There are medicines that can help with erection problems after surgery. You might need a drug like tadalafil or sildenafil (Viagra) to help you get an erection. Your doctor or specialist nurse can also refer you to a clinic for people who have sexual problems after treatment.

Leaking urine

You are likely to have problems controlling your bladder after a radical prostatectomy. Being unable to control when you pee and leaking urine is called incontinence. You might also need to pass urine more often than usual, and it might be harder to hold it in. Ask your surgeon how likely it is that you might have these problems and how long it may take to recover. Leaking urine usually improves with time. But a few men may never get back full control.

There are things that can help you manage this. Your doctor or nurse will teach you muscle exercises to control your bladder. These are called pelvic floor muscle exercises. You should practice these exercises before your operation. And then carry on with them after your catheter comes out. Your team might also advise you to avoid caffeinated drinks, such as tea and coffee. These can make your bladder more sensitive.

Your doctor can refer you to a special clinic if leakage becomes a problem. If your bladder control does not recover with time, further surgery may help.

Ejaculation problems

After a radical prostatectomy, you no longer ejaculate semen. This is because the prostate makes most of the fluid in semen. Your testicles continue to make sperm cells but they are reabsorbed back into your body. This means you are still able to have an orgasm, but this is a dry orgasm with no ejaculation.

Some men say that a dry orgasm feels normal. But others find them less intense and pleasurable. The loss of a visible ejaculation can also be significant for some people.

Having children

After your operation, you will not be able to get someone pregnant by sexual intercourse. If you want to have children in the future, your doctor might suggest collecting sperm before surgery. They freeze the sperm and store it until you decide you want to use it for fertility treatment to have a baby. This is sperm banking.

Damage to your bowel or back passage

Very rarely, surgery might cause damage to the lower part of your bowel or rectum. You might need a temporary colostomy while your bowel heals. 

Difficulty passing urine

A few men find it difficult to pass urine after surgery. This is called urine retention. This can be because of scarring or swelling around the opening of the bladder or the urethra .

You might need a small operation to help with this.