What I should expect after a prostatectomy – Recovery

“Having nerve-sparing surgery has helped me to feel that I’ve put the experience of surgery behind me and that I am able to move on.”
Dr Richard Commander, prostate cancer patient

Patients often ask what should they expect after a prostatectomy – how long will recovery take and how long should they wait before undertaking certain activities. This guide has been written by Birmingham Prostate Clinic to help answer common questions and concerns.

It is important to emphasise that every patient is different and your recovery will be influenced by individual factors, such as your overall health, the time it takes you to recover continence and your activity levels before surgery.

What can I expect immediately after surgery?

You will come round in an intensive care or high dependency unit. A prostatectomy is a major operation and although laparoscopic (keyhole) techniques significantly reduce the impact of surgery, it is still necessary to monitor you closely after your operation. You will have a drip fitted and receive fluids intravenously until you are able to start drinking adequately, which is usually about 24 hours after surgery. You normally spend one night in intensive or high dependency care before being moved to a general surgical ward.

Good pain management medication means patients often experience little pain or discomfort. You will be encouraged to get up and become mobile as soon as you are able to do so. The nursing staff will keep a record of how much fluid you are drinking because it is important to stay hydrated and pass urine regularly after a prostatectomy. In the first few days after surgery, you are likely to have a little blood in your urine.

Traditionally, patients are fitted with a urethral catheter which is worn for seven to 14 days, which means going home with the catheter in place. It is fitted to enable patients to pass urine while the join between the bladder and the urethra heals. However, consultant urologist Mr Alan Doherty at Birmingham Prostate Clinic pioneered the introduction of early removal of the catheter.

We aim to remove the catheter on day two after surgery. This is possible because of the high quality of the anastomosis achieved during laparoscopic surgery. The anastomosis is the reconnection, or join, between the bladder and urethra made after removing the bladder during a prostatectomy. This means that two-thirds of patients are able to pass urine normally once the catheter is removed and are able to go home from hospital catheter-free.

The traditional rationale for leaving the catheter in for 7–14 days was that if a patient is not able to pass urine normally, it would then be difficult to re-fit the catheter. The quality of the anastomosis and the minimally invasive nature of laparoscopic surgery means re-fitting the catheter, if necessary, is no longer a serious challenge: listen to patient David Lehane’s account of leaving hospital without a catheter.

Will I need continence pads?

During the first few weeks after a prostatectomy, almost all patients experience some urinary incontinence. This is because removing the prostate disturbs the area between the bladder and urethra, which carries urine out of the body. During surgery, the bladder is pulled down to join the urethra and in so doing, restoring continuity. The bladder neck muscle (internal sphincter) is sometimes also weakened during surgery. We recommend that you buy continence pads before surgery and bring them into hospital with you. They can be purchased in high street pharmacies.

At the Birmingham Prostate Clinic, we specialise in nerve-sparing laparoscopic surgery which significantly reduces the impact upon the bladder. This means that many patients are dry within weeks of surgery. However, we recommend that all patients buy male incontinence pads before surgery and bring them into hospital when they come in for surgery. The results of our study of nerve-sparing prostate surgery show 82 per cent of men no longer need pads three months after surgery and this figure increases to 92 per cent six months after surgery. For the small number of men who have longer term continence problems or require further support, we can refer you to your local continence service.

When can I leave hospital and go home?

Patients normally spend three nights in hospital after a laparoscopic prostatectomy. If you have had open surgery, you may spend a little longer in hospital, perhaps five or six days. Before you go home, hospital staff will check that you are able to walk around for short distances, ensure that any pain or discomfort is well controlled with medication, your bowels are functioning and you are passing urine. If you are wearing a catheter, they will ensure you know how to use and manage it and if you are not, you will be given a supply of pads and given continence advice.