Prostatectomy

Prostatectomy means removing the prostate, and it covers two quite different operations. In one, the inner part of the gland that surrounds the urine channel is cut away from the inside, through the penis, leaving the outer shell in place. In the other, the whole gland is removed along with the seminal vesicles and the bladder is then joined directly to the urethra.

Which of these you are having changes everything about the day, the recovery and the after-effects, so establish it at the consultation. Your surgeon will tell you plainly which one is planned and why.

Removing the whole gland can be done through a cut in the lower abdomen, through several small cuts with a laparoscope, or robotically, where the surgeon operates the instruments from a console beside you. The robot is not doing the operation and the surgeon is. What the approach changes is blood loss and the size of the wounds; the work done inside is the same.

This is an Inpatient operation under general anaesthetic, so you are fully asleep throughout and remember nothing of it. You come in on the morning of surgery or the night before, having not eaten since midnight.

An operation done from the inside through the urine channel takes about an hour. Removing the whole gland takes two to four hours, and the anaesthetist will also place a drip and often a tube in your back for pain relief.

Everybody wakes with a catheter draining the bladder, and this is the part patients are least prepared for. After an internal resection it usually comes out within two days, once the urine has cleared. After removal of the whole gland it stays in for one to two weeks while the join between bladder and urethra heals, and you go home with it and return to have it removed.

Expect one to three nights in hospital, a drain in the wound for a day or so after open surgery, and to be walked to the end of the ward the day after your operation.

Plan for four to six weeks off any physical work, and two to three weeks off desk work. Walking is encouraged from day one and is the single best thing you can do for your recovery; lifting anything heavy waits six weeks. Most people drive again at three to four weeks, once an emergency stop would not be agony and the catheter is out.

After the catheter is removed, leakage of urine is usual and it is not permanent for most men. It improves over weeks to months, is worst on standing, coughing and lifting, and improves faster if you do the pelvic floor exercises the physiotherapist teaches you. Start them before the operation if you are given the chance.

Urine stays blood-tinged on and off for several weeks and a small bleed at two to three weeks, as the internal scab separates, is expected. Drink enough water that your urine is pale.

You will be seen at about six weeks, and follow-up after removal of the whole gland continues with regular blood tests for years.