Urological Cancer Surgery

Urological cancer surgery covers three quite different operations on three different organs, and which one applies changes almost everything about the day and the recovery.

Kidney surgery removes either the affected part of the kidney, keeping the rest, or the whole kidney. Partial removal is preferred wherever it is technically possible, because kidney function preserved now matters for decades. One healthy kidney is enough to live a normal life.

Prostate surgery removes the whole prostate along with the seminal vesicles, and joins the bladder directly to the urethra. The nerves controlling erections run in a sheet on either side of the prostate and, where disease allows, your surgeon will work to preserve them. Bladder surgery ranges from removing a growth from the bladder lining through a telescope passed up the urethra, with no cut at all, to removing the whole bladder and building a new route for urine from a segment of intestine, either to a bag on the abdomen or as a new internal reservoir.

Most of these are now done by keyhole or with a robot, which reduces blood loss and shortens the stay. Your surgeon will tell you which operation is planned, which route, and what is being preserved.

You are admitted the day before or on the morning of surgery, with a bowel preparation where intestine will be used.

All of these are done under a general anaesthetic except the telescopic bladder procedure, which is sometimes done under a spinal. A partial kidney removal or a prostate removal takes two to four hours; removing the bladder and reconstructing urinary drainage takes five to eight.

A catheter is placed to drain urine and this is the part most people underestimate. After prostate removal it stays for one to two weeks to let the new join heal and goes home with you; a nurse will show you how to manage it. You wake on the ward or, after major reconstruction, in a high-dependency bed. Telescopic bladder surgery means a night in hospital; kidney and prostate surgery means one to three; removal of the bladder means seven to fourteen, and a stoma nurse sees you before and after.

After keyhole kidney or prostate surgery expect two to four weeks before you feel well and four to six weeks before full activity. After bladder removal and reconstruction, expect three months.

Start pelvic floor exercises before prostate surgery, not after. They are the single thing that most shortens the period of leaking urine afterwards, and doing them correctly matters more than doing them often, so be taught by a physiotherapist. Leaking is expected once the catheter comes out. Most men improve steadily over three to six months and a majority are dry or need only a light pad by a year.

No heavy lifting for six weeks after any of these. Driving at two to four weeks depending on the operation, and not at all while a catheter is in place. Desk work at three to six weeks. Drink well and watch for any burning or fever. After kidney surgery your kidney function is checked at intervals and blood pressure is monitored, since a single kidney does the work of two. The laboratory report comes back in one to two weeks and determines what follows.