Prostatectomy

Prostatectomy is a potentially life saving surgery for the treatment of prostate cancer. Unfortunately, the nature of the surgery means that many men are likely to experience side effects post operatively. The main issues that will be encountered are urinary leakage and erectile dysfunction.

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Symptoms

Bladder/urinary leakage:

Most men cannot control their bladder properly in the early days following their surgery, this is because the surgery can damage the muscles and nerves that control urination. Symptoms vary greatly, for instance you may just leak a few drops, or you may leak on a sudden movement, a cough or a sneeze. This is known as stress urinary incontinence (SUI). Some people experience a sudden need to visit the toilet or they may need the toilet more often than usual. This would be referred to as an over active bladder (OAB)or an irritable bladder.
A small proportion of patients will continue to leak more substantially and this will be managed by your urology team or continence advisor.
Our experience tells us that leakage usually reduces with time and the rate of improvement varies vastly. Evidence also tells us that starting the Pelvic Floor Exercises pre operatively can help reduce symptoms in the early post-operative phase.

Erectile Dysfunction

Following surgery most men have difficulty achieving an erection. For many men this is a major issue and health professionals involved in your care are well aware of this. There are medical strategies in place to help you improve or maximise erection if you wish

Treatments

Pelvic floor physiotherapy;

A specialist physiotherapist can help you regain strength in your pelvic floor post operatively.
You will be taught how to strengthen the pelvic floor muscles generally, but also specifically, to the area in the pelvic floor which is most affected by the surgery. If the muscles can be strengthened and then maintained by a commitment to regular exercise those people are likely to have the best outcomes. In addition to bladder control, there is evidence that pelvic floor exercises can help with erectile dysfunction.
As well as exercises, your specialist Pelvic Health Physiotherapist will also be able to give advice on bladder training, return to work and hobbies, penile rehabilitation (this is essentially keeping the blood flow to the penis healthy while we wait for nerves to recover), and general advice to help get the best out of every day.

References

POGP booklet: Pelvic Floor Muscle Exercises (for men)
https://www.bbuk.org.uk/adults/adults-resources/
https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/
https://www.ageuk.org.uk/globalassets/age-uk/documents/information-guides/ageukig15_bladder_bowel.inf.pdf
https://www.continence.org.au/pages/men.html
https://www.nafc.org/mens-conditions
Anderson CA, Omar M, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence
Prostate UK
Prostate Scotland
Joanne E. Milios, Timothy R. Ackland, Daniel J. Green,
Pelvic Floor Muscle Training and Erectile Dysfunction in Radical Prostatectomy: A Randomized Controlled Trial Investigating a Non-Invasive Addition to Penile Rehabilitation
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