Recovery after radical prostatectomy

The first few days

• Discharge home between 24 and 48 hours after surgery when done robotically.
• Pain mild to moderate, controlled with oral analgesics. The gas used during surgery, felt in the shoulders, usually bothers people more than the incisions.
• You go home with a catheter, removed between the seventh and fourteenth day. It is the most uncomfortable part of the process and the shortest-lived.
• Walk from day one. This is not generic advice: it reduces the risk of thrombosis and speeds bowel recovery.
• No straining, lifting or driving until the catheter is out.

The real timeline

This is the part most often dressed up, and the one where having no reference points causes most anxiety. The percentages vary between series and depend on age, previous function and whether the nerves were spared, but the order of magnitude is this:

Continence, and how to speed it up

Removing the prostate removes one of the two mechanisms that hold urine back, leaving only the external sphincter, the one you do control. Regaining continence is largely a matter of training that muscle.

• Start the exercises before your operation. Several weeks of prior practice improve subsequent recovery. It is the only part of the result you can work on in advance.
• Technique matters more than quantity: it means contracting the muscle you use to stop the stream, without clenching buttocks or abdomen or holding your breath.
• Short sets, several times a day, every day. Consistency beats intensity.
• Avoid constipation: repeated straining works against you.
• If at twelve months leakage still affects your life, surgical solutions exist —a sling or an artificial sphincter— with very good results. It is not the end of the road.

Erectile function

It depends on three things, and only one is negotiable in theatre: whether the neurovascular bundles were spared, your function before surgery and your age. Where the tumour forces their removal, sparing them would have compromised cancer control, and that hierarchy is not up for debate.

• Rehabilitation begins early, as soon as the catheter is out: regular low-dose medication, a vacuum device or injections, as appropriate. The idea is to keep the tissue oxygenated while the nerve recovers.
• Recovery is gradual and uneven: night-time erections appear before induced ones, and partial erections before full ones.
• If after two years recovery is insufficient, a penile prosthesis remains available, and it is the treatment with the highest satisfaction rate in all of urology.

What almost nobody warns you about

• Orgasm will be dry. There is no ejaculate because the prostate and seminal vesicles were removed. The sensation remains; the fluid does not.
• There may be urine leakage during orgasm in the first months. It is common, improves with time, and is almost never mentioned beforehand.
• A sense of penile shortening. It is usual in the first months and generally improves; rehabilitation helps.
• Permanent infertility. If you intend to have children, sperm must be banked before surgery.
• Transient urinary symptoms after catheter removal: urgency, frequency, burning. They settle within weeks.

PSA after surgery

With no prostate, the PSA should become undetectable within the first weeks. That is the target and the parameter for follow-up.

• The first measurement is usually taken between six and twelve weeks, and periodically thereafter.
• A PSA that begins to rise is called biochemical recurrence. It does not mean metastasis: it means active prostatic tissue remains and has to be located.
• Salvage treatment with radiotherapy exists, with good results when given in good time. That is why follow-up matters as much as the surgery.

When to call without waiting for your appointment

• Fever above 38 degrees.
• Pain or swelling in one leg, or difficulty breathing.
• Fluid leaking from an incision, or spreading redness.
• Inability to pass urine after the catheter is removed.
• Severe abdominal pain, persistent vomiting or no passage of wind.

Recovery is decided in theatre

Why it matters who looks after you

Everything you have just read about timescales and percentages depends on decisions already made on the day of surgery, and on follow-up that begins the day after.

• Sparing when it is possible and not when it is notSparing the bundles improves erections; sparing them when the tumour is close compromises cancer control. That decision is made inside theatre and admits no middle ground.
• Reconstructing the join wellHow the bladder neck is reconstructed and the urethra supported influences how quickly continence returns. It shows in no scar.
• Starting rehabilitation early and sustaining itPelvic floor before surgery and erectile rehabilitation from catheter removal. It requires follow-up that does not end at the one-month review.
• Watching the PSA and acting in good timeA biochemical recurrence caught early is salvaged with radiotherapy and good results. Caught late, it changes the picture entirely.

Put clearly: the operation lasts three hours and the recovery lasts two years. It is worth having whoever operated on you still there for the two years.

A urologic oncologist is a urologist who additionally completed a postgraduate fellowship devoted solely to urological cancer. Mine was at Centro Médico Nacional Siglo XXI, accredited by UNAM. It can be verified. What exactly changes →