Prostate surgery, continence and sexuality: what do you need to know?

Soon you will undergo total radical prostatectomy surgery, which involves removal of the entire prostate. In the vast majority of cases, men undergo this surgery due to the development of a malignant tumor of the prostate (cancer). The surgeon removes the prostate and with it the elements of the smooth sphincter it contains, the urethra that passes through and the seminal vesicles. Continuity of the urinary system is restored by suturing the bladder to the urethra. When you wake up, you will be wearing a urinary catheter. It is put there so the bladder can rest and to allow the suture between the bladder and the urethra to heal well. The nurse will usually remove this catheter 10 days after surgery.

After surgery

When the nurse removes the urinary catheter, it is NORMAL that you will have some urine leaks initially, especially when changing position or through effort (coughing, blowing your nose, getting up from a chair…). It is therefore a good idea to prepare yourself with urinary pads when you go for your appointment to remove the catheter, and also for the next few days. These leaks are temporary and will reverse themselves within 6 weeks about 80% of the time. 90% of patients will be completely continent 4 months after surgery.

Any intervention at prostate level modifies sexuality. You will have discussed this beforehand with your surgeon. Where possible, without taking risks with the cancer, the surgeon will preserve the vessels and nerves that come into contact with the prostate and then feed and control the erectile bodies. Many patients retain their abilities and can have quality sexual relations. It can take between 3 or 4 months and 1 year before the satisfactory return of sexual function.

How can physiotherapy help you?

Pelvic-perineal physiotherapy treatment in patients who undergo prostatectomy generally reduces the intensity of leakage on removal of the urinary catheter, reduces the duration and intensity of leakage during the recovery period, and allows a faster return to an active life, including sexual relations. In addition, prompt post-op care is important: patients seen less than 3 months later are more likely to regain continence than those who wait before starting treatment.

Prior to surgery, the goal of the first physiotherapy session will, in addition to checking the risk factors for any possible pelvic dysfunction present, is to teach you to develop the voluntary musculature (striated sphincter) in order to replace the automatic musculature (smooth sphincter) as much as possible.

Following surgery, you will need to continue your exercises. At 6 weeks and then 4 months after your operation it is advisable to see the physiotherapist to ensure optimal function of your pelvic muscles. If problems persist, more regular monitoring could be considered.

Patience and perseverance will be your allies in the coming months.Remember that in the vast majority of cases, you will notice a gradual improvement during the first year, and the vast majority of patients regain excellent urinary continence and can return to their occupations, just as they were before!

Document inspiré de : Enseignement pré-opératoire pour l’opéré de prostatectomie radicale totale, clinique pelvi-périnéologie du CHUS, Sherbrooke.
Rajkowska-Labon E et coll (2014) Clinical study: Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery, BioMed Research International, Article ID 785263, 9 pages