From the Guidelines
Total radical prostatectomy can cause several significant side effects, including urinary incontinence and erectile dysfunction, which affect 15-30% and 30-70% of patients, respectively, with recovery of sexual function taking up to 2 years. The most common side effects of radical prostatectomy include:
- Urinary incontinence, which typically improves within 6-12 months but may persist longer in some cases
- Erectile dysfunction, which affects 30-70% of patients, depending on age, pre-surgical function, and whether nerve-sparing techniques were used
- Other potential side effects include penile shortening (by about 1-2 cm), dry orgasm (no ejaculate) due to removal of the prostate and seminal vesicles, and infertility
- Some patients may experience bladder neck contracture, causing urinary obstruction symptoms
- Less common complications include deep vein thrombosis, pulmonary embolism, infection, and bleeding requiring transfusion
- Rare but serious complications include rectal injury, lymphedema if lymph nodes were removed, and inguinal hernia According to the most recent study 1, patients should discuss these potential side effects thoroughly with their urologist before surgery and understand that rehabilitation programs, including pelvic floor exercises for incontinence and medications like sildenafil (50-100mg as needed) or tadalafil (5mg daily) for erectile dysfunction, can significantly improve outcomes. Additionally, early penile rehabilitation after prostate cancer surgery may improve sexual function outcomes and prevent end-organ penile damage due to neurovascular injury and fibrosis, as suggested by 1. It is essential to consider the patient's age, preoperative erectile function, and the degree of preservation of the cavernous nerves when assessing the risk of erectile dysfunction, as noted in 1 and 1.
From the Research
Side Effects of Radical Prostatectomy
The side effects of radical prostatectomy, which is the removal of the prostate gland, can be significant and varied. Some of the common side effects include:
- Urinary incontinence: This can range from mild to severe and can be temporary or permanent 2, 3, 4, 5.
- Erectile dysfunction: This is a common side effect of radical prostatectomy, with studies suggesting that up to 59.9% of men may experience impotence after surgery 3, 4.
- Orgasm-associated incontinence (OAI) and urinary incontinence in relation to sexual stimulation (UISS): These are common side effects, experienced by 20-93% of patients after surgery 3.
- Altered perception of orgasm: Approximately 80% of patients may experience alterations in orgasmic function after radical prostatectomy 3.
- Orgasm-associated pain (OAP): This is experienced by a subset of patients, with reported rates varying between 3% and 19% 3.
- Penile shortening (PS): This occurs in 15-68% of patients after radical prostatectomy 3.
- Psychological stress: This can be a significant side effect, particularly in relation to sexual function and urinary incontinence 6.
Factors Influencing Side Effects
Several factors can influence the likelihood and severity of side effects after radical prostatectomy, including:
- Age: Older men may be more likely to experience urinary incontinence and erectile dysfunction 4.
- Race: Black men may be more likely to experience erectile dysfunction after surgery 4.
- Nerve-sparing techniques: These can help to preserve erectile function and reduce the risk of urinary incontinence 3, 4.
- Preoperative counseling: This can help to prepare patients for the potential side effects of surgery and improve outcomes 6.
- Pelvic floor muscle therapy: This can help to improve urinary continence and erectile function after surgery 2, 6.