If you have been diagnosed with prostate cancer, your doctor may recommend having a prostatectomy. This procedure is often life-saving, but can come with some adverse effects after surgery. It is important to be aware of these ahead of time, and take steps prior to surgery to minimize them. In this blog, we will outline different types of surgery, and the most common adverse effects post-op. We will also discuss how physical therapy can help minimize or eliminate some of these issues. It is important to note that often, you will end up needing to request a referral for physical therapy from your doctor, as many physicians are still not aware that these services are available. If you are able to see a physical therapist prior to surgery as well as post-op, you will most likely have a better surgical outcome.
There are several different surgical approaches to removing the prostate. This will be determined by your surgeon and yourself. The purpose of this blog is for general information only.
- Removal of the entire prostate gland, seminal vesicles, may include removal of the internal urethral sphincter.
- The bladder is surgically reconnected to the urethra
- Surgical outcomes linked with the surgeon’s level of experience with this technique
- Technique that has been used historically
- Incision made in the perineum
- There is a greater chance of rectal injury with this approach
- This approach is considered to be the “gold standard”
- Minimally invasive, less blood loss
- Big learning curve for surgeons
- Allows for 2-D visualization
Robotic Assisted or “DaVinci”:
- With experienced surgeon, allows for more precision
- Allows for better visualization
- Shorter hospital stay
- Less urinary irritation/obstruction
- Outcomes depend on surgeon’s level of experience with this technique
Common adverse effects of prostatectomy
There are the most commonly experienced issues for men following prostatectomy, but not all men experience these issues. It is somewhat dependent on the surgical approach used, as more conservative approaches that allow for nerve sparing generally result in fewer adverse effects. As a general rule, the more extensive a surgery the more chance of complications. Most often, men will experience urinary incontinence, urethral stricture, erectile dysfunction, and emotional distress following prostatectomy. Sometimes these issues will resolve themselves with normal tissue healing time (8-12 weeks), but often they persist and become extremely distressing to many men.
How can physical therapy help?
For men, the prostate is a very important part of their continence mechanism. After it is removed, the pelvic floor muscles have to act “overtime” to help compensate. Most (but certainly not all!) men have never heard of pelvic floor or “Kegel” exercises, and do not know how to identify and contract their pelvic floor muscles. Pelvic health physical therapists are specially trained to help people learn how to use their pelvic floor muscles, and will teach you exercises to help strengthen these muscles. This helps reduce or eliminate urinary incontinence. The pelvic floor muscles also play a role in sexual function for both men and women. In men, the pelvic floor muscles assist in maintaining an erection. Learning to do pelvic floor exercises correctly can help address sexual dysfunction following prostatectomy. The therapist may use something called biofeedback, which involves placing small surface sensors (similar to those used during an EKG) externally on the pelvic floor muscles. These connect to a computer with special software that interprets the electrical activity generated by the muscles. Biofeedback does NOT provide information about muscle strength, this can only be assessed with an internal manual muscle test. Generally, internal exams are only performed when necessary and other less invasive options have failed. You have the right to refuse any test or treatment that you are not comfortable with. (This applies to all healthcare, not just physical therapy). Biofeedback is a very useful tool, as it allows people to see their performance visually, instead of trying to guess based on feeling.
Seeing a physical therapist prior to surgery to start learning these exercises ahead of time can help reduce the impact of post surgical adverse effects, and reduce your recovery time. Your therapist is also a valuable resource for education, as we are able to spend a lot of time with you and answer your questions.
Written by Genevieve Tatara DPT- Pelvic Floor Therapist at our Lewes Delaware Location