Life after Radical Prostatectomy

You aren’t the first and won’t be the last. There are many here that have had the surgery. I am sure they will answer any questions you have. My best wishes for a successful outcome.
Jack

Yes, it is depressing. I found that keeping my spirits up before and after surgery was key — positive thinking! Physically, don’t do what I did after RP and overdo it. I ended up with a nasty hernia. I feared long term incontinence but I was pleasantly surprised that I was fine after a couple of months. Physical therapy and kegels helped in that regard. Wishing you the best during this difficult and stressful time….

Well, here's what my surgeon told me before the fact--and he proved to be correct.

For ED, give yourself an honest assessment of where you are today, at 65. Not where you think you are, just 18 with gray hair (or no hair). On a 1-10 scale, with 10 being you at 18, where are you? Subtract 1 step. That is most likely where you will be after surgery.

For incontinence, same thing.

This assumes good, nerve-sparing surgery. If they 'cut wide', or have to cut one or both nerves, all bets are off. Get a scrip for viagra or cialis, and start taking it after the catheter is removed. It will help with pelvic blood supply..which is overall good for healing.

Otherwise, follow the instructions, especially the one that says no lifting over 15 pounds for a while.

My surgery was 12 years ago. I got myself into really good physical condition prior to the surgery, mostly through quick-paced walking for two or three miles per day. I didn't have much pain afterwards and recovered continence in a couple of weeks. I was 65 at the time of surgery, and sex had become significantly less important than when we were younger, so even though I was surprised to find myself no longer able, it really wasn't a big deal. True, I'd still like to have actual sex one more time before I die, but we have found ways to have an active sex life without intercourse, so again, no big deal.
I played 18 holes of golf six weeks after the surgery.
I was 200 pounds on the day of surgery, down from 220 when diagnosed. I'm now 170 and feeling very good, better than I ever expected to feel at 76.
All this from a surgeon who had done only about 50 DaVinci procedures prior to mine (but he was known around here as an excellent surgeon, and had done many prostatectomies of the "open" variety).
Like any medical procedure, outcomes differ from person to person. I just like to point out that surgery can work out quite well.
Good luck to you, whatever you decide. It's good to have options.

True words spoken here. RALP is not going to improve existing incontinence or ED. For me I had the artificial urinary sphincter installed to solve that part of the problem. As for the ED issue, there are a variety of work arounds including getting a new hobby. (I started expanding my collection or 1960s-1970s audio equipment and bought a sport touring motorcycle.)

As mentioned, getting oneself in shape before surgery is really a good idea. I’m a distance runner and the recovery went fine. The only hitch was the anastomosis (new connection between the urethra and bladder) took a bit longer to heal up and I was passing clots and blood for a few months longer than expected.

Thank you for the comments! They really help when I’m trying to stay positive.

Another question to ask your surgeon: "What are your personal stats related to ED and Continence on cases similar to mine?" Most surgeons will share their patient responses.

I guess the bottom line is that reasonable expectations are key. The actual SE outcome stats are notoriously difficult to get a handle on. A forum like this tends to be skewed towards those who have poor outcomes, because the men who had the surgery and moved on, tend to move on from here as well.

Sexual issues post surgery, IMO, tend to be magnified--everyone can point to 'THAT GUY" who had a disaster of an outcome, and then say that because of that, it's never a good idea. It's also kind of like the old joke about the guy who was having hand surgery and asked his doc if he'd be able to play the violin after surgery. When the doc said, sure, not problem...the patient said, "great! I never could before...."

My advice, again:

Pre surgery:
Learn how to do kegals, and do them. Several times a day.
If you need to lose a few pounds, do it. Get is shape if you can.
Have a lot of sex.
Eat healthy
Quit smoking

Post surgery:
Walk, walk, walk some more
Drink LOTs of water
Pay attention when they tell you how to deal with the catheter
Don't do heavy lifting for a while
Take naps
Get a scrip for viagra or cialis, and start taking it once the catheter is out (I expect a night erection wouldn't feel good at all with a catheter in place)

Hang in there. We're here.

Thanks to Cwrkr for posting this question, and thanks to those who have replied. My RALP is scheduled for mid-May (but I'm still working through the process of exploring radiation options). Leaning heavily towards RALP but keeping an open mind. The responses in this thread have been very helpful in answering some of my underlying worries as well. Already starting my kegels and am walking about 4 - 5 miles a day. I had a catheter a few months ago for a TURP and dealing with that thing was the worst part of the entire process -- it's like a dog that won't let go of your ankle. Hard to get a good night's sleep and if it tugs a little it hurts. Dr. said that because of my TURP surgery I'll need to keep the catheter in for about two weeks post-RALP.

Here's a question: they say that getting in frequent walks is important after RP. How do you do much of that with the catheter installed? Best I could do after my TURP was get up and gently walk around the room in circles.

Had an RP of the "open" kind April 24/2013 so almost 9 years ago. Was in very good shape before the operation which I am sure helps in your recovery. Went for a walk pushing the iv trolley with my wife around the hospital halls morning after surgery and almost passed out. Was discharged that after noon and next day started walking. We are blessed with thousands of acres of parkland just behind our property and because the snow had just left, I was able to walk each day doing more hills all of the time. After a month, got on the bike and rode for 6 weeks in preparation for a 2 month self contained cycle tour through the Alps and Dolimites in Europe. Had still some dripping before we left in Early July so took some pads along but threw them away as I did not need them. Sex life came back to a new normal even though there was some nerve damage with help from Cialis and a few other kinky techniques.

For many years before the surgery, every five minutes I had to pee for five minutes. After surgery, like a racehorse. One thing that has probably been mentioned is the more negative physical issues you have (obesity, type 2 diabetes, cardiovascular, smoker, etc,) the longer it is going to take you to get back to your pre surgery normal, so if you can, try to reverse some of your ill gotten, poor lifestyle choices that were established long before the surgery. Your post surgery body will thank you.

Dave

I had urinary issues before treatment. That factored into to my choice for RP. Following RP it was great that I could pee like a garden hose and sleep through the night again. Later, after RT I was back to slower flow and getting up 3 or 4 times per night. My RO explained it as a loss of bladder elasticity due to the RT.

This is one of about a half-dozen "little" details my doctors "forgot" to discuss prior to treatment.

I was 72 when I had surgery, and I would do same again, if I had to. No major issues afterward, other than the surgeon left a tumor on my prostate cavity wall.

Less than a year later I had SRT, and the side effects from radiation have been most annoying and never ending. While some urologists are very fast to recommend surgery, many radiologist are quick to recommend radiation, with little discussion about the long last impact of possible side effects and ADT damage.

There are no silver bullets, and anecdotal stories by self anointed patients should be taken for what they are worth. Very little, IMHO. Good luck my brothers, and do some in-depth medical research yourselves, not depending on one off stories from people you don't even know.

Cwkr: Are you a generally lucky guy? Because guys who do well after prostate surgeries do at least as well as guys who have other forms of treatment. Being in generally good shape before surgery improves your odds but you still have to be lucky to recover continence or erectile function quickly. For most guys it takes time. More or less two thirds will be dry after three months and nine out of ten are continent after a year. Doing your Kegel exercises as instructed can help and physical therapy to make sure you are doing them right also helps but that is already baked into the nine out of ten figure. That unlucky tenth guy will need to talk to his surgeon about other options. Recovery of erectile function has a similar but slightly different progression. Again, the luckiest guys (generally also the youngest and healthiest) will be back in action quickly but that is unusual. More typical is for recovery (when it happens at all) to take six months to up to two years, and the problem often gets worse during the first few months before it starts to get better. The way you improve your odds with erectile function is, again, to follow your surgeon's instructions carefully and to push him (or her) for other alternatives if whatever you are doing doesn't seem to be working. There's not much that can be done to hurry the recovery of the erectile nerves -- they will recover when (and if) they recover. But it is important to keep your erectile tissues in good shape while you wait. A normal man gets several erections a night while he sleeps; this helps keep the tissues oxygenated and keeps things stretched out. Damaged erectile nerves can prevent nocturnal erections causing the tissues to shrink and atrophy. It is important to do whatever you can to get some sort of erections on a regular basis while you wait for the nerves to heal. Your pump will help get some blood into the tissues even if the nerves don't work at all. Pills will help if the nerves are working but not working very well. If the pills don't work the next thing is injections, and if none of this works there are surgical implants... they almost always work.
The takeaway from this is that surgery frequently has bothersome side effects but they can usually be overcome by patient effort.
As for getting ready for surgery the most important thing is to make sure you can see the television from your recliner. You won't be moving any furniture when you come home.
AZRoadRunner: I think someone mentioned a leg bag somewhere above. It is a catheter bag that straps to your leg so you can get out and about. It won't let you run a marathon but you can walk around the block, or go grocery shopping, or catch a movie. I wore mine on my inner thigh just above my left knee. If you wear 'convertable' hiking pants -- with zippers to take off the legs to make shorts -- the zipper lets you get at the drain on the bottom of the bag so you can pee standing up, as God intended.
You mentioned that you are still looking into radiation. Keep doing that homework. Radiation therapy has been getting impressive results lately and seems to offer a better story with side effects.