Nerve Sparing
The nerves that control urinary and erectile function are located on either side of the prostate. If these nerves are damaged, then some degree of impotence will result. Incontinence is also more common when nerve sparing is not performed.
Our modern surgical techniques place a great emphasis on “nerve-sparing” – that is, maintaining as many of the nerve bundles as possible. However, sometimes the areas where the nerves are located are cancerous and must be removed so nerve damage is unavoidable.
The chances of long-term incontinence and impotence after surgery depend on a number of factors:
- The progress of the cancer;
- Your age;
- The type of surgical procedure; and
- The skill of your surgeon.
Even so, it is impossible to predict individual results.
It is important to understand and accept that your life may not be the same after prostate surgery as it was before.
Incontinence
Incontinence is the inability to control the flow of urine. Damage to the nerves that control this function, or damage to the external sphincter of the bladder can cause incontinence.
During surgery, the bladder is reattached to the urethra tube and a catheter inserted, held in place with a small balloon. This catheter will stay in place for several weeks, but usually only 7 days after robotic surgery. Following its removal, you will usually suffer from incontinence. The duration of the incontinence will depend on the success of the surgery and the pelvic floor exercises you performed before your operation. Many of my patients regain full bladder control after only a short while. Over 90% of patients have regained control by 3 months after the surgery. In most cases, the majority of function returns within 12 months.
Suffering from incontinence can be embarrassing and you may want to look at some of the products on the market that let you manage accidents. There is some excellent advice on the Continence Foundation of Australia website.
Sex
There is a lot of information on the internet about sex after a prostatectomy, some of good and some of it bad. Some of the personal stories are well worth reading, but remember that they are individual accounts and not necessarily applicable to you.
You should also remember that much of the information relates to surgeries performed before the advent of robotic nerve-sparing techniques.
If you are looking for a good article on more modern surgical results, this post from MedicineNet contains an account of a Cornell University study.
A sexual rehabilitation program is strongly recommended to improve the chance of recovery of sexual function. Regular use of medications called PDE inhibitors such as Viagra, Cialis or Levitra can improve the chance of return of normal spontaneous sexual function.
The bottom line is that how enjoyable your sex life is will depend on you and your partner.