Dr. Adam Stuart Kibel discusses the potential risks and side effects of prostate cancer surgery, with a focus on erectile dysfunction and urinary incontinence. He explains how age, physical fitness, and surgical techniques can influence recovery, emphasizing that most patients regain urinary control over time.
The first side effect of surgery is obviously the general risk of surgery. Things like infection, heart attack, stroke, death, injury to other organs, things like that. Leaks where you sew things together. All those things are positive, possible, excuse me. Any surgeon who says, "I never have any complications," you should just stay away from, because they're not telling you the truth.
Most patients do extremely well though for most of these side effects and complications. Mortality death from the surgery is extremely low. Because, as I outlined, if you're not a healthy patient, you shouldn't be operated on. Not because of the risk of surgery, but because you're probably not going to benefit from the surgery.
With the better and better techniques, things like clots in the legs and pulmonary embolus, that's where a clot breaks free and ends up in your lungs, potentially a lethal event, we take a lot of steps to prevent that from happening. Giving people very low doses of blood thinners, getting up and walking them around very early.
The big ones that people focus on are not the boring ones the general risks of surgery, they're impotence and incontinence. It depends a little bit on the patient. Some patients are extremely sexually active, well into their 70s. Other people are in their 50s are saying, "Look, I'm not really that interested in sex anymore." I often say I live in the real world, not in a Tom Cruise movie, and everybody is different and you need to recognize that.
Surgery is not good for erections. There's really no way to get around it. For people who have low risk disease, we can spare the nerves on both sides. And the younger you are, the more likely you are to maintain erections, versus older patient. But whatever happens to you is 100%.
I think everybody takes a little bit of a hit. The nerves don't just go... They're not nerves. They're like a spiderweb of fibers that go not only around the prostate, but through the prostate. And we do everything we can to preserve that spiderweb, but it's delicate and you can get injured. I think incontinence is the bigger problem. I think that's what caused... Before surgery, people are more focused on the impotence piece, but we can take care of the impotence piece. We have a lot of tricks up our sleeves to solve impotence for somebody who's very motivated. But incontinence is much more debilitating, causes many more problems.
I tell all of my patients that 30% of patients are dry when I take the catheter out, meaning 70% leak. And I tell the patient when I'm consenting them, everybody thinks they're going to be in that 30%, but the only 30% of people will be in there. And I know when I call you after surgery, what you're going to be focused on is the incontinence. And it's always the case. They're always worried that it's not going to get better. They don't realize how important it is to be able to urinate well.
By a year, 90%, in good hands, my hands, 90% of patients are dry. 10% of patients will have some stress incontinence. They'll cough, they'll sneeze, they leak a few drops of urine. For most people, that's not very debilitating. For some people it is. And then one to 2% can have life altering incontinence. The risk factors for incontinence are age, older people do worse, how physically fit you are, people that are fit do better, and people that are thinner do better. And I think it makes sense. Holding onto urine is a physical act. Who does physical acts better? People that are young, thin, and fit or old, fat, and unfit? Young, thin, and fit. But that doesn't mean everybody who's a little heavier, or doesn't exercise all the time and is a little long of tooth is going to do poorly, it just means it's a little more likely.