All operations can have complications such as deep vein thrombosis (blood clots), infection, heart attack, stroke, pneumonia, bleeding and ileus (bowel not functioning after surgery). Specific complications for robotic prostatectomy include impotence, incontinence, rectal injury and strictures. There is also a risk of conversion to an open operation as a result of anatomical problems or technical issues.

Incontinence

Following the robotic prostatectomy surgery, you will have a catheter in your bladder for a week. Most men have difficulty with urinary control initially after the catheter has been removed and will require a pad that fits inside the underwear for a period of time. You should bring adult urinary pads with you the day the catheter is removed.

You will notice that during the night, when you are lying down and the effect of gravity on the urine in your bladder is less, your control will be better than when you are up and about during the day.

You will likely have more leakage with straining, coughing, or reaching down to lift something (stress incontinence). This can be particularly so if the bladder is full, if you become tired at the end of the day or drink alcohol. The degree of urinary control varies greatly but most men will have achieved reasonably good control within one to three months and require minimal protection, if any at all.

The recovery of continence is sometimes slower, but rarely more than three to six months. Around 1% of patients may still have incontinence at 12 to 18 months. The chance of recovering urinary control depends on your age, whether the nerves were preserved, and whether you develop a rare stricture (or narrowing) at the anastomosis (where the bladder is sewn to the urethra).

If problems persist, something can be done. Although rarely needed, placement of a male urethral sling or rarely an artificial urinary sphincter will almost always restore satisfactory control. Some success has also been achieved with injections of collagen beneath the sphincter.

The operation removed your prostate and bladder neck, the secondary (internal) sphincter muscle responsible for holding in the urine. Now the primary (or external) sphincter muscle has to provide continence. This muscle can by trained and strengthened by performing pelvic floor exercises, which can result in improved continence and earlier return of continence.

It is ideal that you learn the exercises and start doing them before the procedure in order to strengthen the pelvic floor muscles prior to surgery. You will meet with Mr Peter Dornan, our physiotherapist, prior to surgery who will teach you how to do pelvic floor exercises.

Once the catheter comes out, these exercises can and should then resume. These exercises can be done for many months and certainly until full continence is achieved. Should you experience pain or an ache below the scrotum when you do these exercises, it is best to stop and recommence a day or two later.

Pelvic Floor Exercises

Pelvic surgery and or radiotherapy can impact on continence. Pelvic floor exercise can reduce the leakage experienced and hasten return to continence however; it is not solely responsible for urinary control. An exercise program should ideally be commenced prior to surgical intervention.

The pelvic floor is a layer of muscles that play an important role in bladder, bowel and sexual function. They also provide support to the pelvic organs, the back and abdomen.

It is important that these exercises are performed correctly in order to be effective in promoting continence. Before you start an exercise program, assess if you are isolating and contracting the correct muscle. When the pelvic floor contracts you should feel a gentle lift, up internally, whilst breathing normally.

Technique Tests

• When urinating attempt to stop the flow mid stream by gently pulling internally - your legs, tummy and bottom should remain relaxed.
• Sit on your hand, with your palm under your perineum and fingers toward your bottom, gently squeeze and lift away from your hand. Your legs, tummy and bottom should remain relaxed.
• Stand in front of a mirror, feet shoulder width apart, shoulders relaxed, knees soft and hands on your hips. Gently squeeze and lift internally – watch your tummy it should remain soft and relaxed with no movement.

These are tests to facilitate your understanding of the correct technique. It is important that you do not perform your entire exercise program when urinating.

If you are having difficulties performing the correct muscle contraction, discuss with Dr Swindle who may refer you to a specialist physiotherapist for Biofeedback therapy.

Strength and endurance are essential for pelvic floor function. Each individual person has different levels of strength and endurance and therefore no single exercise program will work for everyone, however please use this program as a guide. In order to improve muscle function, progress the program every week by increasing the sets, reps, holds or decreasing the rest interval. If you are having difficulty with any aspect of the exercise program, discuss it with Dr Swindle and he may refer you to a specialised physiotherapist for an individualised pelvic floor exercise program.

You should aim to complete your exercises 3-6 times per day. Attempt to do them whilst completing daily activities for example at red lights, when doing the washing up, during commercial breaks on television.

Set your rest period between repetitions of 10-30 seconds. A “hold” requires sustained contractions of 90% effort and “pulses” require quick short gentle contractions of 60-80% effort.

Body position impacts on how hard the pelvic floor muscle has to work to contract. When you start these exercises you will find them easier in lying and side lying as the affects of gravity and the abdominal contents pushing weight on to your pelvic floor is lessened. Work towards performing your exercises in an upright position.

The Knack

Part of the function of the pelvic floor is to assist the sphincter muscle to prevent leakage of urine during activity. It is important to not just strengthen this muscle but practice using it for the purpose it was intended.

Every day activities such as coughing, laughing, sneezing, bending, running or standing up, increase pressure in the abdomen. This can increase pressure in the bladder pushing a small amount of urine into the urethra leading to an episode of incontinence. Contracting the pelvic floor before these activities can prevent leakage. This pre-emptive pelvic floor contraction is often referred to in literature as "The Knack".

To practice "The Knack" you need to contract your pelvic floor before you laugh, cough, stand etc. When learning any new skill, practice and repetition is required and eventually it will become automatic.
Sit comfortably on a chair with your knees apart and your feet flat on the floor. Lean forward and rest your forearms on your thighs.

Begin by drawing up in the back passage as though you are trying to stop yourself passing wind. Draw up around the front passage as if you are trying to stop yourself passing urine.

Try holding while you count to 2, and then as your muscles become stronger, you can increase the count to 10. Relax the pelvic floor.

Repeat the above for 5 sets, 3 or 4 times a day, remembering to;

• continue breathing normally
• not push or bear down as if you were trying to pass wind
• trying not to tighten your stomach, buttock or thigh muscles
• not pull your knees together

and finally…

Remember everyone is different; try to avoid comparisons with your peers. Other factors that have been shown in literature to promote continence, are maintaining a healthy weight, maintaining an active life style and avoidance of constipation. Age is also a factor with younger men regaining their continence earlier than older men following surgery.

Read about more Potential Complications