Acute and long-term complications – what's the difference?
Prostatectomy can be a life-saving operation, but like most surgeries it can be associated with complications. These are useful to classify into two major groups: acute (occurring in the days–weeks after surgery) and long-term (which may persist months–years later).
Key point
The two most common long-term complications are urinary incontinence and erectile dysfunction. Both have several evidence-based treatment options available — and in many cases you can actively support recovery at home with appropriate devices.
Acute (short-term) complications of prostatectomy and their management
These typically appear in the days or weeks after surgery and are generally manageable.
| Acute complication | What it means | Treatment |
|---|---|---|
| Bleeding | Significant blood loss during or after surgery, which rarely may require blood transfusion. | Close monitoring, blood transfusion if necessary. |
| Infection | A urinary tract infection or wound infection may develop. | Antibiotics, careful wound care. |
| Urinary retention | Temporary difficulty urinating due to postoperative swelling. | Urethral catheterization for the duration of healing. |
| Blood clot formation (deep vein thrombosis, pulmonary embolism) | The risk of clot formation is increased around the time of surgery and clots can reach the lungs. | Anticoagulants, early mobilization. |
| Suture failure | The bladder–urethra suture may not heal properly, causing urine leakage. | Extended catheter use, medical follow-up. |
| Pain and swelling | Postoperative pelvic pain and swelling can persist for weeks. | Pain relief (NSAIDs, stronger analgesics if needed). |
Long-term complications of prostate surgery
Complications that can appear months or even years after surgery — their effects are often more persistent and their treatment may be prolonged.
Decreased ability to hold urine due to damage to the muscles and nerves that control the bladder and urethra. It is one of the most common long-term consequences of prostatectomy and often improves over time with targeted training.
Permanent erection problems may occur because of damage to the cavernous nerves that control erection. Nerve regeneration can take months–years, and early active rehabilitation can help significantly during this time.
Pathological scarring at the surgical site can narrow the urethra, causing difficulty urinating. Urological follow-up and interventions when needed can resolve this.
Some patients report persistent lower pelvic pain after surgery, which is managed individually (analgesics, physiotherapy).
Rarely, dysfunction of the nearby rectum can occur, leading to problems with bowel movements.
Removal of the prostate and seminal vesicles eliminates ejaculation and therefore natural fertility. This should be discussed with your treating physician before surgery (e.g., sperm banking options).
Treatment of urinary incontinence
Urinary control problems are common after prostatectomy, but there are several research-backed treatment methods:
Pelvic floor strengthening exercises (Kegel exercises). Strengthening the pelvic floor muscles helps with urine retention. Effect is achieved with regular, persistent training: several times daily, at least 10–15 minutes per session — noticeable improvement often takes 5–6 months. Systematic reviews indicate that pelvic floor training can speed up the return of continence.2,3
Functional muscle stimulation. A modern adjunct: the effect of Kegel exercises can be supported by electrical muscle stimulation, which may shorten the time needed to achieve benefit. Meta-analyses suggest that adding pelvic floor devices can favorably influence post-surgical incontinence symptoms.4 Click here to find suitable devices →
For the period until continence returns, a simple device — the Prosecca belt — can discreetly help prevent involuntary dribbling of urine.
Treatment of erectile dysfunction
Erectile dysfunction is one of the most common long-term consequences of prostate surgery, and there are several solutions — from medications to mechanical devices.
Vacuum erection device. A mechanical device that creates a vacuum around the penis; as a result blood flows into the penis, helping produce an erection, which is then maintained by a constriction ring placed at the base of the penis. It is a non-invasive, drug-free method considered safe and can help many men.5
Penile rehabilitation. A specific device has been designed for erectile rehabilitation after prostate surgery: the Rehabi PVT vacuum penis trainer, developed specifically for post-surgical penile training. You can read about the scientific background, protocol parameters and correct use in the detailed article linked below.
When should you see a doctor urgently?
Certain symptoms during postoperative recovery require urgent medical evaluation. Always consult your treating physician before using home devices (pelvic floor stimulation, vacuum devices) — especially in the following situations:
- Fever, severe pain or purulent wound discharge — may indicate infection
- Sudden leg swelling, chest pain or shortness of breath — may indicate a blood clot and requires urgent care
- Planned vacuum device use while on anticoagulant therapy — only after medical consultation
- Complete urinary retention or heavy blood in the urine — urgent urological assessment needed
Home devices are adjuncts to treatment
Pelvic floor stimulators and vacuum devices are adjuncts to medical rehabilitation and do not replace specialist care and regular follow-ups. Always start use in agreement with your treating physician.
Frequently asked questions
For most men, urinary control gradually improves over months, especially with regular pelvic floor training. Systematic reviews indicate that pelvic floor muscle training can speed up the return of continence.2,3 The pace of improvement varies individually — discuss the treatment plan with your urologist.
Meta-analyses indicate that pelvic floor devices — including electrical stimulation — as an adjunct to training can favorably influence post-surgical stress incontinence symptoms.4 The specific device and protocol should be chosen with a specialist.
Early, active rehabilitation is important, but the exact start time should always be determined by your treating urologist — typically in the weeks after surgery, after catheter removal. You can read details in the rehabilitation article below.
Not necessarily. Nerve regeneration can take months–years, and rehabilitation during this period can help preserve tissue condition. Prognosis depends on nerve-sparing technique and individual healing — discuss this with your urologist.
Summary
Prostatectomy can be a life-saving operation but may be associated with significant short- and long-term complications. Urinary incontinence and erectile dysfunction are the most common long-term problems — both have several evidence-based treatment options, and you can actively support improvement with home devices in agreement with your treating physician.
Sources
- European Association of Urology. EAU Guidelines on Prostate Cancer. uroweb.org
- MacDonald R, Fink HA, Huckabay C, et al. (2007). Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Int. 100(1):76–81. PubMed: 17433028
- Yang JM, Ye H, Long Y, et al. (2023). Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy: An umbrella review of meta-analysis and systematic review. Clin Rehabil. 37(4):494–515. PubMed: 36305082
- Sacomori C, et al. (2023). The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: A systematic review with meta-analysis. PMC10538711
- Yuan J, Hoang AN, Romero CA, et al. (2010). Vacuum therapy in erectile dysfunction—science and clinical evidence. Int J Impot Res. 22(4):211–219. PubMed: 20410903
