Questions to Ask Before Prostate Surgery
Prostate surgery can mean taking the whole gland out for cancer or opening a channel through an enlarged one with a TURP or a laser, and this list is for a man facing either and for whoever sits in on the appointment with him. It runs in the order the talk with the urologist or surgeon tends to go: the operation and the reasons for it, the surgeon's record and the risks, the catheter and bladder control, sex and fertility, getting ready, and recovery and follow-up. A question that fits only one of the two operations says so in its note, and what applies to you is for your own surgeon to say.
The questions
Each question, and why to ask it
The plan
Which operation are you recommending for me, and what will it be called on the consent form?
Why ask it
Prostate surgery covers two very different jobs: taking out the whole gland for cancer, and clearing part of it so an enlarged prostate stops blocking the flow. Have the full name written down, because what you read at home about catheters, side effects and recovery only helps if it belongs to your operation.
What else could I do instead of surgery, and what makes an operation the better choice for me?
Why ask it
For cancer the other routes are usually radiation and, for some men, monitoring; for an enlarged prostate they are medication or living with it a while longer. The reasons you hear should be drawn from your own grade, gland size, symptoms and age. 'It is what we do here' is a reason about the hospital, so ask what the answer would be if every option were under one roof.
What is this surgery meant to achieve for me, and how will we know it worked?
Why ask it
For cancer the measure is usually the pathology report and the PSA tests that follow. For an enlarged prostate it is the stream, the nights and how well the bladder empties. Find out which applies and when it gets checked, so you are not judging the result by how you feel in the second week.
What happens if I put this off for three or six months?
Why ask it
Some men have room to wait and some do not, and the reason should come from your own results or symptoms. If a delay is safe, ask what would be checked in the meantime and which change would end it.
Will you remove the prostate with a robot, by keyhole surgery or through an open incision, and what does that choice change for me?
Why ask it
This one is for a prostatectomy. Ask what differs in nights in the hospital, blood loss and the first weeks, and also what the surgeon says does not differ. Many will say the surgeon's experience counts for more than the machine, which is your opening for the questions about their own record.
Which procedures for an enlarged prostate do you offer, and which would you choose for a prostate my size?
Why ask it
TURP, laser removal, steam and small implants are the names you may hear, and the size of the gland often narrows the list, so ask for yours in grams or milliliters. If only one or two are done here, ask whether another center offers one that would suit you and what the trade would be in catheter days, sexual side effects and how long the relief lasts.
Is the plan to spare the nerves on both sides, one side or neither, and when will you know for sure?
Why ask it
The intention usually comes from the MRI and the biopsy, and surgeons often make the final call during the operation, once they can see the tissue. Ask to be told afterward what was done on each side, since that is the starting point for every later conversation about erections.
Will you take out lymph nodes as well, and what does that add?
Why ask it
Only for cancer surgery. Whether nodes come out usually follows from the risk group, so ask which of your results decides it. Then ask what it adds in operating time, in risks such as fluid collecting or swelling, and in what the pathology report will be able to say.
How likely is it that I will need radiation or hormone treatment after the operation anyway?
Why ask it
A cancer question, and the answer stays an estimate until the removed prostate has been examined. Ask which findings would lead to more treatment: cancer at the cut edge, growth through the capsule, a positive node, or a PSA that does not fall. If the chance is high, it is fair to ask how that weighs on choosing surgery in the first place.
Is there anything in my scans or my history that makes my operation less straightforward than most?
Why ask it
A very large prostate, a mesh hernia repair, earlier surgery in the abdomen, your weight or previous radiation are the sort of things a surgeon may bring up. The part to listen for is how it changes the plan: a longer operation, a different approach, or a different conversation about risk.
Surgeon and risks
How many of this exact operation have you done, and how many do you do in a typical month?
Why ask it
Name the operation and the approach planned for you, not prostate surgery in general. No single figure settles it, but a surgeon who does it every week tends to say so easily. If the reply stays vague, that is worth knowing before you choose where to have it done.
Leaving aside leaks and erections, what can go wrong, and which of those is more likely with my health?
Why ask it
A consent form gives a long list with no ranking, so have the surgeon put it in order for you. Bleeding, infection, a clot and scar tissue that narrows the urethra or the bladder opening months later are among the ones commonly named, with injury to the bowel as a rare one after a prostatectomy. Mention your heart, weight, diabetes and earlier surgery yourself, so the ranking is for you and not for the average patient.
Do you keep a record of how your own patients are doing a year later, for leaking and for erections?
Why ask it
Published figures usually come from large specialist centers and may not describe the person in front of you. A surgeon who follows their own patients can say how many wear no pads at twelve months and how that was asked. If nobody keeps count, find out whose numbers you are being quoted.
How often does your pathology report show cancer at the edge of what was removed, and what follows when it does?
Why ask it
This is called a positive margin, and it is one of the lines on the report after a prostatectomy. Ask for the surgeon's rate in cancers like yours, and what a positive margin would lead to for you, whether that is closer PSA checks or a talk about radiation.
Will you do the whole operation yourself, and who else will be working on me?
Why ask it
At a teaching hospital a fellow or resident may do some steps under supervision, and how that is arranged is up to the hospital. Ask who is at the controls for the delicate parts around the nerves and the bladder join, and whether the surgeon you have met stays from start to finish.
In the past year, how many of your patients needed a transfusion, a second trip to the operating room or a readmission in the first month?
Why ask it
Three named events are easier to answer than 'what is your complication rate', and harder to wave away. What caused each one, and how it was dealt with, tells you more than the count.
If I wanted another specialist to look at my case first, how long could I take, and would your office send everything?
Why ask it
A number of weeks and a plain yes is the reply to hope for. For cancer the other specialist may be a radiation oncologist and not a second surgeon, since each explains their own treatment best. For an enlarged prostate it could be a urologist who does a procedure this one does not.
Catheter and bladder
How many days will the catheter stay in, and what decides when it comes out?
Why ask it
The figure is very different after a full removal than after a procedure through the urethra, and it varies between surgeons too. Find out whether an X-ray or a trial without the catheter comes first, and whether removal happens at the clinic or with a nurse at home.
Who will teach me to look after the catheter and the bags before I leave?
Why ask it
Ask to do it yourself while a nurse watches: swapping the leg bag for the night bag, emptying, cleaning around the tube and fixing it to your thigh so it cannot tug. If your partner will be helping at three in the morning, they should be standing there too.
What do I do if the catheter stops draining, leaks around the tube or comes out?
Why ask it
Get this one on paper with a phone number that is answered at night. After a prostatectomy many surgeons do not want anyone outside their own team putting a catheter back in, so ask exactly what to say if you end up in an emergency department.
What are bladder spasms, and what should I do if I get them?
Why ask it
A catheter can make the bladder cramp, which may feel like a sudden, strong need to go with the tube still in place. It frightens men who were not told about it. Ask how to tell a spasm from a blockage, whether there is medicine for it, and at what point to call.
What happens at the appointment where the catheter is taken out?
Why ask it
Ask what to bring. Nurses commonly suggest a pad and a spare pair of dark pants, because leaking at first is expected after a prostatectomy. Find out how long you will be kept to check that you can pass urine, and what the plan is if you cannot.
How much leaking should I expect in the first weeks, and when do most of your patients stop needing pads?
Why ask it
Ask for three points in time: one month, three months and a year. Check what this surgeon counts as dry, since a single 'just in case' pad a day gets counted both ways. After a procedure for an enlarged prostate the complaint is more often urgency and frequency while things heal, so ask how long that tends to run.
Can I learn pelvic floor exercises before the operation, and when do I start them again afterward?
Why ask it
Many surgeons want the exercises paused while the catheter is in and picked up once it is out, so get both dates. It is hard to tell on your own whether you are squeezing the right muscles, which is the case for seeing a pelvic floor physical therapist once beforehand. Whether one is available and paid for depends on where you live.
Which pads or guards should I buy, and roughly how many will I get through at the start?
Why ask it
A nurse can usually name the types: a guard shaped for men, a pull-up, a pad for the bed. Start with a small pack of each, because what you need in the first week is rarely what you need in the sixth. Ask as well whether any are supplied or reimbursed under your health system or plan.
If I am still leaking a year from now, what can be done about it?
Why ask it
Hearing the list before the operation makes a slow recovery less frightening. It usually runs from more therapy and medication to a sling or an artificial sphincter. Find out whether this surgeon does the later ones or refers you on, and how many months they would wait before raising it.
After a procedure for an enlarged prostate, how long before I see the full improvement, and will I still need my prostate pills?
Why ask it
Burning and rushing to the bathroom can get worse for a while before the stream gets better, and a man who was not warned assumes the procedure failed. Get the point at which the surgeon judges the result, what happens to your medication, and how often their patients need the procedure repeated years on.
My bladder has been struggling for a long time. Could it stay weak even after the blockage is cleared?
Why ask it
Raise this if you have been in retention, have used a catheter, or have been told you do not empty properly. Surgeons sometimes warn that a bladder which has been overstretched may not fully recover, so ask whether a pressure study beforehand would tell you anything and what the plan would be if you still could not empty.
Sex and fertility
Given how my erections are today, what should I expect at six months, at a year and at two years?
Why ask it
Describe your starting point truthfully, including whether you already use a pill, because the forecast is built on it. Recovery after nerve-sparing surgery is usually described in months and sometimes years, so ask what 'recovered' means in the figures you are given: firm enough unaided, or with medication.
Do you put patients on an erection recovery program, and when would mine start?
Why ask it
Clinics call this penile rehabilitation, and it ranges from a regular pill to a vacuum device to nothing organized at all; surgeons disagree on how much it helps. Find out who runs it and what it costs you, and try to have the first appointment booked before the operation so it does not depend on you raising it in month four.
Will orgasm feel different afterward, and will anything come out?
Why ask it
Surgeons generally explain that there is no semen once the whole prostate is removed, and that after procedures for an enlarged prostate it often passes back into the bladder. Have yours say which applies to your operation, and ask about the things men rarely mention first: a change in sensation, discomfort, or leaking urine at climax.
Which of the enlarged-prostate procedures is most likely to leave ejaculation as it is now?
Why ask it
If this matters to you, say so before the method is picked, because it is one of the main ways the procedures differ. Ask what you would give up in return, such as how much the flow improves or how long the result holds.
We may still want children. What has to happen before the operation?
Why ask it
Say it even if you are undecided, because storing sperm has to be arranged first and a surgeon may assume from your age that it does not apply. Ask where it is done, what it costs and how many days it needs, so it fits before the date.
When is it safe to try for an erection, to have an orgasm and to have sex again?
Why ask it
Those are three questions, and surgeons often give a different timing for each. The limits after a procedure through the urethra are mostly about bleeding, so ask what you should stop for if it happens.
What do partners tell you they wish they had known beforehand?
Why ask it
One for the partner to ask in their own voice. The replies tend to be about the first week at home and about sex some months later, and either one is a natural moment to ask whether the hospital has a counselor or a sexual medicine clinic that sees couples.
Before the day
Do I need a urine test, a heart check or any other clearance before the date?
Why ask it
A urine sample is often checked ahead of prostate procedures, because an infection can push the date back. Ask how many days before it has to be done, who books it, and what happens to your slot if something comes back abnormal.
I take a blood thinner or daily aspirin. What is the plan for it around the operation?
Why ask it
Bleeding is a main worry after prostate procedures, so this needs calendar dates and not 'a few days before'. The surgeon and the doctor who prescribed it can each assume the other is deciding, so ask who sets the stop and restart days. Put fish oil, vitamin E and any herbal products on the list as well.
Do I need a bowel prep, a special wash or a change in what I eat the day before?
Why ask it
Some surgeons ask for an enema or a day of clear fluids and others for nothing at all, which is why men comparing notes get confused. Read your own hospital's instructions a week ahead, early enough to buy whatever they list.
Will I be fully asleep or numbed from the waist down, and is there anything about my eyes, breathing or back you need to know first?
Why ask it
A robotic prostatectomy is commonly done with the table tilted head-down for a long stretch, and procedures through the urethra are sometimes done under a spinal with you awake or lightly sedated. Mention glaucoma, sleep apnea, reflux or back trouble now, and ask whether the anesthesiologist sees you before the morning itself.
How long will I be in the operating room, and who tells my family how it went?
Why ask it
Ask for the stretch from being wheeled in to the first call, because that is what the person in the waiting room lives through. Find out whether the surgeon comes out, phones or sends a message, and leave the right cell number at the desk. Ask too what running past the quoted time usually means, so an extra hour is not spent fearing the worst.
How long will I be in the hospital, and what has to be true before I can go home?
Why ask it
It may be the same day, one night or several, depending on the operation and the hospital. The conditions are more useful than the number: walking, eating, pain that pills can handle, urine clear enough for the nurses. Knowing them tells your ride when to be ready.
What should we have in the house before I come back?
Why ask it
Ask the nurse for an actual shopping list. Apart from pads, it tends to include a waterproof sheet, loose pants with room for a leg bag, a stool softener, a soft cushion and a bucket to stand the night bag in. Buy it the week before, since discharge day is a bad day for errands.
How much help will I need in the first week, and could I manage alone?
Why ask it
Have whoever will be at home with you hear this, or say plainly that nobody will be. A useful reply covers stairs, lifting, the night bag and whether someone has to drive you to have the catheter removed.
Who can tell me what I will have to pay myself, and does a robotic or laser approach change the figure?
Why ask it
Surgeons often do not know the billing side, so get the name of the person who does and ask for the estimate in writing. Whether a robotic operation, the anesthetic, pads and pelvic floor therapy are covered depends on your country and your plan, so ask how each one is handled where you are.
Recovery
What does day five at home look like for most of your patients?
Why ask it
By day five the hospital is behind you and, after a prostatectomy, the catheter often is not, so ask about that day in particular: how far men walk, whether they sleep through with the night bag, what they manage to eat. After a keyhole or robotic operation some also report bloating and an aching shoulder, so ask if that applies. It gives you something to measure your own first week against.
How much blood in my urine is normal afterward, and for how long?
Why ask it
Ask for it by color: pink, red, dark with clots. After procedures through the urethra, surgeons often warn that bleeding can return a week or two later, which is alarming if nobody mentioned it. Find out which shade means drink more and rest, and which means call.
What do you do to prevent blood clots in the legs, and what is my part?
Why ask it
Stockings, leg pumps, injections you give yourself at home and simply walking early and often are the usual tools, and which ones you get depends on the operation and your own risk. If injections are prescribed, ask who teaches you and for how many days. Say out loud if a clot is part of your history, even though it is in your notes.
Which painkillers will I go home with, and what keeps me from straining on the toilet?
Why ask it
Surgeons usually want no straining in the first weeks, and the stronger painkillers work against that, so ask what to take for the bowels starting the day you get home. Check which over-the-counter painkillers they are happy with and which they would rather you left alone while bleeding is a concern.
When can I drive, lift, ride a bike and go back to my kind of work?
Why ask it
Give the job and the activities by name. Ask about cycling separately, because pressure from the saddle is a reason surgeons often give for a longer wait than for other exercise. How sick leave and driving after surgery are handled is up to your employer, your insurer and local rules, so check with each.
Which problems in the first month do you want to hear about the same day?
Why ask it
Read the list out and have each one marked office or emergency department: fever, a catheter that has stopped draining, clots, a swollen calf, chest pain, a wound that leaks, swelling in the scrotum. Save the after-hours number in two phones before the operation.
When will the pathology report be ready, and what will it tell us?
Why ask it
After cancer surgery the report gives the final grade, whether the cancer reached the edge and whether any nodes were involved. Where a procedure for an enlarged prostate removes tissue, that is usually sent to the lab too. Ask who calls you and by what date, and set a day after which you call them.
When is the first PSA test after the operation, and what result are you hoping for?
Why ask it
The target depends on the operation. After the whole prostate is removed, surgeons generally look for a PSA too low to measure, and after surgery for an enlarged prostate they expect it to fall but not to vanish. Write down what yours should be, how often it will be checked and who orders the test.
What is the schedule of visits afterward, and who do I contact in between?
Why ask it
Get them as dates: catheter out, the first check, the PSA or flow test. Then ask for the name of the nurse who takes calls about leaking and erections, because those questions tend to arrive in the second month, when nobody is due to see you.
Using these questions at the pre-op visit
Practical guidance for the conversation itself
Start from the operation you are actually having
Two operations share one name
A radical prostatectomy takes out the whole gland and is done for cancer. A TURP, a laser procedure and the newer steam or implant methods open a channel through an enlarged prostate and leave the rest in place. The catheter, the side effects and the follow-up differ so much that a list for one is half wrong for the other.
Cross out before you go
Go down the page with a pen and strike every question that belongs to the other operation: lymph nodes, margins and nerve sparing if yours is for an enlarged prostate; choice of procedure and prostate pills if yours is for cancer. What is left is short enough to get through.
If both problems are in the picture
Some men have a cancer and an enlarged gland that already slows the stream, or a blocked prostate with a PSA that is being watched. Say so at the start of the visit, because questions from both halves of the page then apply to you, and ask what the planned operation does and does not do for the second problem.
Find out which visit is for what
Many hospitals split this into a consultation with the surgeon and a later pre-op visit with a nurse. Ask at the start which one you are in. The decision questions belong to the surgeon, and the catheter, supplies and instructions for the day usually get a fuller answer from the nurse.
Getting figures you can plan around
Turn 'most men' into a count
'A small risk' and 'most men do well' sound reassuring and are impossible to repeat at home. Ask for it as so many men out of ten, or out of a hundred, with a prostate and a starting point like yours. A count is also the only form in which what a second surgeon tells you can be set against the first.
Attach a date to every figure
'Most men are dry' means little until you know whether that is at six weeks or at a year. Ask for the early figure and the late one each time. The early one prepares you for a rough first month and the late one is the result you are choosing.
Agree what the words mean
Dry can mean no pads at all or one pad kept for safety. An erection can mean firm enough for sex unaided or only with medication. Ask the surgeon which definition sits behind their numbers before you write them down.
Fill in the clinic forms as things really are
Many urology clinics hand out a short scored form about urinary symptoms and another about erections before an operation. Answer for an ordinary week, not your best one. The same forms afterward are how you and the surgeon tell what changed, and a flattering 'before' makes the 'after' look worse than it is.
If you are the partner at the appointment
Take the practical half
Agree beforehand that you will handle the questions about the catheter, supplies, the drive home and the first week, and write down every answer. He can then keep his attention on the decision and on the things that are harder to ask.
Be there for the catheter teaching
If you will be the one helping at night, ask to be in the room when the nurse shows how the bags are changed and emptied, and try it yourself. Watching once in daylight is very different from working it out from a leaflet at 3 a.m.
Ask your own questions
You are allowed to ask what this will mean for you: how much time off you should arrange, what you should watch for, how sex is likely to change for both of you. Surgeons and nurses hear these from partners all the time.
Offer to step out
Some men talk more freely about erections and leaking with nobody else listening, and some want their partner there for exactly that part. Ask him before the visit which he prefers, and make leaving the room an easy thing to do.
Between booking and the operation
Book the appointments that come after
Catheter removal, the first check, pelvic floor therapy and any erection clinic are easier to schedule before the operation than from the couch afterward. Ask the office which of them you book yourself and which they arrange.
Work backward from the date
Several things on this page have a lead time of their own: a blood thinner that stops days ahead, a urine test, one session with a pelvic floor therapist, sperm storage if you want it. Ask the office how many days each one needs and mark them on a calendar counting back from the operation, so none of them turns up in the final week.
Try the supplies while you feel well
Open the pads, work out which pants fit over a leg bag, and decide where the night bag will sit beside the bed. Ten minutes of rehearsal takes most of the dread out of the first evening at home.
Plan work and travel around the catheter
Once you know roughly how long the catheter stays in and when the pathology or first check is due, fit your leave, any trips and visitors around those dates. Your employer and insurer set their own rules on leave and driving, so ask them directly and do not go by a general estimate.