In the fall of 2013, Les Cavicchi was diagnosed with prostate cancer. Because his cancer was localized (meaning it was contained to the prostate gland—it hadn't spread), he opted for a radical prostatectomy—the complete removal of the prostate gland.
Below, Les answers the question "what is a radical prostatectomy," as well as what life is like after getting one, including the unexpected complications he had prior to surgery.
As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.
[Editor's note: This article was reviewed and updated on 9/20/21.]
Les: My surgery was scheduled for October 17, 2013—the Thursday of Columbus Day week. On that Monday—Columbus Day—I suddenly could not urinate. I was in retention. And it really hurt.
Dr. Donovan had me go to the hospital where Dr. Kraus, one of his colleagues and a fellow GBU doctor, was on call. Dr. Kraus put a catheter in me. About 1800 cc of urine came out. It's important to note that you get the urge to urinate between 200 and 300, so by the time you're at 1800, you feel like you're going to burst.
I told Dr. Kraus that Dr. Donovan was my doctor and I was scheduled for a radical prostatectomy in three days. He said, "Then, that catheter's staying in until the surgery." I said, "No problem." They gave me all the necessary equipment, if you will, to go home with the catheter.
Les: No. The catheter eliminated that problem, but something else happened that I didn't expect. I started to have bladder spasms. Your bladder contracts to try to push the catheter out. I was not even aware this could happen, and I've been in this business a long time. When your bladder reacts this way, it actually pushes urine around the catheter because it's just contracting like a fist. It's just trying to push everything out. The catheter can't come out because it has a balloon that's inflated inside your bladder and that's what holds it in place.
Dr. Donovan said he had some medication he could give me, but he didn't want to give me too much because he didn't want it to interfere with the surgery. Unfortunately, the medication didn't ease it, so I lived with these bladder spasms every 20 minutes for the next three days until the surgery.
The morning of the surgery, the anesthesiologist gave me a medication that ended the spasms right then and there. It wasn't long after that they wheeled me down the hall to the operating room and I don't remember a thing after that. The surgery lasted about seven hours.
Les: A radical prostatectomy is usually two to three hours, but my prostate was huge (five times the normal size). It was complicated, getting this thing out of me. Dr. Kraus actually scrubbed in and helped Dr. Donovan. But together, they combined forces to accomplish a successful procedure, and I woke up in recovery.
Les: The recovery nurse came over and asked how I was doing. She told me the surgery was a success and that Dr. Donovan would be coming to see me. She told me I had a morphine drip and all I had to do was press the button. There was a catheter in as well, standard as part of the post-operative care management process.
I was admitted, and I stayed for five days, which is unusual, but it was because my surgery was ultimately much more involved due to my prostate's size. Once I was brought upstairs, Dr. Donovan came to see me. He told me the surgery was a success and that he and his team did their best to preserve the nerves that relate to sexual function, erection, and so forth.
I already knew much of this based upon my research. The nerves that relate to orgasm are intact regardless of the prostatectomy, so you'll still have an orgasm, but with your prostate gone, everything related to ejaculation is disconnected; there is no more semen at orgasm. In other words, there's no more sperm. You can have a "dry" orgasm. There will never be semen, but it feels the same. You can still enjoy having sex, if you will.
But the big question post-surgery is this: will I get an erection or not? You don't know that for a while because you've been cut wide open and everything has to heal.
Les: Well, in my case, because of my prostate's size and the amount of work it took to get it out, Dr. Donovan had to essentially re-engineer my bladder. Essentially, there was some damage to my bladder and he had to put it back together, resize it, and sew it up. There was a drain, which is a little bit unusual, from my abdomen and that had to do with making sure that the work that he did on the bladder was going to be successful.
At this point, in recovery, all I can think is "What do I know? I'm the patient." So I'm lying there listening to all this and I'm wide awake so I get it. I'm just thinking, "Well whatever he did, it was the right thing to do and I'm assuming everything's going to heal up and it's going to be fine and off we go." A bit naïve, perhaps…
So all I say is, "Can I get up?" And Dr. Donovan says, "Absolutely. Get up, move around, walk around. Actually, I want you to do that."
Les: A little on day one, but it was certainly manageable with the morphine, and I wasn't pushing the button that often. The problem days were day two and day four and when I say problem, I mean pain wise. For some reason, those two days were pretty intense, and I was up walking around. What I did was I would stroll the entire unit three or four times and then sit down. I would do that four or five times a day. Days two and four were much more difficult than days one, three, and five, and I don't know why.
Dr. Donovan prescribed some medication. Oxycontin, I think, but I didn't want to take that. I said, "Put it away. Just get some Tylenol." That's what I did at home, too. I got by with the Tylenol, but it took a couple of weeks before the pain subsided enough that I didn't think about it every minute.
Les: I was discharged with the catheter. I went home on day five. On day seven or eight, there was a question about whether that catheter would come out. Dr. Donovan had me see a radiologist (at the hospital as an outpatient) to take some pictures to make sure the bladder wasn't leaking.
So I went to the hospital and they did some fluoroscopy with some dye, and sure enough, the bladder was leaking. The work that he had done to reconstruct hadn't fully healed, hadn't fully mended the bladder, so I ended up with the catheter for two weeks because I had to go back again in another seven days to radiology, take some more pictures, and then we determined in fact that everything was solid. That healing process for the bladder took a little longer than expected.
As far as the incision for the prostate and so forth, that all moved along fine without any complications. No infection, none of that. That was fine.
I started working again seven days after the surgery from home, which was easy because it's all on a computer. Then, 14 days after, I went to the office.
In the next series of articles, Les will talk candidly about side effects he suffered after a radical prostatectomy, including urinary incontinence and erectile dysfunction—and the remedies/treatments he pursued.
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