What Happens When A Man’s Prostate Is Removed

Does Penis Length Recover After Prostate Removal

By Andrew M. Seaman, Reuters Health

5 Min Read

– After prostate removal for cancer, men sometimes complain to their doctors that their penis shrank, but a new study from Japan suggests they should not lose hope.

Following men for up to two years after surgery, researchers found the patients penises were shortest a few days after their procedures. Penis lengths generally returned to normal after one year, however.

The studys lead author said the research was started after encountering a few patients complaining of penis shortening after prostate removal, which is known medically as a radical prostatectomy.

Past reports mentioned shortened penises after prostate removal, but the results were a bit different, said Dr. Yoshifumi Kadono, of Kanazawa University Graduate School of Medicine Science.

Therefore, we started our study to obtain our data, he told Reuters Health.

For the new study, the researchers measured the penis lengths of 102 men before having their prostates removed and then at 10 days after surgery and again one, three, six, nine, 12, 18 and 24 months later.

The mens stretched penis lengths were shortest 10 days after surgery, when measurements were an average of about 1.99 centimeters shorter than before prostate removal.

The researchers wanted to know what caused the shortening and if any particular variable, such as the size of a mans prostate gland, would predict which men would experience this effect.

Advantages And Disadvantages Of Surgery

What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.

Advantages

• If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
• The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
• Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
• If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
• Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.

Disadvantages

When To Call Your Doctor Or Nurse

Its important to tell your doctor or nurse if:

• your bladder feels full or your catheter isnt draining urine
• your catheter leaks or falls out
• your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
• your wound area or the tip of your penis becomes red, swollen or painful
• you have a fever
• you feel sick or vomit
• you get cramps in your stomach area that will not go away
• you get pain or swelling in the muscles in your lower legs.

Your doctor or nurse will let you know if you should go to the hospital.

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The Purpose Of Prostate Surgery

Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.

It has been performed for many years and was regarded as the gold standard of prostate cancer treatment. However, few studies compare its efficacy to other techniques.

Most men diagnosed with prostate cancer today are typically diagnosed with Gleason 6 cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:

Misuse of the term cancer has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.

The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they dont really have.

Aggressive treatment, usually a complete surgical removal of the prostate , is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.

Can You Live Without A Prostate

You can live without a prostate, though there are some side-effects.

The prostate is removed to prevent the spread of prostate cancer, while it might also be removed because it has enlarged through normal ageing and is putting pressure on the uretha .

A prostatectomy is the removal of all or part of a prostate, with the most common procedure being the transurethral resection of the prostate .

Laser prostatectomies are also performed which is the least invasive type of removal.

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Things You Should Expect After Prostate Surgery

Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.

In the immediate hours after surgery:

Ask Your Doctor About Solutions

Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.

Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.

While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.

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Sex After Prostatectomy: How To Have A Healthy Sex Life After Surgery

Medically reviewed by Kristin Hall, FNP

Prostate health issues such as benign prostatic hyperplasia and prostate cancer affect hundreds of thousands of men in the United States every year.

If youve been diagnosed with a serious prostate issue, your healthcare provider may suggest a prostatectomy a surgical procedure in which your part or all of your prostate gland is surgically removed from your body.

Prostate removal surgery is usually highly effective at treating cancer and prostate enlargement , but it can potentially lead to complications.

These include some sexual performance issues, such as erectile dysfunction and difficulty ejaculating normally.

Although these effects can change your sexual experience, many men are still able to enjoy a fulfilling, satisfying sex life after prostate surgery by making certain lifestyle changes and using medication.

Below, weve talked about what to expect if youre scheduled to undergo a prostatectomy and want to maintain an active sex life after surgery.

Weve also explained how you can have a healthy sex life after a partial or complete prostate removal, whether through exercises to improve sexual functioning, medications, devices or a combination of different approaches.

Help For Ed After Prostate Surgery: The Basics

Whats the secret to having a good sex life after prostate cancer? Its very simple, says Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Also, having a loving and understanding partner always helps. Theres also the vacuum erection device . It is not a first-line treatment for ED because theres a high drop-out rate, Bivalacqua says. However, the VED can play a very important role in another aspect of surgical recovery: penile rehabilitation .

First, the pills: When one of my patients leaves the hospital after a radical prostatectomy, he takes home a prescription for Viagra, says Bivalacqua. Does he take it every day, like a vitamin? No. Although some doctors prescribe the pills this way, its not what physicians call an evidence-based practice that is, the medical literature doesnt back it up conclusively. Instead, Bivalacqua tells his patients to take it as needed. It is very difficult for me to tell a man that he should spend $600 a month to take a daily erection drug, because the evidence of a quicker return of erections is just not there. However, he adds, taking a pill daily may provide a benefit, and a lot of prostate cancer patients want to take a proactive approach. If thats the case, then I encourage them to go ahead.

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Can I Have An Orgasm Without An Erection

Yes. An erection is not necessary for orgasm or ejaculation. Even if a man cannot have an erection or can only get or keep a partial erection, with the right sexual stimulation you can experience an orgasm. Your orgasm has little to do with your prostate gland. As long as you have normal skin sensation, you can have an orgasm.

Uk Guidelines For Keyhole Surgery

The National Institute for Health and Care Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the prostate but they must:

• tell people having the surgery about the risks and benefits
• monitor people closely
• collect information about any problems people have and report on them

Researchers are looking into whether keyhole surgery is as good as open surgery.

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What Is Urinary Incontinence And How Is It Related To Prostate Cancer Surgery

Urinary incontinence is the loss of the ability to control urination . Urinary incontinence sometimes occurs in men who’ve had surgery for prostate cancer.

If youve had prostate cancer surgery, you might experience stress incontinence, which means you might leak urine when you cough, sneeze or lift something that is heavy. This happens because of stress or pressure on the bladder. There is also a type of incontinence that is called urge incontinence. When this happens, you are hit with a sudden need to urinate right away and have leakage before you can make it to the bathroom.

Life After Prostate Cancer Treatment

Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.

Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.

Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.

“It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.

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Other Possible Side Effects

Anorgasmia is the inability to achieve orgasm regardless of the level of stimulation.

2) Penile shrinkage

Removal of the prostate seems to initiate a phase of penile shrinkage that varies between 2 to 3 cm. For men with large organs, this may have little effect. But a man that starts on the small side might be very dismayed about it.

Early penile rehabilitation may avoid structural endothelial and smooth muscle damage by improving penile oxygenation.

3) Urine leakage or pain during intercourse

4) Urine leakage at orgasm

5) Pain or discomfort at orgasm

Side Effects From Radiation

Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.

Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

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Other Medications And Devices

Although medications like sildenafil and tadalafil are effective for many men with post-surgery erectile dysfunction, they arent the best choice for everyone.

If your prostatectomy causes damage to the nerves near your penis, or if you take medication for hypertension, angina or other health conditions, using an oral ED medication may not be a suitable option for you.

In this case, your healthcare provider may recommend a different type of medication or a device to help you achieve an erection. Your options may include:

• Penile injection therapy. This involves using injectable medications to stimulate blood flow and improve your erections. These medications are typically administered using a very small needle to minimize discomfort.Although this treatment method may sound unpleasant, its relatively simple to use and has a success rate of 70 percent to 80 percent.

• Vacuum constriction devices . Also known as a penis pump, a VCD works by creating a vacuum around your penis. This draws blood into your penis and allows it to become erect.

What Is A Urethral Sling Procedure And How Does It Help With Urinary Incontinence

In the urethral sling procedure, a synthetic mesh tape is placed around part of the urethra, moving the urethra into a new position. This is a minimally invasive procedure, which means that the surgeon only has to make a small incision in the perineum .

Your provider may recommend a urethral sling procedure if you have mild to moderate urinary incontinence after a radical prostatectomy that hasnt improved using other more conservative measures. It’s highly successful in helping men overcome incontinence, or reduce episodes of leaking urine.

Before the surgery, the provider may do some tests, including the following:

• A urodynamic study, to test how well the bladder is working.
• A 24-hour pad test .
• A cystoscopy, a test in which the doctor looks inside the bladder with an instrument called a cystoscope.

You dont have to donate any of your own blood before surgery.

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What Happens Right After Prostate Surgery

After surgery, youll stay in the hospital for a day or two. You may feel sore, but nurses will encourage you to get up as soon as possible. Walking helps your body start to recover from the surgery and function normally again.

Because you cant urinate on your own right away, youll have a catheter in your penis. The thin, flexible tube empties urine into a bag.

Your doctor may prescribe pain medicine for a few days immediately following surgery. After that, youll switch to over-the-counter pain meds.

Radical Prostatectomy Retropubic Or Suprapubic Approach

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How To Maintain Your Sex Life After Prostate Surgery

Although prostate surgery can affect your sexual experience and performance, getting surgery to remove part or all of your prostate doesnt mean that you can no longer have sex or enjoy a satisfying sexual life.

However, it does mean that you may need to make some changes to how you and your partner have sex. These may include using ED medications, erection-promoting devices or engaging in penile rehabilitation exercises to keep your penis stimulated and healthy.

If youve recently had prostate surgery, its important to talk to your healthcare provider before you make any changes to your health habits. Theyll be able to inform you about what you can do to restore and improve your sexual function after surgery.

How Will Prostate Surgery Affect My Sex Life

Experienced robotic surgeons like Dr. David Samadi dont open the endopelvic fascia during surgery, which spares the rick of damage to nerve bundles that control sexual function. The recovery of the function, however, is not immediate and you should not feel discouraged if weeks or even a few months after surgery you experience erectile dysfunction. It is not an indication of long-term damage.

One major change that you will notice in your sex life is the absence of sperm. Having no prostate, the body will not produce semen during the orgasm. The sperm cells will be simply reabsorbed by the body them. This is not harmful and you shouldnt be worried about it. Plenty of men deal with the problem with the help of medication that improves erectile dysfunction.

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