What Happens When They Remove Your Prostate

What Does The Prostate Do

The prostate is a male gland that releases prostate fluid, one of the components of semen.

The muscles of the prostate gland help propel this fluid into the urethra during ejaculation.

It is a muscular gland that is often described as walnut or small apricot-sized.

An enlarged prostate can be a sign of prostate cancer, the third biggest cancer killer.

What Happens After Radical Prostatectomy

Patients are usually discharged within 24 hours of surgery after radical prostatectomy.

You may have a drain that gets rid of excess fluid from the surgery site. If a drain is placed at the time of surgery, it is typically removed before you leave the hospital.

A urinary catheter continues to drain your urine into a bag. You may need to leave the catheter in place at home for a few days to one week.

After a surgeon removes your prostate, youll no longer ejaculate semen. But you can still be sexually active.

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.

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How To Return To An Active Sex Life After Prostate Cancer Treatment

No matter the cancer, treatments often cause side effects that affect patients quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patients sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment.

Unfortunately, sexual dysfunction is a possibility for nearly all treatment options for prostate cancer, including surgery, says Scott Shelfo, MD, FACS, Medical Director of Urology at our hospital near Atlanta. The degree of dysfunction depends on many factors, including the patients overall health, co-existing medical problems, as well as the patients level of sexual function and ability before treatment.

Orgasm After Prostatectomy Is It Possible

You can expect to enjoy sex and orgasm after prostate surgery.

Many men are surprised to find that they even experience pleasurable orgasm without an erection. Keep in mind that your sexual pleasure does not depend on penetration.

Dr. David Samadi says restoring an enjoyable sex life after prostate cancer surgery is in part dependent on prostate cancer treatment and choice.When men and their partners know what to expect, they can accelerate recovery, experiment, and work together. Sex-related activities should be resumed as soon as you are ready but keep in mind some changes are temporary, and some might be permanent, but the bottom line is that all of the problems can be overcome.

Patients that recover from robotic prostatectomy can expect one significant change regarding orgasm, the orgasm without ejaculation. It will feel different but the pleasure part will still be there.

Note that the male orgasm has 3 main components:

Even though the first 2 parts of the orgasm are affected by the radical prostatectomy, the third one that involves brain stimulation and generates the sensation of pleasure still remains.

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Surgery To Remove Your Prostate Gland

You might have surgery to remove your prostate gland if:

• your cancer hasn’t spread outside the prostate gland
• you are younger and have a fast growing tumour
• as part of treatment for locally advanced or high risk localised prostate cancer

The aim of a radical prostatectomy operation is to cure prostate cancer. It is major surgery with some possible side effects. If you’re an older man with a slow growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer might grow so slowly that you’re more likely to die of old age or other causes than from prostate cancer.

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

Also Check: What Is The Definition Of Prostate Gland

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

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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Recovering From Prostate Surgery

To treat prostate cancer, doctors perform tens of thousands of surgeries each year. In recent years, one procedure — called a radical prostatectomy — has become a fine art, says J. Brantley Thrasher, MD, a professor of urologic surgery at the University of Kansas Medical Center in Kansas City. While side effects like incontinence and impotence are still major concerns, most patients respond well to the surgery, Thrasher says.

In fact, many men respond almost too well. “They feel so good after the surgery that they start to push themselves too hard,” he says. One of his recent patients went on a two-mile jog — while still wearing a catheter. “I told him he needed to slow down and rest for a while.”

If you have a radical prostatectomy in your future, you’ll want to know what to expect. Here’s a closer look at this procedure. As you’ll see, your life won’t necessarily take a turn for the worse after prostate surgery. In fact, it just might get better.

Why do surgeons perform radical prostatectomies?

According to the Food and Drug Administration, radical prostatectomy is considered to be the most definitive treatment for many men with prostate cancer, a disease that kills about 30,000 American men each year. Depending on their age and the stage of their cancer, however, some men do well with a less invasive treatment.

How should I prepare for surgery?

What happens during a radical prostatectomy?

What will happen during recovery in the hospital?

References

Open Or Laparoscopic Radical Prostatectomy

In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.

In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.

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Risks Of Prostate Surgery

The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:

• Reactions to anesthesia
• Blood clots in the legs or lungs
• Damage to nearby organs
• Infections at the surgery site.

Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.

If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.

In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.

What Are Pelvic Floor Exercises And Can Improve Erection Quality

As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.

Those muscles are the core of how your body maintains blood flow to the penis and therefore keeps erections strong.

They put pressure on the veins in your penis, preventing blood from flowing back into the rest of your body. If they arent strong enough then even if you can get an erection, you wont be able to keep it.

The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.

Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.

Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.

Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.

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How Does Prostate Surgery Affect You Sexually

If you are diagnosed with prostate cancer and opt for a prostatectomy, particularly a radical prostatectomy, the surgeons will have removed your prostate.

While the prostate isnt directly responsible for your libido or sexual sensation, in some men who have had a prostatectomy, there can be damage to nerves or blood vessels.

The prostate is next to a dense group of nerves and the seminal vesicles .

There is a heightened chance of an infection such as spermatocystitis which can cause you pain or in some cases impotence.

For men who have had an open prostatectomy, they will find that they can no longer ejaculate. This is known as a dry orgasm and can still be pleasurable.

Even with less invasive surgeries, the most common complaint or side effect tends to be sexual in nature.

However, according to systematic reviews and meta-analysis of the scientific data, these cases of sexual dysfunction are often associated with psychological factors that might be present before surgery or as a result of stress related to the surgical procedure.

Radiation therapy can impact the pelvic floor muscles and nerves that control erections and provide pleasure.

According to a 2016 study, around half of Prostate Cancer patients who have any form of radiation therapy go on to develop erectile dysfunction.

For a large section of men who opt for radiation-based therapies, the first stage is usually hormone therapy.

When Should I See My Healthcare Provider

Talk to your healthcare provider if you have any of these symptoms after your surgery:

• Bleeding, swelling or drainage from the incisions.
• Inability to have a bowel movement.
• Inability to urinate after catheter removal.
• Increased pain around the incisions.

A note from Cleveland Clinic

Radical prostatectomy is a common surgery to remove the entire prostate gland. This prostate cancer surgery may be robotic surgery or open surgery. Robotic surgery has a shorter recovery time. Full recovery can take weeks, with some side effects lasting for months. Light exercise and medication can help you heal faster.

Last reviewed by a Cleveland Clinic medical professional on 08/03/2021.

References

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Radical Prostatectomy To Remove The Prostate

• Sexuality, Intimacy and Cancer ebook905kB

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Risks Of The Procedure

As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:

Some risks associated with surgery and anesthesia in general include:

• Reactions to medications, such as anesthesia

• Difficulty with breathing

• Bleeding

• Infection

One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.

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What About Other Treatments I Hear About

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.

Prostate Surgery And Erectile Dysfunction

The short answer is yes prostate surgery is very likely to cause erectile dysfunction.

A prostatectomy, even though modern surgeries are nerve-sparing is likely to cause months of issues to a mans sex life.

Less invasive procedures that avoid the bundle of nerves and seminal vesicles next to the prostate will still likely cause ED, even if its a shorter-term issue.

Other surgeries are less likely to cause lasting damage, but the fact is that sexual dysfunction is a complicated issue. Men have to grapple with the mental side of it as well.

A cancer diagnosis can weigh heavily on a mans mind, which can impact both his sex drive as well as his ability to maintain an erection.

Theres also the fact that as we age, men experience a natural reduction in sex drive and are likely to be less able to get and maintain an erection.

The likelihood is that any surgery would just exacerbate the underlying issue.

Around 1 out of every 4 men over the age of sixty will experience some form of erectile dysfunction. Thats also the most likely group to undergo surgery, which is why the two are often linked, but not necessarily the sole cause.

If you have some pre-existing medical condition that impacts your floor muscles, sexual function or urine/ urinary function than you might find that the side effects of the surgery are more severe.

You should talk with your Urologist about any pre-existing medical conditions and how they might affect the treatment.

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Urinary Problems After Surgery

Leaking urine

Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.

Difficulty urinating

A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.

Watch Paul’s story for one man’s experience of managing urinary problems after surgery below.

Sexual problems after surgery

Erection problems

Change in penis size and shape

Changes to orgasm

The seminal vesicles, which make some of the fluid in semen, are removed during surgery. This means you wont ejaculate any more. You may have a dry orgasm instead where you feel the sensation of orgasm but dont ejaculate. This may feel different to the orgasms youre used to.