Benefits and Risks of Prostatectomy
Prostatectomy is surgery that removes part or all of a man’s prostate gland. It’s a treatment option for prostate cancer and BPH (benign prostatic hyperplasia). If prostate removal is in your future, it’s important to weigh the risks and benefits. This includes understanding the possible prostatectomy side effects that may affect your life. Your doctor is best able to help you through the decision-making process, which will cover at least some of these topics.
If you have early prostate cancer, the most obvious benefit is removing the prostate gland may cure it. This is possible in men with prostate cancer that has not spread beyond the prostate gland. Prostate removal can also be an important treatment option for men with prostate cancer that has grown through the prostate. Combining it with radiation therapy and hormone therapy can effectively treat the cancer. Even men with advanced prostate cancer can benefit from removing part or all of the prostate. It can help relieve pain and other symptoms.
Frequent or urgent need to urinate including frequent urination during the night
Problems starting to urinate or dribbling at the end of urination
Painful urination or ejaculation
Urinary incontinence and incomplete bladder emptying
Weak urine stream or starting and stopping during urination
Removing part or all of the prostate will relieve pressure on the urinary tract and improve BPH symptoms.
Prostate removal is major surgery, even with minimally invasive techniques. Risks with any surgery include bleeding, blood clots, infection, and problems related to anesthesia. The two main prostatectomy side effects are erectile dysfunction (ED) and urinary incontinence.
ED is understandably a major concern after prostate removal. One function of the prostate gland is to force prostate fluid into semen as it moves through the urethra during ejaculation. Without a prostate gland, all men will notice some decrease in the ability to get an erection after surgery. But there are several factors that will affect the degree and duration of ED including:
Age: Younger men are likely to have less severe problems and recover erectile function more quickly. ED is more likely to be permanent in older men.
Pre-surgery erections: If you were able to achieve a firm erection before surgery, you are less likely to have severe problems afterwards.
Nerve supply: The nerves that control erections are situated on either side of the prostate. If both nerve bundles are removed during surgery, it will not be possible to get a spontaneous erection. It may still be possible to achieve one with a vacuum device or implant. Removing the nerves on one side will cause some amount of ED. Nerve-sparing surgery will preserve your ability to have an erection in the future.
Erection vs. orgasm
It can take up to two years to regain normal erectile function. This recovery is gradual and you may need to use medicines or devices in the meantime. The good news is that men are still able to achieve orgasm even without an erection. The nerves involved in orgasm are different than the ones controlling erections.
The experience of orgasm will be different after surgery. Some men have changes in the intensity of orgasm. It will also be a “dry” orgasm, meaning there will be little to no fluid. Your body will still produce sperm, but it will not release it through semen anymore. This means you will not be able to father children naturally. If this is a concern, talk with your doctor about fertility options before surgery.
Like ED, some degree of urinary incontinence is very common after prostate removal. Like ED, younger men are less likely to have severe problems. Most men fully regain the ability to control their urine within a few weeks or months after surgery. Physical therapy exercises to strengthen the pelvic floor can help. It is rare to have complete loss of bladder control or permanent problems.
Other potential prostatectomy complications include:
Damage to nearby organs and tissues, such as the urethra, bladder or rectum
Retrograde ejaculation, which occurs when semen flows into the bladder during orgasm
Shortening of the penis by 1 to 2 centimeters
Urethral or bladder neck stricture (narrowing due to scar tissue) which can make urination difficult
Ask your doctor about success and complication rates. Often, an experienced surgeon (urologist) can make the difference and deliver the best possible outcomes.