Prostate Surgery

Prostate Surgery

Other than containing important fluids to help sperm swim toward their ultimate destination, and being a potential means of providing sexual pleasure, the Prostate Gland does not appear to fulfill any other significant function. However, this male gland has a potentially significant down-side; it has a high probability of causing physical problems if it swells too much during middle age, or if it becomes stricken with cancer.

Although there are a number of conditions that afflict the gland's functioning, prostate cancer is one of the more severe. The incidence rate indicates that it is a serious health problem affecting a high proportion of men throughout the world; the Centre for Disease Control (CDC) reports that one in six men will be diagnosed with prostate cancer, while one in thirty-three will die from the disease. It is the second leading cause of cancer death in men, behind lung cancer … and, in men over forty five, it is the fifth overall leading cause of death!

Possible treatment options for prostate cancer include partial to complete removal of the gland - but the complicated surgery is not without risk. The post-operative effects can also be burdensome, significantly impacting a man's lifestyle and well-being, particularly his sex life. The major possible side effects of surgical intervention are the loss of capacity to Ejaculate , and potentially permanent Erectile Dysfunction.

The procedure

Not every man will be stricken with a form of prostate disease that requires surgery. For those who are, ideal candidates for a radical prostatectomy are men whose cancer is believed to be contained to the prostate. He must also be able to withstand the physical impact of surgery and general anesthesia, and be healthy enough to combat possible post-operative complications.

If a doctor deems it necessary to remove the prostate, they embark upon a procedure that is considered one of the most difficult for urologists to master. The structures in the male pelvic region are complex, requiring precision and expertise in order to be treated successfully. Surgeons will use a method called radical prostatectomy to remove the diseased gland. Depending on the patient’s particular situation (as well as malignancy of cancer), specialists can potentially remove some, or all, of the following: prostate, seminal vesicles, vas deferens (the muscular cords that help pump sperm from the testicles to the urethra), surrounding tissues, and lymph nodes. Due to the intricate arrangement of these structures the risk of damage to them or the nerve endings is high, and is the reason for the incidence of potential complications of erectile dysfunction and urinary incontinence following surgery.

An alternative technique that can be performed is called a ‘nerve-sparing radical prostatectomy’. Instead of removing both of the two bundles of nerves that are attached to either side of the prostate, one (or even both) can be left in the body so long as they're deemed non-cancerous. The reason this surgical option is so ideal is that it lessens the risk of erectile dysfunction, as these nerve bundles send messages to the penis to become engorged with blood, thus making them responsible for initiating erections.

The risks associated with prostate removal

After prostate surgery, a man's body won't be able to function in exactly the same manner as it used to - at least not for a while. As with other surgeries performed in the pelvis (such as bladder or colon removal), prostate removal can impede blood circulation and damage nerves, which can lead to pain and discomfort.

As a result of extracting the prostate and the seminal vesicles, a man's ejaculate will be reduced - and may actually cease altogether, causing him to 'dry cum'. Known as ‘retrograde ejaculation’, semen that is normally ejected through the urethra gets redirected into the bladder. Retrograde ejaculation causes cloudy urine and low fertility.

Depending on the method used, one of the most dreaded after-effects a patient can experience is accidental urine escape and (possibly) stool leakage from the rectum. During the healing period it is a good idea to wear adult diapers and keep a change of underwear and pants nearby when outside the home (perhaps in the car). The chance of permanent urinary incontinence is approximately one percent, while mild incontinence results up to thirty percent of the time.

Another very troublesome consequence of this procedure is erectile dysfunction and/or a loss of libido. Because of the nature of this delicate surgery, it almost always impairs the workings of the penis. According to "The Sexual Male: Problems and Solutions" by Richard Milsten & Julian Slowinski, patients who undergo treatment for prostate cancer are at risk for the development of impotence. This is true not just for patients who have surgery to remove the prostate but also for those who receive radiation externally. However, "It may be necessary to accept erectile problems as a trade-off for a cure from cancer."

Other reported outcomes are a slightly shorter, thinner penis as well as weaker orgasms.

Weighing the risks

There are pros and cons of undergoing prostate surgery. Depending on an individual's particular stage of cancer, doctors may recommend a period of watchful monitoring before making the ultimate decision to undergo surgery. This is because many prostate cancer tumors progress very slowly by nature; so the odds of an older man dying from another disease while he has prostate cancer might be higher than they are of him actually dying from it. The waiting gives patients a chance to try alternative therapies (if applicable) such as hormone treatment, radiotherapy, brachytherapy, cryotherapy, combination treatment … or simply nothing at all.

In analyzing the effects of surgery versus no-surgery on slower spreading forms of cancer, a clinical trial tested early stage prostate cancer patients. The patients were divided into two groups: 'watch and wait' and radical prostatectomy. After approximately six years of involvement in the study the groups showed no difference in overall survival rate, but there was a marked difference in their quality of life. The 'watch and wait' group exhibited more issues with urinary obstruction whereas the radical prostatectomy group had erectile dysfunction and urinary leakage. This illustration is not intended to sway patients toward one treatment option or the other; rather, it is meant to show that tradeoffs can exist in the decision to have surgery - or not.

A common fear is that Prostate removal equates to the end of sexual functioning. While it is true that surgery carries significant implications in this area, it need certainly not be the end of the matter! Please look out for our follow-up article on ‘Sex After Prostate Removal’ for more information…