The prostate gland, a small organ about the size of a walnut, is located in the male pelvis, just below the bladder and in front of the rectum. It encircles the urethra, the tube that carries urine and semen out of the body. While it serves specific functions, individuals can live a full life after its removal.
The Prostate’s Essential Functions
The prostate’s primary function involves contributing fluid to semen. The prostatic fluid, which is slightly alkaline and milky, makes up about 20-30% of semen volume. It contains components like enzymes, zinc, and citric acid, which nourish sperm and support their motility.
Beyond semen production, the prostate’s muscular tissue helps regulate urine flow. During ejaculation, it contracts, closing the bladder-urethra opening to prevent urine and semen mixing. This highlights its role in both reproductive and urinary processes.
Reasons for Prostate Removal
Prostate removal, or prostatectomy, is typically performed for specific medical conditions. The most common reason is prostate cancer, especially when confined to the gland. A radical prostatectomy removes the entire gland and some surrounding tissue, including seminal vesicles.
Another reason for prostate removal is severe benign prostatic hyperplasia (BPH), or enlarged prostate. When BPH causes significant urinary obstruction, leading to difficulty or frequent urination, or bladder stones, a simple prostatectomy may be recommended. This procedure typically removes only the inner part of the prostate blocking urine flow, leaving the outer capsule.
Life Without a Prostate
A prostatectomy results in several changes due to the gland’s absence. Urinary function is commonly affected, with many experiencing temporary or long-term incontinence. This can manifest as stress incontinence (leaks during coughing or sneezing) or urge incontinence (sudden, strong need to urinate). The prostate’s role in providing pressure around the urethra means its removal can weaken continence control.
Sexual function also undergoes alterations after prostate removal. Erectile dysfunction (ED) is a common side effect, as erection nerves often run close to the prostate and can be damaged or removed during surgery, even with nerve-sparing techniques. Ejaculation changes; without the prostate’s fluid, individuals experience a “dry orgasm,” meaning no fluid is expelled.
A prostatectomy typically leads to male infertility. The vas deferens, which transport sperm from the testicles, are cut during the procedure, preventing sperm from mixing with seminal fluid and being expelled. While sperm continue to be produced, they cannot leave the body naturally.
Adapting and Thriving Post-Prostatectomy
Despite challenges, individuals can adapt and maintain a good quality of life after prostatectomy through various management strategies. For urinary incontinence, pelvic floor (Kegel) exercises are frequently recommended to strengthen muscles that control urine flow. Medical devices like urethral slings or artificial urinary sphincters may also be options for persistent incontinence.
Erectile dysfunction can be addressed with several treatments. Oral medications, such as PDE5 inhibitors, are often a first-line treatment, particularly if nerve-sparing surgery was performed. Other options include vacuum erection devices, penile injections, or penile implants. Penile rehabilitation programs, which may involve early use of these treatments, aim to encourage the return of natural erectile function.
Beyond physical recovery, psychological and emotional support play an important role in adapting to life post-prostatectomy. Open communication with healthcare providers and partners, and participation in support groups, can help navigate emotional adjustments. While changes occur, understanding and utilizing available management strategies allow many to lead fulfilling lives.