A prostatectomy is a surgical procedure involving the partial or complete removal of the prostate gland. This gland is located beneath the bladder and surrounds the urethra. The prostate’s functions include producing fluid that contributes to semen and assisting in ejaculation. While a prostatectomy is commonly performed to treat prostate cancer, particularly through radical prostatectomy where the entire gland and surrounding tissues are removed, it can also address benign prostatic hyperplasia (BPH) through a simple prostatectomy. Understanding potential changes after this surgery is important.
Changes in Urinary Control
Individuals undergoing prostate removal often experience alterations in urinary control, with urinary incontinence being a common and significant side effect. This condition manifests primarily as stress incontinence, where urine leakage occurs with activities that increase abdominal pressure, such as coughing, laughing, sneezing, or exercising. Less frequently, urge incontinence may develop, characterized by a sudden, intense need to urinate followed by involuntary leakage before reaching a restroom.
These changes stem from the anatomical modifications during surgery. Specifically, the internal urethral sphincter, located at the bladder neck and within the prostate, is removed during a radical prostatectomy. Consequently, urinary continence after surgery relies heavily on the external urethral sphincter, a voluntary muscle located below the prostate. Damage to the external urethral sphincter or its associated nerves and supporting structures during the procedure can weaken its function, leading to varying degrees of incontinence. While some degree of stress urinary incontinence is almost universally experienced immediately after catheter removal, many individuals see improvement over several months as healing progresses.
Impact on Sexual Health
Prostatectomy significantly impacts sexual health, with erectile dysfunction (ED) and changes in ejaculation being prevalent concerns. Erectile dysfunction arises due to potential damage to the neurovascular bundles, networks of vessels and nerves near the prostate gland. These bundles are responsible for controlling blood flow to the penis, a process essential for achieving an erection. Even in nerve-sparing procedures, these delicate nerves can be bruised, stretched, or otherwise traumatized during their careful separation from the prostate, hindering their function. While some recovery of erectile function can occur over time, often taking several months, the extent of recovery depends on factors such as the patient’s age, pre-surgical sexual function, and the degree of nerve preservation.
During a radical prostatectomy, the entire prostate gland and the seminal vesicles, glands behind the bladder, are removed. Both the prostate and seminal vesicles contribute a substantial portion of the fluid that makes up semen. With their removal, the production of seminal fluid largely ceases, leading to a phenomenon known as “dry orgasm,” where an individual can still experience orgasm but without the expulsion of semen. This alteration also means that individuals will not be able to conceive naturally through sexual intercourse after a radical prostatectomy, although the testicles continue to produce sperm.
Other Physical Considerations
Beyond urinary and sexual function, other physical changes can occur after prostatectomy, though these are generally less common or less severe. Given the prostate’s anatomical proximity to the rectum, some individuals may experience temporary bowel issues. This can include changes in bowel habits or, less commonly, rectal irritation, particularly if surrounding tissues were affected during the surgical process. These symptoms typically resolve as the body heals.
Another potential, though infrequent, consideration is lymphedema. This condition involves swelling, most often in the legs or genital area, and can occur if lymph nodes in the pelvis are removed during the prostatectomy, a procedure known as pelvic lymph node dissection. Lymph nodes are part of the body’s lymphatic system, and their removal can sometimes disrupt normal fluid drainage, leading to fluid accumulation. The risk of lymphedema varies depending on the extent of lymph node removal.
Strategies for Managing Life Without a Prostate
Living without a prostate often involves adapting to and managing the associated side effects, with various strategies available to improve quality of life. For urinary control challenges, pelvic floor muscle exercises, often referred to as Kegel exercises, are a primary recommendation. These exercises strengthen the muscles that support the bladder and urethra, helping to improve continence. Lifestyle adjustments, such as timed voiding schedules and mindful fluid intake, can also help manage urinary leakage. Absorbent products, including pads or specialized penile clamps, offer practical solutions for managing any remaining leakage and maintaining comfort.
Regarding sexual health, a range of treatments exists to address erectile dysfunction. Oral medications, such as phosphodiesterase-5 (PDE5) inhibitors, can help facilitate erections by increasing blood flow to the penis. Other options include vacuum erection devices or penile injections. For individuals who do not respond to these therapies, penile implants offer a more permanent solution.
Open communication with healthcare providers, including urologists and sexual health specialists, is important for exploring these options and finding the most suitable management plan. Engaging with support groups can also provide a valuable platform for sharing experiences and receiving emotional support from others facing similar challenges.