The prostate is a small gland that sits just below the bladder. Its absence is almost always the result of a surgical procedure called a prostatectomy, where the entire gland is removed. This procedure, while often lifesaving, introduces specific physiological changes as the body adjusts to the absence of the organ. Understanding these changes, which primarily affect urinary and sexual function, is important for preparing for life after the surgery.
Basic Function and Reasons for Removal
The primary biological role of the prostate is related to reproduction, as it produces a fluid that makes up a significant portion of semen volume. This fluid contributes to sperm mobility and helps create an environment for sperm survival. The prostate surrounds the urethra where it exits the bladder.
The complete surgical removal, known as a radical prostatectomy, is mainly performed to treat localized prostate cancer. The procedure aims to eliminate all cancerous tissue before it can spread. Less commonly, surgery may be necessary to address severe symptoms from benign prostatic hyperplasia (BPH), a non-cancerous condition involving an extremely enlarged prostate that has not responded to other treatments.
Changes to Urinary Control
The location of the prostate, wrapped around the urethra beneath the bladder, makes changes to urinary control a common outcome of its removal. The surgery requires the surgeon to reconnect the bladder directly to the urethra. This process can sometimes affect the surrounding muscle structures responsible for maintaining continence.
The main change patients experience is stress incontinence, which is the involuntary leakage of urine during physical activities that place pressure on the bladder. Actions like coughing, sneezing, or lifting can cause this leakage. This occurs because the internal sphincter muscle, which helps keep the bladder closed, may be damaged or removed during the procedure. The body relies on the remaining external urinary sphincter for control, which often needs strengthening to compensate.
Fortunately, this type of urinary leakage is often temporary, with most men regaining control within several months to a year after surgery. Rehabilitation methods, specifically pelvic floor muscle exercises, often called Kegel exercises, are frequently recommended. These exercises strengthen the muscles that support the bladder and urethra, helping the external sphincter become more effective at preventing leakage.
Impact on Sexual Function and Ejaculation
The absence of the prostate leads to two distinct changes in sexual function: a change in ejaculation and a risk of erectile dysfunction (ED).
Ejaculation Changes
Since the prostate and the seminal vesicles are removed during a radical prostatectomy, the body can no longer produce the fluid that makes up the majority of semen. As a result, men who have had a prostatectomy experience a “dry orgasm.” The sensation of climax is still present, but no fluid is expelled.
Erectile Dysfunction
The ability to achieve an erection depends on the cavernous nerves, which run along the sides of the prostate. Even with the most careful surgical technique, these nerves can be stretched or damaged during gland removal, which can lead to ED. Surgeons employ nerve-sparing surgery to minimize this damage, though it may not be possible if the cancer is growing too close to the nerve bundles.
The recovery of erectile function is variable and can take several months up to two years. To help with this recovery, penile rehabilitation may be recommended. This often involves the use of oral medications like phosphodiesterase-5 inhibitors (e.g., sildenafil or tadalafil) to promote blood flow. Other options for managing ED include vacuum erection devices or penile injections, all aimed at helping maintain blood vessel health and function during the recovery period.
Long-Term Health Monitoring and Quality of Life
Long-term medical surveillance remains a necessary part of health management. The primary tool for monitoring is the Prostate-Specific Antigen (PSA) blood test. Since the prostate is the main source of this protein, PSA levels should ideally drop to an undetectable level shortly after surgery.
Regular PSA testing continues because a detectable or rising PSA level suggests that cancer may have been left behind or has recurred in the surrounding tissue. An increase in PSA is often the first sign of biochemical recurrence, prompting further investigation and potential treatment. The frequency of follow-up tests is initially every few months and then typically yearly, depending on the individual’s health profile and initial cancer stage.
Beyond medical monitoring, the overall quality of life following a prostatectomy is a focus of long-term care. While the functional changes can be challenging, resources are available to help manage them. Physical therapy for the pelvic floor, counseling, and support groups aid in psychological adjustment and adaptation.