1. Side Effects of Prostatectomy (Prostate Removal by Surgery)
A prostatectomy involves removal of the prostate gland, and in some cases, the adjacent lymph nodes as well. Surgeons have several options for removing the prostate; that is, they can cut into the urethra and bladder (open radical retropubic surgery), remove the prostate through an incision made between the anus and scrotum (radical perineal prostatectomy), or make five tiny incisions and perform a laparoscopic technique (minimally invasive laparoscopic radical prostatectomy, also done as robot-assisted).
In all cases, surgeons attempt to spare the nerves that run alongside the prostate. This technique offers men the best chance of preserving erectile function. Whether a surgeon will be able to spare the nerves depends on how far the cancer has invaded the nerves and not on the surgical technique itself. If a man’s nerves cannot be spared, surgeons may surgically graft or attach nerves from other areas of the body.
Sexual Side Effects of Prostatectomy for Prostate Cancer
A report published in Review in Urology offers the following stats on the sexual side effects of prostatectomy.
- Erectile dysfunction. Impotence occurs in nearly all men immediately after they undergo prostatectomy. Erectile function can return, although it can take as long as 18 to 24 months or longer as neurapraxia (temporary loss of motor and sensory (nerve) function) resolves. As the neurapraxia improves, men are more likely to be responsive to the numerous ED drugs (phosphodiesterase-5 inhibitors) such as sildenafil. Few men respond to PDE-5s within the first six months, but trying them again 18 to 24 months postsurgery can be successful. Even men who have nerve-sparing prostatectomy can generally expect their posttreatment erections to be less robust than their preoperative ones.
- Ejaculatory dysfunction. Problems with ejaculation, including retrograde ejaculation, occurs in 100 percent of men.
- Orgasmic problems. About half of men who undergo prostatectomy will experience orgasmic problems, such as an inability to reach climax
- Nocturnal and morning erections. These erections disappear immediately after surgery and gradually return over time along with restoration of erectile function.
- Penis shrinkage. A reduction in penis length and circumference frequently occurs after prostatectomy and can worsen over time. One study found that 63 percent of men who didn’t use a vacuum erection device after their surgery experienced penis shrinkage compared with 23 percent of men who used the device regularly.
- Retrograde ejaculation. Between 40 and 90 percent of men experience retrograde ejaculation following prostatectomy. There is no known treatment for this condition, which is painless but can jeopardize a man’s fertility.