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Can You Ejaculate After Prostate Removal

What Are The Side Effects Of Prostate Cancer Surgery

How and Why Prostate Cancer Treatment Affects Mens Lives

People often ask what happens if the prostate is removed? What to expect after prostate surgery? And can you have your prostate removed at all? The answer is yes it is possible to have the prostate removed.

Life without a prostate can be close to normal for some, though not free from the after effects of prostate removal.

There are few prostate surgery complications. Some are acute, and others chronic. Among acute side effects could be a reaction to anesthesia, bleeding issues, blood clots in legs, damage to nearby organs, and infection at the surgery site.

However, in most cases, people are interested in life after prostate removal, the pain after prostate surgery, and the long-term after effects of a prostatectomy.

There are two main side effects of prostate surgery. These are urinary incontinence and erectile dysfunction.

Sex After Prostatectomy: How To Have A Healthy Sex Life After Surgery

Medically reviewed by Kristin Hall, FNP

Prostate health issues such as benign prostatic hyperplasia and prostate cancer affect hundreds of thousands of men in the United States every year.

If youve been diagnosed with a serious prostate issue, your healthcare provider may suggest a prostatectomy a surgical procedure in which your part or all of your prostate gland is surgically removed from your body.

Prostate removal surgery is usually highly effective at treating cancer and prostate enlargement , but it can potentially lead to complications.

These include some sexual performance issues, such as erectile dysfunction and difficulty ejaculating normally.

Although these effects can change your sexual experience, many men are still able to enjoy a fulfilling, satisfying sex life after prostate surgery by making certain lifestyle changes and using medication.

Below, weve talked about what to expect if youre scheduled to undergo a prostatectomy and want to maintain an active sex life after surgery.

Weve also explained how you can have a healthy sex life after a partial or complete prostate removal, whether through exercises to improve sexual functioning, medications, devices or a combination of different approaches.

How Can A Prostatectomy Impact Your Quality Of Life

Prostatectomy is not life-threatening, but prostate removal significantly affects the quality of life, and it may cause problems like urinary symptoms, bladder issues, erectile dysfunction, and more. T

These issues may last for several months and even years, something patients should be ready for if they decide to have the surgery.

However, a lot depends on the patients age and the kind of surgery done. Studies show that about 60% of patients would make an almost complete recovery within 3 months with no long-term complications. By 12-months, almost 90% of patients can expect to feel much better and nearly normal.

Unfortunately, improvement is slow for some people, and they need 2-3 years to revive their sexual function and get rid of urinary issues. Regretfully, these issues may continue to haunt some for a while.

Here it is vital to understand that the above data is for radical proctectomy . The outlook is better after partial proctectomy.

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Options After Initial Pde

The options for nonresponders to PDE-5 inhibitors include injection therapy, intraurethral prostaglandin, vacuum erection devices, and penile implants. The concomitant use of the PDE-5 inhibitors is discouraged in the regulatory documents for all 3 PDE-5 inhibitors. Nonetheless, there is a rationale for combination therapy. Corpus cavernosum smooth muscle relaxation, and hence penile erection, is regulated in part by increases in smooth muscle synthesis of the second messengers cyclic adenosine monophosphate and cyclic guanosine monophosphate . Intraurethral or intracorporeal prostaglandin E1 increases both second messengers. Therefore, in men with failure of PDE-5 inhibition or prostaglandin therapy, a synergistic effect might occur with combination therapy.

Along those lines, in my practice, I also combine sildenafil with intracorporeal injections in men after radical prostatectomy who are experiencing failure of intracorporeal injection therapy. The combined use of sildenafil with injection or MUSE therapy, though logistically cumbersome, has allowed some patients to avoid implant therapy.25

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Prostate enlargement

Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

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Erectile Dysfunction After Prostate Surgery

At least one in five men over the age of 40 experience some degree of erectile dysfunction, which is the difficulty getting or maintaining an erection. Erectile dysfunction is more common if you have a chronic disease such as diabetes, are overweight, smoke cigarettes or dont exercise.

Prostate cancer treatment increases your likelihood of erectile dysfunction considerably, with up to 85% of men having problems with getting and keeping an erection after surgery2. This is because your prostate is located next to the nerves, blood vessels and muscles that help you have an erection, and surgery to treat prostate cancer can damage these areas. However, surgical techniques and technologies can help prevent damage to the nerves that allow erections and lower the chance of permanent erectile dysfunction. Factors such as your age, erectile function before surgery, other health conditions you may have, how well the nerves are preserved during surgery and the recovery process can influence your outcomes. It can take between 18 and 24 months after prostate surgery for your erections to improve.

The process can be particularly distressing for transwomen. The diagnoses of prostate cancer and the interaction with the health system can be a rather traumatic period for these individuals, Brett-Renes says.

Open Or Laparoscopic Radical Prostatectomy

In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.

In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.

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What Do We Know About Potency After A Robitic Prostatectomy

The return of potency is dependent on several factors:

  • Previous sexual function before surgery. Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery. It will not improve upon what you already had before surgery.
  • Age. Theyounger you are, the better your chances. Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
  • How many nerves are spared. As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections. However,even men with no nerve sparing can regain erectile function.

What Are The Long

How To Prevent Prostate Cancer

As per the American Cancer Society, there are two common long-term effects when the prostate is removed urinary inconsistency and erectile dysfuction.

Both these issues are quite common and will last at least three months in all the cases. Most will see improvement in about 12 months.

Nevertheless, some urinary issues and erectile dysfunction may be chronic and last for a few years, requiring continuous care and treatment.

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Making An Informed Decision

There are many things to consider when agreeing to proctectomy. Thus, one should ask healthcare providers various questions, from the cost of prostate cancer surgery to prostate cancer surgery after side effects.

During appointments or doctor visits, take more interest in prostate cancer treatment medications, supplements, how the process is done, whether the doctor would consider hormone therapy, other treatment options, sex life after prostatectomy, diet after surgery, rehabilitation, and more.

When agreeing to proctectomy, one should consider the risk and benefits and explore all non-surgical options. Once the prostate gland is removed, one will have to live with specific issues for a long.

If You Have A Partner Get Them Involved From The Start

If youre in a relationship, you should discuss sexual issues with your partner before and after surgery. Aside from the potential changes to your sex life together, your psychological distress and frustrations with sexual function can significantly impact your partners mental health as well3.

Its important to get your partner involved as soon as possible and take them on this journey with you, because the cancer doesnt just impact you, but it impacts your partner as well, be it the worry and stress of you going through the surgery and treatment or the long-term impact post-surgery and treatment, Brett-Renes says. From my experience, most partners want to be involved, and are very glad that they get to be heard and validated in this experience.

It might not be an easy topic to discuss but its incredibly important that you do, for both you and your partners sexual health and overall wellbeing.

With the couple working as a team they are going to achieve better outcomes as they are firstly, both on the same page, and secondly, theyre aware of whats is happening with each other, Brett-Renes says.

Dont hesitate to seek support together with the help of your GP, counsellor or psychosexual therapist, who can offer strategies for better communication, emotional regulation and sexual satisfaction.

You can find more resources about sex and prostate cancer from the Prostate Cancer Foundation of Australia.

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How Does Prostate Surgery Affect You Sexually

If you are diagnosed with prostate cancer and opt for a prostatectomy, particularly a radical prostatectomy, the surgeons will have removed your prostate.

While the prostate isnt directly responsible for your libido or sexual sensation, in some men who have had a prostatectomy, there can be damage to nerves or blood vessels.

The prostate is next to a dense group of nerves and the seminal vesicles .

There is a heightened chance of an infection such as spermatocystitis which can cause you pain or in some cases impotence.

Even with less invasive surgeries, the most common complaint or side effect tends to be sexual in nature.

However, according to systematic reviews and meta-analysis of the scientific data, these cases of sexual dysfunction are often associated with psychological factors that might be present before surgery or as a result of stress related to the surgical procedure.

Radiation therapy can impact the pelvic floor muscles and nerves that control erections and provide pleasure.

According to a 2016 study, around half of Prostate Cancer patients who have any form of radiation therapy go on to develop erectile dysfunction.

For a large section of men who opt for radiation-based therapies, the first stage is usually hormone therapy.

That means a drug like Lupron which inhibits or completely stops the production of Testosterone, the hormone most responsible for mens sex drive.

Getting Help For Sexual Dysfunction

PROSTATE SURGERY AND EXERCISE

Many treatment options and supports are available for sexual problems. The best outcomes occur with a combination of treatment for erectile dysfunction and counselling to improve coping skills and your relationship with your partner.

Your urologist will be able to prescribe and advise you on treatment options for erectile dysfunction. Also, the Prostate Cancer Centre offers support groups and information for men dealing with sexual dysfunction following prostate cancer treatment.

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What Is Erection Restoration

UCLA HealthThe Mens Clinic offers a penile rehabilitation program for men after prostate cancer therapy. You do not have to have your cancer care through UCLA Health to see the specialists at The Mens Clinic. The idea of penile rehabilitation is to optimize blood flow to the erectile tissue as it is recovering from surgery or radiation therapy.

Can A Man Function Sexually Without A Prostate

Life without a prostate can be different. While regaining an erection after prostate removal may not be possible for every patient, an erection is not the only way to have a satisfying sex life.

  • Sexual fulfillment

People also ask, does prostate removal cause impotence? What is the chance of impotence after prostate surgery?

Research institutions studied sexual and urinary function 1 or more years after radical prostatectomy. Findings suggest that incontinence rates ranged from 4% to 40%. And the odds of impotence were as high as 29% to 75%.

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Percentage Of Men Obtaining Full Erections 2 Years After Open Prostatectomy

15% 13%

As one can see, the chance of regaining potency diminishes with age and with the number of nerves damaged. Even though it is usually technically possible to spare the nerves, sometimes the nerves themselves are cancerous and must be removed since the primary goal of the surgeon is to remove the prostate cancer. If the cancer has not reached the nerves controlling erection, the da Vinci Robot has the visual capabilities and the precision necessary to spare these nerves in most cases, thus it is possible that using the robot may add to the chances of being potent after surgery. However, there is no way to guarantee this due to variability in patient anatomy and condition. It is important to realize that some men never regain the ability to maintain an erection after robotic prostatectomy.

As mentioned above, medical therapy may aid in return to erections, but this has not as of yet been fully substantiated. Usage of sildenafil and newer erectile medications may potentially increase the potency percentages in the table above but this has not been proven. A recently presented study found that daily doses of 50mg or 100mg sildenafil for 9 months increased full erections by 7 fold when compared with a group who did not receive any medication.

I Don’t Have Erections After Surgery Am I Impotent For Life

Treatment Strategies for Men Who Have Advanced Prostate Cancer

Think of your erections as a well conditioned athlete, who has been injured. This injury is going to take time to heal. You should try to remain patient, and remember that this will be an ongoing battle for many months and even years. Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.

If you see any fullness in your erections in the months after your robotic prostatectomy surgery, this is a positive sign that some of the nerves are working or re-growing. You are taking the first steps down the potency recovery path. Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.

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Erection After Prostate Cancer Treatment

Following prostate cancer treatment of any kind, it is a possibility that you will no longer be able to have an erection. If you are unable to have an erection following treatment, this condition may last only for a short time or could be permanent.

All of the currently available, potentially curative treatment options for prostate cancer can result in temporary or permanent erectile dysfunction , though many men who undergo treatment for prostate cancer see little or no ill effects to their erectile function. Radiation therapy, prostate surgery, cryotherapy, hormone therapy, and others can all result in ED.

Unfortunately, there is no definitive way to determine which men will have ED following treatment. In general, men with vascular conditions, diabetes, obesity, or pre-existing erectile problems are at greater risk for ED.

Studies that have sought to determine the chance of men having ED following prostatectomy, radiation, and other prostate cancer treatments have resulted in widely varying numbers. Some studies seem to show that only a small percentage of men have long-standing issues with ED, while others have shown much higher numbers.

Additionally, for men being treated with hormone deprivation therapy, the symptoms of ED often end after stopping the treatment.

Can I Have Sex During Treatment

There are a few factors that determine if sexual activity is safe during treatment.

  • In general, sexual activity is fine during treatment as interest, energy, and comfort levels allow. While you may not feel up to sexual intimacy after surgeries or during chemotherapy and radiation hugging, kissing, holding hands, and massages may feel good and be comforting.
  • If you had surgery involving the pelvic area , you may need to allow extra time for healing before having sex that involves penile stimulation or vaginal or rectal penetration . If you are being treated for oral cancer, use caution during oral sex.
  • If you have mouth sores , you should not perform oral sex.
  • Do not have vaginal intercourse if you have open sores on your genitals.
  • If you received brachytherapy for prostate cancer , be sure to follow your oncology teamâs guidance about limiting close physical contact to avoid exposing your partner to radiation.

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How Long Does It Take For Nerves To Heal After Prostatectomy

How long does nerve regeneration take? Recovery of potency may be very rapid in younger patients and is sometimes immediate. However, for most patients the recovery is gradual and can take up to 3 years to plateau, although typically a patient sees a return to erectile function after about 12 months .

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