Prostatectomy And Sexual Issues
As a man, your prostate gland plays several important roles in your bodys sexual and urinary function.
During sex, your prostate gland is responsible for releasing seminal fluid, or semen, into your urethra. As you reach orgasm and ejaculate, the muscle tissue of your prostate forces semen and sperm out from your penis.
The nerves that surround your prostate also play an important role in allowing blood to flow to the erectile tissue of your penis when youre sexually aroused.
Because prostate surgery involves removing the prostate gland, its normal to lose some parts of your normal sexual function after the surgery.
For example, radical prostatectomy involves cutting the connection between your urethra and your testicles. This means that sperm is no longer able to flow down your urethra and out the tip of your penis during sex.
As a result of this, men who undergo radical prostatectomy surgery can still reach orgasm, but arent able to ejaculate.
Several different approaches are used to remove your prostate gland during surgery. Some of these approaches particularly those used to treat prostate cancer may result in damage to the nerves that surround your prostate gland, testicles and penis.
Nerve damage caused by prostatectomy surgery may affect your erectile health. If your nerves need to be cut during the procedure , you may find it difficult or impossible to get and/or maintain an erection after surgery.
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Types Of Prostate Surgery
There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.
Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.
The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.
Keyhole surgery .
- Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da VinciÂ® Robot.
- Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.
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Within 30 Days Of Your Surgery
Before your surgery, youll have an appointment for presurgical testing . The date, time, and location will be printed on the appointment reminder from your surgeons office. Its helpful to bring the following things to your PST appointment:
- A list of all the medications youre taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name and telephone number of your healthcare provider.
You can eat and take your usual medications the day of your appointment.
During your PST appointment, youll meet with a nurse practitioner . They work closely with anesthesiology staff . Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
Complete a Health Care Proxy form
If you havent already completed a Health Care Proxy form, we recommend you complete one now. If youve already completed one or have any other advance directives, bring them to your next appointment.
Male Sexual and Reproductive Medicine Program
Do breathing and coughing exercises
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Reasons For The Procedure
The goal of radical prostatectomy is to remove all prostate cancer. RP isused when the cancer is believed to be confined to the prostate gland.During the procedure, the prostate gland and some tissue around the gland,including the seminal vesicles, are removed. The seminal vesicles are thetwo sacs that connect to the vas deferens , and secrete semen.Other less common reasons for radical prostatectomy include:
Inability to completely empty the bladder
Recurrent bleeding from the prostate
Bladder stones with prostate enlargement
Very slow urination
Increased pressure on the ureters and kidneys from urinary retention
There may be other reasons for your doctor to recommend a prostatectomy.
How Will Sex After Prostate Cancer Be Different
One of the treatments of prostate cancer is to remove a portion of the prostate or the totality of the gland before cancer spreads beyond it You may have heard that the tumor is inside the capsule, but moving fast.
The procedure is known as radical prostatectomy and involves incisions, either above the perineum or on the lower abdomen.
Newer surgeries are sometimes robot-assisted, and we also have laparoscopic prostatectomies that do not require a large incision.
The end result is the removal of a portion or the totality of the prostate, and certain surgical approaches may be associated with a lower risk of nerve damage than others. Youll see this referred to as nerve-sparing prostatectomies throughout this guide.
As soon as a man is informed that he will need to go through a Radical Prostatectomy, the likelihood is that one of the very first questions will be about the effect that it will have on their sex life. In a lot of mens minds, the surgery is thought of like its castration.
However, now that there are multiple types of nerve-sparing prostate surgery, many men have found they can maintain sexual activity after surgery.
Likewise, there are plenty of sexual activities open to those who do find they still have the desire, even with some physical changes. We want to help you understand the changes that men can experience after prostate surgery, whether that is physical or mental.
For more information on prostate surgery, click here.
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Should You Worry About An Elevated Psa After Prostate Removal
PSA stands for prostate-specific antigen and is often a very good indicator of how effective treatment has been, in case of prostate removal or other prostate surgeries.
After prostate surgery, the PSA level gets very low, but this result isnt always reliable. Thats why the patient should discuss the expected PSA levels after prostatectomy with their doctor.
A lower PSA level following the removal of the prostate gland is only a part of the overall picture. There are many factors to monitor closely after prostate surgery.
Can You Live Without A Prostate
Although the prostate is essential for reproduction, it is not essential to live.
In cases where the cancer is contained to the prostate it can be surgically removed through a prostatectomy.
A radical prostatectomy involves removing the entire prostate gland, the surrounding tissue, and some of the seminal vesicles.
Alternatively, laser prostatectomies can be effective as the least invasive type of prostate removal.
The most common prostatectomy is the transurethral resection of the prostate .
TURPs involve removing part of the prostate gland using a resectoscope which is passed through the urethra – this procedure is commonly used for people with an enlarged prostate.
In come cases prostate cancer can be treated with radiotherapy.
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Am I Too Old To Have Prostate Surgery
How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense that is, for the benefits to outweigh the risks you need to be young enough to take advantage of the added survival time that surgery can offer. Thats why I generally dont recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
What Necessitates Prostate Removal
Prostate cancer and sometimes benign prostatic hyperplasia can necessitate the removal of prostate gland. However, the most common cause is prostatic cancer as BPH can nowadays be managed with other treatment options. The prostate gland removal surgery is known as prostatectomy. The risks, benefits and side-effects of prostatectomy should be discussed with the patient, before making the decision to get prostate gland removed.
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Immediately After A Prostatectomy
- You will stay in hospital for two to five days.
- Nurses will monitor your vital signs.
- Your pain will be managed with medication.
- You may be given antibiotics to reduce the risk of infection.
- You may have a drip inserted into your arm or hand for a few days.
- You will most likely have a drain tube out of your abdomen that will be removed in the first day or two after the surgery.
- You will be fitted with a small tube in your penis. The catheter drains urine into an attached bottle or bag. This catheter will be removed about one to three weeks after the operation. Your surgeon will tell you when it can be removed.
- In most cases, you will have to go home still wearing the catheter. You will be taught how to care for it.
What Does The Prostate Do
The prostate is a small muscular gland located between the base of the penis and the bladder, surrounding the urethra.
Its role is to secrete prostate fluid which is one of the components of semen.
The prostate’s main function is to produce the thick white fluid that mixes with the sperm produced in the testicles, to create semen.
The muscles of the prostate gland help propel this fluid into the urethra during ejaculation.
As men get older their prostate often enlarges.
Benign prostate enlargement causes men to urinate more frequently and is a common medical condition in men over 50.
BPE does not make a patient more likely to develop prostate cancer, however.
The causes of prostate cancer are largely unknown, although research suggests that it’s linked to obesity and family history.
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Life After Prostate Removal
For many men with prostate cancer, prostate removal is never needed because the cancer is often slow-growing and managed with non-surgical treatments. But, if the cancer has grown beyond the prostate, the oncologist may recommend prostate removal surgery, also called a prostatectomy. If you are going to have prostate removal surgery, this information can help you in your discussion with the doctors.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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What Types Of Surgery Are There
Radical prostatectomy involves removing the prostate, part of the urethra and the seminal vesicles. After the prostate is removed, the urethra will be rejoined to the bladder and the vas deferens will be sealed.
Some people are able to have nerve-sparing surgery, which aims to avoid damaging the nerves that control erections. Your doctor will discuss whether this is an option for you. Nerve-sparing radical prostatectomy is more suitable for lower-grade cancers and is only possible if the cancer is not in or close to these nerves. It works best for those who had strong erections before diagnosis. Problems with erections are common even if nerve-sparing surgery is performed.
Cancer cells can spread from the prostate to nearby lymph nodes. For intermediate-risk or high-risk prostate cancer, nearby lymph nodes may also be removed .
How The Surgery Is Done
Different surgical methods may be used to remove the prostate:
- open radical prostatectomy usually done through one long cut in the lower abdomen
- laparoscopic radical prostatectomy small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen for guidance
- robotic-assisted radical prostatectomy laparoscopic surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and move robotic arms that hold the instruments.
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Success Of Radical Prostatectomy
The goal of radical prostatectomy is to cure prostate cancer. But a prostate cancer cure is only possible from prostatectomy if your prostate cancer is limited to the prostate.
During radical prostatectomy, a member of your treatment team examines your removed prostate under a microscope to see if your cancer has reached the edge of the prostate. If so, the prostate cancer has probably spread. In these cases, you may need more treatments.
Men with no evidence of prostate cancer spread have an 85% chance of surviving 10 years after radical prostatectomy.
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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How To Return To An Active Sex Life After Prostate Cancer Treatment
No matter the cancer, treatments often cause side effects that affect patients quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patients sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment.
Unfortunately, sexual dysfunction is a possibility for nearly all treatment options for prostate cancer, including surgery, says Scott Shelfo, MD, FACS, Medical Director of Urology at our hospital near Atlanta. The degree of dysfunction depends on many factors, including the patients overall health, co-existing medical problems, as well as the patients level of sexual function and ability before treatment.
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Using Medication To Reduce Symptoms
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the âstageâ of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.