Living without a pros­tate: consequences of pros­tate surgery

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Men with prostate cancer often have to have their entire prostate gland removed. But living without a prostate will restrict their lives in certain ways. Incontinence is just one of the potential consequences.

Prostate's function

Put simply, the prostate is a valve that regulates the flow of urine and sperm. It also produces a fluid that is partly responsible for creating semen. The older a man is, the greater his chances of getting prostatitis or prostate cancer, the most common form of cancer in men over 65.

 

Treating prostate complaints

If prostate cancer requires treatment, radiation therapy may be used or the entire prostate may be surgically removed. In very early stages of the disease, it's possible to remove only part of the prostate gland using ultrasound waves.

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The prostate is located below the bladder, with the urethra passing through it.

Prostate surgery

Prof. Daniel Eberli, Director of the Department of Urology at University Hospital Zurich, has this to say: «In most cases, the procedure is performed using what is known as the Da Vinci method, a high-precision robotic technique in which the operator steers the robot arm via a console.» This minimally invasive surgery not only lets patients recover more quickly, it also minimises the chances of damage being caused to the neural pathways that run along the prostate and which are partly responsible for erection.

Influence on erection

«So, if the operation goes to plan and the tumour isn't already too big, it shouldn't cause any erectile dysfunction,» points out Daniel Eberli. «However,» he goes on to say, «men without a prostate will only experience a dry orgasm without ejaculating as, without this gland, they're no longer able to produce semen.» This is because the seminal vesicles are also removed along with the prostate, and the vas deferens are tied off. Men who have a full prostatectomy are thus no longer able to have children.

Incontinence as a side-effect

Almost all men who have a radical prostatectomy experience some difficulty in holding their urine immediately after the operation. «However, in most cases, this incontinence disappears again during the first few months after a radical prostatectomy,» says Daniel Eberli. «But about 5-10% of those affected will remain incontinent, which can adversely impact their life in a number of ways.»

 

Incontinence during sex

In this context, Daniel Eberle makes particular mention of climacturia, i.e. urinary incontinence during sexual activity. «Climacturia affects a small number of patients. However, the problem lessens the more time passes after the surgery.» Urinating before sexual activity and wearing a condom are potential ways to alleviate the problem.

Post-prostatectomy therapy and treatment

There are basically a variety of ways to manage urinary incontinence. These include:

  • Losing weight: The higher the weight, the greater the pressure on the abdominal cavity and the bladder. Therefore, losing weight can help patients alleviate incontinence.
  • Exercise: It can help to strengthen the pelvic muscles in a natural way. Gymnastics, walking, hiking, cycling or even yoga are recommended.
  • Stopping smoking: Heavy smokers especially suffer from chronic coughing, which places a strain on the pelvic floor.
  • Medication: If conventional methods don't improve the situation, your doctor may prescribe medication for you to try.
  • Operation: In cases of severe incontinence lasting for more than a year, surgery may be considered if all other measures have proved unsuccessful. «In these cases, an artificial urinary sphincter is fitted to bring the patient's urinary habits back under control.»
  • Pelvic floor training for men: This form of training aims to strengthen the remaining urinary sphincter system and get it working better again.

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