What are the functions of the prostate?

The prostate is a gland located just below the bladder, present only in males. It is about the size of a walnut and has, together with the testicles and seminal vesicles, the function of producing seminal fluid. The urethra, the tube that connects the bladder to the outside through the penis and allows the evacuation of urine, crosses this gland through the center of it, which is why any alteration of the prostate usually manifests itself with urinary symptoms.

What are the consequences of prostate removal?

The removal of the prostate is called radical prostatectomy and is usually performed after the diagnosis of a prostate tumor. The development of the latest surgical techniques, mainly the use of robotic surgery, has greatly minimized and reduced the appearance of side effects after this surgery, and in most cases they do not even appear. Even so, in certain cases of aggressive tumors or the use of other techniques for the treatment of these tumors, certain adverse effects may develop after surgery.

The main side effects of this radical surgery are: urinary incontinence (urine leakage, mainly with some effort) and erectile dysfunction (difficulty in achieving and maintaining erections). These effects are due to the fact that, with the intention of completely eliminating the tumor during surgery, it is sometimes necessary to remove areas through which part of the nerves responsible for controlling these functions run.

Urinary incontinence is defined as the presence of urine leakage or dribbling. There are different levels of incontinence. What must be taken into account is that this effect not only conditions the patient physically, but usually emotionally and socially as well. The following are the three main types of incontinence:

  • Men with stress urinary incontinence may leak urine when coughing, laughing, sneezing or exercising. Stress incontinence is the most common incontinence after prostate surgery. The various treatments for prostate cancer can damage the muscles that form the sphincter (valve that controls the passage of urine) or the nerves that make the muscles that activate the sphincter work. It is a type of incontinence that may appear in the first days or weeks after surgery but usually disappears with time. In some cases, rehabilitation exercises are required to accelerate its disappearance.
  • Men with overflow incontinence have difficulty emptying their bladder. These men need to exert a lot of effort to start urinating, take a long time to finish, and have a weak dribbling flow. It is usually due to a blockage or narrowing of the bladder outlet due to excessive scarring. It is very rare, and requires minor dilation of the duct for resolution.
  • Men with urge incontinence have a sudden urge to urinate. This problem occurs when the bladder becomes overly sensitive or active during bladder filling. It may appear in the first few days after surgery because of the resulting inflammation, but usually disappears after a few weeks when the tissues return to normal.

In general, nowadays, following robotic surgery for prostate cancer, there is normal control of urine continence within a few days or within the first few weeks of surgery. A later resolution of the problem or subsequent actions required for its solution is infrequent.

Erectile dysfunction is defined as impotence or difficulty in achieving an erection sufficient for sexual intercourse. Erections are controlled by two small groups of nerves located on both sides of the prostate. In the case of small prostate tumors, very localized and distant from these areas, and if prior to surgery you had normal erections, the surgeon will try to preserve these nerves during the radical prostatectomy. This is known as bandelette preservation. However, in the case of tumors that are aggressive, larger or closer to the tumors, the surgeon will be forced to resect them with the intention of completely clearing the area of tumor.

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In the first weeks after prostate surgery to remove a tumor in the prostate, it is normal for some degree of impotence to develop, which in many cases gradually recovers without help, and in other cases requires drug treatment for recovery. In one way or another, most patients who have undergone radical prostatectomy, a few months after surgery, can have satisfactory sexual relations.

When should prostate surgery be performed?

There are different types of surgery that can be performed on the prostate depending on the pathology occurring in the prostate. It is common for people to confuse them, but not all prostate operations are the same, nor do they have the same side effects or the same indications. Generally speaking, there are two different types of prostate surgery depending on the reason for which they are performed. The most common is the surgery performed when the prostate grows in size (Benign Prostatic Hypertrophy or BPH). It is a surgery that consists of removing only the part of the prostate that blocks the urine outflow duct to the penis, leaving the rest of the prostate. It can be performed by different techniques: classic open surgery (adenotomy) or through the urethra (resection, vaporization, use of different lasers, etc. ….). It is a partial surgery of the prostate, therefore with hardly any side effects as mentioned above and only reserved in case the patient has a lot of urinary obstructive symptoms and the medications administered in the office have not been sufficient to control the symptoms. It is therefore a surgery to treat a benign pathology (the growth of the prostate), it is partial (so the prostate remains) and usually without any side effects.

On occasions when prostate cancer is diagnosed, one of the treatment options is radical surgery or radical prostatectomy. In this case, if the entire prostate is removed, there may be side effects such as those described above, although with the use of robotic surgery these are practically non-existent or minimal, and it is performed to treat a malignant pathology such as a prostate tumor.

Is it possible to preserve ejaculation after the operation?

In the case of partial prostate surgeries, the patient will preserve ejaculation. It is true that sometimes, in case of surgeries with large prostates, ejaculations called “retrograde” may occur. This means that the semen during orgasm will go backwards, towards the bladder instead of towards the penis, which has no side effects for the patient, except that he will not notice the exit of semen through the penis, and may think that he does not ejaculate. Strictly speaking, he ejaculates backwards, retrograde, although he does not notice anything. In addition, it is advisable to take contraceptive measures in case your partner may become pregnant.

In the case of radical surgery with total removal of the prostate due to the presence of a tumor, the answer is NO, since one of the functions of the prostate is to produce seminal fluid and when it is removed, therefore, it will no longer be produced. Patients will be able to have erections, they will be able to reach orgasm, but they will not expel seminal fluid during orgasm.