The Function of the Prostate
The prostate is vital for reproduction. A walnut-sized gland located between the male penis and bladder, the prostate discharges semen (the fluid that sustains and protects sperm) during ejaculation, forces it into the urethra and pushes it out of the body with the sperm.
The prostate gland is also essential to the proper functioning of the urinary tract as it moves urine from your bladder to your penis.
When is Prostate Surgery Used?
The two most common reasons for having prostate surgery are cancer and the treatment of a blocked urethra.
Radical prostatectomy is a method of treating prostate cancer when it is restricted to a small area that has yet spread outside of the prostate gland. This operation removes the entire prostate gland and parts of the tissue surrounding it, including the seminal vessels.
Types of radical prostatectomy include the following:
- Laparoscopic, in which the prostate is removed through several small incisions in your lower abdomen with special small-sized tools using a lighted instrument for viewing.
- Robotically-assisted, in which the prostate is removed through several small incisions in your lower abdomen using instruments that attach to a computer-assisted mechanical device guided by a specially-trained surgeon; this method follows the exact movement of the surgeon’s hands, providing unrivaled efficiency, accuracy, ease, and comfort. Three out of four prostatectomies are performed using this method, making it the clear standard of care.
Advantages of robotic radical prostatectomy include the following:
– Significantly less pain
– Shorter recovery time
– Briefer hospital stay
– Less loss of blood, reducing chances of requiring a transfusion
– Reduced scarring
– More rapid return to normal daily activities
– Often, more favorable sexual potency and continence in clinical outcomes
- Open (retropubic), in which the prostate is removed through an incision in your lower abdomen.
- Blocked Urethra
In cases where prostatectomy is performed to treat a blocked urethra caused by benign prostatic hyperplasia (BPH, a non-cancerous enlargement of the prostate gland), complete removal is not always necessary; the procedure may be performed as open surgery or robotically.
Following Prostate Surgery
If there are no complications, you will probably be walking the day of the surgery, or at least the day after. In most cases, you will be discharged the following day with a catheter, a slim tube that allows urine to flow freely into a drainage bag; this is usually left in place for one to two weeks. Until the catheter is removed, you will not be able to drive.
You will be on a liquid diet at first, slowly graduating to solid “soft” foods. Walking daily is encouraged. For at least six weeks, lifting anything in excess of 30 pounds is prohibited, as are abdominal exercises.
Unless your doctor says otherwise, you should resume your normal activities gradually.
Possible Side Effects of Prostate Surgery
Complications of prostate surgery will depend largely on your current health, age, and the stage of your cancer. There are two significant side effects that may occur:
- Urinary incontinence (inability to control urine flow)
Although following prostate cancer surgery, normal bladder control is usually recovered within several weeks or months, it is difficult to predict how each patient will be affected.
There are three different levels of incontinence that include being unable to control your urine or having dribbling or leakage; these conditions can affect you not only physically but emotionally and socially as well.
- Stress incontinence, the most common of the three, occurs when you leak urine upon laughing, coughing, sneezing, or exercising; this is usually a result of a problem with the bladder sphincter, the valve that keeps urine from escaping from the bladder.
- Overflow incontinence, meaning that you have trouble emptying your bladder, requiring a long time that results in only a trickling flow with little force: scar tissue that blocks or narrows the bladder opening is usually the cause.
- Urge incontinence, a sudden need to urinate, occurs when the bladder is overly sensitive to stretching when filled with urine.
Continuous incontinence, the loss of all ability to control urine flow, is also a possibility but is very rare.
- Erectile dysfunction (impotence), difficulty attaining or retaining erections
Prostate cancer does not cause erectile dysfunction, but prostate surgery may; some degree almost always follows, regardless of the type of technique used. Treatment options for erectile dysfunction post-surgery may include:
- Oral prescription medications, e.g., Cialis, Levitra, Staxyn, Stendra, or Viagra
- A vacuum constriction apparatus that draws blood into the penis, causing an erection
- Medication injected into the penis prior to intercourse (intracavernous injection therapy)
- A drug suppository deposited in the penis prior to intercourse
- Penile implant (prosthesis), which requires an operation
Although your testicles will continue to produce sperm, you will have a loss of fertility: should this be an issue for you, discuss collecting and “banking” your sperm in advance of the procedure with your physician.
There is no ejaculation of semen, and some men report their orgasms as less intense and in rare cases, painful. However, in most men, the sensation of having an orgasm is still gratifying.
When Considering Robotic Radical Prostatectomy
If you are considering prostate surgery, it is vital that you discuss your expectations regarding the outcome with your physician. Make sure you understand the benefits and risks of each option for your situation.