Prostate Surgery Side Effects and Treatment Options

Posted by Renee Reintzel on Jul 3rd 2024

There are two reasons that someone would need to have prostate surgery:

1. To relieve obstruction to the flow of urine, often caused by benign prostatic hyperplasia.

2. To treat cancer.

Most of the time, this procedure is done to relieve the flow of urine. Because the ureter runs directly through the prostate, enlarged prostate tissue can block the flow of urine. Surgery should help let the urine run freely.

If prostate surgery is performed as part of a cancer treatment plan, your physician may recommend a prostatectomy (partial or complete removal of the prostate). This is considered a more radical treatment and may result in a range of side effects, including urinary incontinence and erectile dysfunction.

Side Effects of Prostate Surgery

While often necessary, prostate surgery can bring a variety of side effects that may impact quality of life.

Urinary incontinence

Immediately after surgery, you may have urine leakage or dribbling, or in some cases inability to control urine. Bladder control usually improves slowly over the following weeks and months, however the path to regaining function in any one individual is difficult to predict. In general, older adults tend to have more challenges with incontinence than younger adults. Large cancer centers - where prostate surgery is done frequently, and surgeons have a lot of experience - tend to have fewer reported incontinence issues among patients.

The good news is that incontinence is treatable, and function is often regained. If you or someone you love experience incontinence after prostate surgery, there are a wide range of treatment and management options available.

Erectile dysfunction (impotence)

Erectile dysfunction (ED) means the inability to develop an erection sufficient for sexual penetration. Erections are controlled by 2 tiny bundles of nerves that run along either side of the prostate. When possible, surgeons will try to avoid injuring these nerves during a prostatectomy. However, if cancer is close to or has penetrated the nerves, a nerve-sparing approach may not be possible.

If both nerves are removed, erections still may be possible through ED treatment options, including phosphodiesterase-5 inhibitors (such as Viagra), alprostadil (a hormone-like substance that mimics natural prostaglandin E1, which can produce erections), vacuum devices, or penile implants.

Your ability to achieve erection after surgery depends on your age, your erectile function before the operation, and whether the nerves were removed or severed. Most individuals will probably have at least some erectile dysfunction, but younger individuals are less likely to be seriously affected.

Experienced prostatectomy surgeons to report lower rates of erection problems among their patients than surgeons who do the surgery less frequently.

Changes in orgasm

After surgery, you should still experience the pleasurable sensation of orgasm, but there is no ejaculation of semen. The glands that made most of the fluid for semen (the seminal vesicles and prostate) are often removed during a prostatectomy, and the pathways used by sperm (the vas deferens) were cut, leading to a “dry” orgasm.

Fertility Loss

As mentioned above, in a radical prostatectomy, the surgeon cuts the vas deferens. These are the pathways between the testicles and the urethra. Your testicles will still make sperm, but they can’t leave the body via the urethra as a part of the ejaculate. Parenthood via fertility treatment may still be possible as long as your testicles continue to make sperm.

Fertility loss can be less of an issue with older adults, however the loss of fertility can have an emotional impact that should be anticipated and supported. If you have concerns about fertility loss, talk to your doctor about banking sperm for future use in fertility treatments.

Additional Side Effects

Less common side effects of a prostatectomy may also include lymphedema – the collection of lymph fluid in the genital area – and a small decrease in penis length. A small decrease in penis length is possible due to the shortening of the urethra when a portion of it is removed with the prostate gland. A prostatectomy also increases future risk of developing a hernia in the groin (inguinal hernia).

Treatment Options for Incontinence from Prostate Surgery

Bladder retraining

You can retrain your own bladder to suppress the desire to urinate. The best way to approach this is to create a consistent schedule to use the restroom. The less frequently you use the bathroom, the less frequently you will feel the need to urinate.

First, note down every trip to the bathroom in a bladder journal for a few days. This can help you be more aware of your current schedule. After you have a good grasp of your wait time between voids, try to increase the wait time by a few minutes between each trip. Over time, this can push your voids farther apart and build your capacity to hold urine.

Pelvic floor exercises

Doing pelvic floor exercises can reduce the urge to urinate. The muscles in your pelvic floor are like a hammock supporting your bladder and bowels. Strengthening these muscles can help with things like stress and urgency when you need to urinate.

Ask a physiotherapist or nurse at your hospital to show you how to do pelvic floor exercises after surgery. You can also learn to do them by yourself at home.

First, find the right muscles to work out. Try sitting comfortably with your legs, bottom, and stomach muscles relaxed. Then, tighten the muscles around your anus as if you are trying to hold in the urge to excrete. You should feel the muscle move. Try not to squeeze your bottom or tighten your legs or stomach muscles.

Once you've found the right muscles, sit, stand, or lie with your knees a little bit apart. Slowly tighten and pull up the muscles as hard as you can. Hold that clench for 10 seconds, and then relax. Build up your strength until you can do 10 slow squeezes at a time, holding each squeeze for 10 seconds, with rests of 5 seconds in between.

Your pelvic floor muscles also need to react quickly to sudden stresses like coughing, laughing, or doing exercise. To practice some quick squeezes, tighten the muscles for just one second before relaxing. Do as many quick and rapid tightening repetitions as possible for 10 seconds, then relax for 5 seconds. Build up your strength until you can do 10 repetitions of 10 seconds each, with a 5 second rest between each one.

It takes time for exercise to make muscles stronger. If you are doing them correctly, there will be no external sign, no tensing of your legs, bottom, or stomach.

Products for Managing Incontinence

A wide range of incontinence products are unisex, however there are a handful of products designed specifically for men. If you are recovering from prostate surgery and are managing incontinence, the following products can provide discreet protection during your recovery and while function is regained: