prostate surgery

Prostatectomy , Radical , Side effects , Urine Incontinece , Impotence

side effects of prostate surgery:

The main possible side effects of radical prostatectomy are urinary incontinence (lack of bladder control) and erectile dysfunction (impotence; difficulty getting and keeping erections). These side effects can also occur with other forms of prostate cancer treatment.

1- Urinary incontinence:

 You may not be able to control your urine or you may leak or dribble urine. Having incontinence can affect you not only physically, but also emotionally and socially. The following are the main types of incontinence:

Men with stress urinary incontinence may leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. Problems with the valve that holds urine in the bladder (bladder sphincter) usually cause stress incontinence. Prostate cancer treatments can damage this valve or the nerves that make the valve work.

Men with overflow incontinence have difficulty emptying their bladder. These men take a long time to urinate and have a dribbling stream with little force. Usually, blockage or narrowing of the bladder outlet due to scar tissue causes overflow incontinence.

Men with urge incontinence have a sudden need to urinate. This occurs when the bladder becomes too sensitive to stretch as it fills with urine.

Rarely, men lose all ability to control urination after surgery, known as ongoing incontinence.

After prostate cancer surgery, normal bladder control usually returns within several weeks or months. Recovery usually occurs slowly over time.

Prostatectomy , Erectile dysfunction , Sperm , Infertility , Vas deferens , Sildenafil , Surgery

Doctors cannot predict with certainty how a man will be affected after surgery. In general, older men tend to have more incontinence problems than younger men. Large cancer treatment centers where prostate surgery is performed frequently, and where surgeons are highly experienced, report fewer incontinence problems.

Incontinence can be treated. Even if your incontinence cannot be completely corrected, it can be lessened. To learn about managing and living with incontinence, see Urinary and Bowel Incontinence.

2- Erectile dysfunction (impotence): 

This means that you cannot achieve an erection sufficient for sexual penetration.

Erections are controlled by two small groups of nerves that run on both sides of the prostate. If you were able to have erections before surgery, the surgeon will try not to affect these nerves during the prostatectomy. This is known as nerve sparing. However, the surgeon will have to remove the nerves if the cancer is growing within them or very close to them.

If both nerves are removed, you will not be able to have spontaneous erections, although you may still be able to have erections using some of the aids described below. If the nerves on only one side are removed, you may still be able to get erections, but that chance will be less than if none of the nerves were removed. If none of the nerve bundles are removed, you may be able to regain normal erections sometime after surgery.

After this operation, the ability to get erections depends on your age, your ability to get erections before the operation, and whether the nerves were cut. All men can expect a reduction in the ability to have erections, but the younger you are, the more likely you are to retain this ability.

Surgeons who perform many radical prostatectomies tend to report lower impotence rates than physicians who perform the surgery less frequently. A wide range of impotence rates have been reported in the medical literature, but every man's situation is different. Therefore, the best way to get an idea of ​​your chances of regaining erections is to ask your doctor about their success rates and what the outlook is likely to be for you.

If his ability to get erections returns after surgery, it often comes back slowly. In fact, this may take anywhere from a few months to two years. For the first few months, you probably won't be able to get an erection on your own, so you may need medication or other treatments.

Most physicians believe that regaining potency is aided by attempting to achieve a erection as soon as possible after the body has had a chance to heal (usually several weeks after the operation). Some doctors call this penile rehabilitation. The use of medications (see information below) may be helpful at this time. Be sure to talk to your doctor about your particular situation.

There are several options to treat erectile dysfunction:

- Phosphodiesterase 5 (PDE5) inhibitors such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra) are medications that can help achieve erections. These medicines will not work if both nerves that control erections are affected or if they were removed. The most common side effects of these medications are headache, flushing (skin becomes red and warm), indigestion, sensitivity to light, and a runny or stuffy nose. Rarely, these medications can cause vision problems, including possibly blindness. Some other medications, such as nitrates used to treat heart disease, can cause problems if you are taking a PDE5 inhibitor. Therefore, be sure to tell your doctor what medications you are taking.

- Alprostadil is a synthetic version of prostaglandin E1, a substance that occurs naturally in the body and can cause erections. This medicine can be injected almost painlessly at the base of the penis 5 to 10 minutes before intercourse, or placed on the tip of the penis as a suppository. You can even increase the dose to prolong the erection. Side effects such as pain, dizziness, and a prolonged erection are possible, but these effects are usually not serious.

- Vacuum devices are another option for achieving an erection. These mechanical pumps are placed on the penis. Air is sucked out of the pump causing blood to be drawn into the penis to produce an erection. The erection is maintained after removal of the pump by a strong elastic that is placed at the base of the penis. The tape is removed after sex.

If other methods don't help, penile implants may restore the ability to have erections. An operation is necessary to place the implants inside the penis. There are several types of penile implants, including those that use silicone rods or inflatable devices.

3- Changes in orgasm:

 After surgery, the sensation of orgasm should continue to be pleasurable, but there is no ejaculation of semen (orgasm is “dry”). This is because the glands that produce most of the fluid for semen (the seminal vesicles and the prostate) were removed during the prostatectomy, and the tubes that the sperm passed through (the vas deferens) were cut. In some men, orgasms may be less intense or disappear altogether. Less often, men experience pain with orgasm.

4- Infertility: 

Radical prostatectomy cuts the vas deferens, the tubes between the testicles (where sperm are made) and the urethra (where sperm leave the body). His testicles will continue to produce sperm, although the sperm will not be able to leave the body as part of the ejaculation. This means that a man will no longer be able to father a child naturally. This is often not a problem since men with prostate cancer tend to be older. However, if you are concerned about this, you can talk to your doctor about how to "store" your sperm before the operation. For more information, see Fertility and Men With Cancer.

Prostatectomy , Erectile Dysfunction , Incontinence , Penis , Doctors , Lympghedema, medications.

5- Lymphedema: 

This is a rare complication, but it can occur after removal of many of the lymph nodes around the prostate. Normally the lymph nodes are a pathway for fluid to return to the heart from all areas of the body. When nodes are removed, fluid can build up in the legs or genital area over time, causing swelling and pain. This condition can usually be treated with physical therapy, although it may not go away completely. You can learn more on our lymphedema page.

6- Change in the length of the penis: 

One of the possible effects of the surgery is a small reduction in the length of the penis. This may probably be due to a shortening of the urethra that occurs when a portion of the urethra is removed along with the prostate.

7- Inguinal hernia: 

A prostatectomy increases the chance that a man will have an inguinal (groin) hernia in the future.