Prostate Removal: 8 Things to Know

The prostate gland is part of the male reproductive system
and lies below the urinary bladder. It is a walnut-sized gland that makes a component of semen. The
two main reasons to remove the prostate are an enlarged prostate and prostate
cancer. If you or a loved one needs prostate removal surgery (prostatectomy),
it’s important to know there are different surgical approaches with different
potential complications and recovery times. Get the facts so you can discuss
the details with your doctor and increase your chances of a successful outcome.

Your doctor may recommend prostate surgery to treat BPH (benign prostatic
hyperplasia) or prostate cancer. BPH
is an enlargement of the prostate gland that happens with age. BPH causes
urinary problems, including incontinence, dribbling, difficulty starting or
stopping, painful urination, and incomplete emptying of the bladder. It’s the
most common prostate problem in men older than 50. Prostate cancer causes
similar symptoms and affects 1 in 7 men in the United States.

Simple prostatectomy removes
just the inside portion of the prostate with a cut from your belly button to
your pubic bone. Radical prostatectomy removes the entire prostate and nearby
lymph nodes with a larger incision or series of smaller incisions under your
testicles or above your pubic bone. It’s the most common procedure doctors
perform for prostate cancer. TURP (transurethral resection of the prostate)
removes all or part of the prostate in pieces through your urethra with a
tube-shaped tool called a cystoscope.

Urologists specialize in diseases and conditions of the urinary tract
and male reproductive organs. Depending on the procedure, it may take place in
a hospital or an outpatient surgery clinic. You will likely have general
anesthesia to put you to sleep. In some cases, doctors use regional anesthesia
and a sedative to help you stay relaxed and comfortable, but you are awake
during the procedure. For outpatient surgery, you will go home the same day. Otherwise,
you may stay in the hospital for a few days.

The general
risks of any surgery include reactions to anesthesia, bleeding, blood clots,
and infections. Other risks of prostate removal include infertility, ED
(erectile dysfunction), urethral narrowing, urinary incontinence, and
retrograde ejaculation—when semen flows into the bladder instead of out the
urethra. Damage to the urethra, bladder, rectum or nerves may also occur. Ask
your urologist about your specific risks and what he or she will do to prevent
or correct them if they happen.

You will have a catheter after surgery to drain urine from
your bladder and give your urethra time to heal. It will stay in place for a
few days to a few weeks. You may have a frequent urge to urinate and small
amounts of blood for up to a month after the catheter is out. These symptoms
should improve steadily with time. Full recovery can take about four weeks. In
general, radical prostatectomy has a longer recovery than the other types of
prostate removal.

Urinary
incontinence is one of the major concerns after prostate removal. In most
cases, it takes a few weeks to months to fully regain the ability to control
urine. It’s rare for men to permanently lose bladder control. Younger men are
less likely to have problems. Problems are also less likely with an experienced
urologist who has performed many procedures. There are several methods your
doctor can use to help you manage urinary incontinence and improve bladder
control.

ED is the other major concern most men have about prostate
removal. Almost all men will have some difficulty achieving an erection after
prostate removal. It is less likely to be a problem in younger men. It is also
less likely with procedures that do not cut the nerve supply. When it happens,
it can take up to two years to regain normal erectile function. In the
meantime, doctors may recommend medicines and other treatments. Similar to
postsurgical urinary incontinence, these problems occur less frequently with an
experienced urologist.

The main difference is there will not be semen to ejaculate
after prostate removal. Instead, it becomes a “dry” orgasm. Some men also have
changes in the intensity of the experience—sometimes weaker and sometimes
stronger. For men with ED after prostate removal, it is still possible to
achieve orgasm—an erection isn’t necessary. The nerves that control erection
are not the same as those involved in orgasm. Have an honest conversation with
your doctor and your partner about strategies to improve pleasure during
intimacy.