What happens to men when the prostate is removed?

In men, the prostate can be removed in cases of prostate cancer, especially when the tumor is at an advanced stage or there is a risk of metastases. “Removal of the prostate is a relatively well-experienced operation from a post-operative point of view, with little pain or immediate complications. A man can live well without a prostate. However, there can be two functional consequences once the prostate is removed, tells us Dr Guillaume Ploussard, urological surgeon, “prostate” referent at the French Association of Urology (AFU).

The first consequence is urinary incontinence called “stress” which occurs for example when the man coughs, sneezes, changes position, walks… Overall, 60% of men without a prostate have urinary leakage after an operation, but you should know that the vast majority of these leaks disappear within 3 months following the operation, either spontaneously or thanks to perineal physiotherapy. “To prevent urinary incontinence, we advise patients before the operation to see a physiotherapist for one or two sessions, not necessarily to strengthen the sphincter, but to become aware of the role of the sphincter and to teach them to contract the correct muscle when he makes an effort“.

The second consequence concerns sexuality. If there are not necessarily official recommendations concerning the resumption of sexual relations after prostate removal, common sense dictates that we wait roughly 15 days before resuming sexual activity. “After removal of the prostate, the man will retain the desire to make love, he will still have pleasure, orgasm, but he will no longer have ejaculation because when we remove the prostate, we remove with it the seminal vesicles which produce sperm. Also, the man may have erection difficulties“This lack of rigidity is common after prostate surgery because the erection nerves (attached to the prostate) may be impaired during the operation.”In certain very advanced cancers, we are obliged to sacrifice them. In cancers that are not very advanced, we will preserve them, but the nerves can be stretched or traumatized, which can cause a sort of nervous paralysis and therefore a lack of transient rigidity.” he explains.

The man can resort, at his request, to medications to improve his erection: either tablets (Viagra®, Cialis® for example), or the application of a gel to the glans or the injection of a product in the penis which will cause an erection before each intercourse. The erection may return over time, up to 3 years following the procedure. “It’s a nervous regrowth, so it’s long, but we must not lose hoper” he specifies. Men can rest assured, doctors offer effective support for these two functional problems. “And in the worst case, we know how to repair the leaks with surgery and we also know how to put in place erection prostheses, but it remains exceptional to go that far.” Consequences on hormonal function? “Noreplies our interlocutor. Even though the prostate is an internal genital organ, it is not an organ that will have a hormonal function, so there is no hormonal disruption in men, no andropause, no drop in testosterone.”