Prostatectomy and Side Effects

Upon my prostate cancer diagnosis, I had an in-depth discussion with my urologist. He was very upfront with information and stressed the importance of reaching out to others — both other patients and doctors — to discuss my concerns. During my scans, it was discovered that I also had an inguinal hernia that would need repair.

This was an integral part of my decision to have surgery versus radiation therapy.

I wanted to know the good — and the bad — about surgery

If I elected to have radiation, I would need to have the hernia surgery prior to starting radiation. Radiation treatments alter surgical procedures because radiation changes tissue. I actually asked my urologist, given my circumstances and scan results, what he would choose if he were me. That was a tough conversation, but I have medical education and training, and he realized I would pursue that answer.

Once the decision for a robot-assisted laparoscopic prostatectomy was made, I came back at another appointment with both doctors who would be involved. I made it clear I wanted to know everything — good, bad, or otherwise — regarding the surgery and the aftermath.

Preparing for side effects of surgery

Both my urologist and the pelvic specialist surgeon were great. I had lost a lot of weight while on a health reset (130 lbs). My exercise routine was seen as beneficial to my recovery by both doctors.

Here are the side effects of surgery we discussed or that happened.

Incontinence

The first discussion revolved around possible incontinence and what I could do to help with that. My urologist discussed how most of his patients had incontinence for a few weeks post-surgery, and that physical therapy could assist me with similar results. The pelvic surgeon agreed and mentioned that the hernia repair could also cause some issues with incontinence, but only temporarily.

They put me in contact with a physical therapist who could set up a series of exercises that would be beneficial after surgery.

Erectile dysfunction

My urologist then went on to discuss issues regarding erectile function. Some surgeries are “nerve-sparing,” and in those cases, erectile dysfunction is usually found to be temporary. However, mine would not spare the nerves. The biopsy and scans had identified perineural invasion. I would require a specific medication to achieve an erection.

I asked if that meant Viagra or Cialis, or some other medication. He clearly told me they would not be effective without the nerves. Instead, I would need to use an injection to achieve an erection.

Other alternatives that I could look at were a penile implant or the use of injections. My urologist was not a big supporter of implants, as there are possible complications. He advised that he saw them as a last resort treatment if all else failed.

Loss of penis length after surgery

In my conversations with a friend who is a doctor, he pointed out that a prostatectomy can also cause a loss of penis length. My urologist concurred that yes, surgery may lead to a loss of length. The numbers — both for how many men experience this and how much loss in length they experience — vary greatly. As a gay man, my doctor asked if this concerned me. I told him being healthy was a bigger concern. My partner also said that was his concern.

My urologist said that 20% to 40% of men report losing 1 to 4 cm of penile length after surgery. For some men, the change is temporary, with recovery occurring within several months to a few years. I lost about 2 cm and do not believe it has returned. But this has never been a concern for either my partner or me.

How I used injections to achieve erections

Understandably, injecting the penis can feel intimidating, and finding the right dose takes some trial and error. Too much medication can cause priapism and require emergency care. Because the injection takes about 15 minutes to work, intercourse requires some planning. Proper placement is also important.

My urologist scheduled an appointment a few weeks after surgery to administer my first injection to achieve an erection and demonstrate the process. He used a small dose so the erection would not last long. Although the procedure may seem daunting at first, it soon becomes manageable.

The needle is small, similar to one used for allergy injections. A specialized mail-order pharmacy prepares the medication and ships it in refrigerated packaging, and it must remain refrigerated. A person typically receives instructions on the initial dose and how to increase it gradually over the first few injections until they find the amount that works for them. Report any problems to your doctor.

Adapting to changes in climax and intimacy

Without a prostate, the body no longer produces the fluid that makes up semen, so orgasm is usually “dry.” However, the wife of another patient I met suggested using condoms because her husband sometimes released urine during orgasm. I found that I experienced the same issue. This condition, called climacturia, can occur because of nerve damage from surgery.¹

My partner has supported me throughout this journey. Neither of us is concerned about the loss of penis length. Although sensation in my penis has changed, I can still achieve orgasm. We have actually seen our intimacy increase as a result.

Above all, being healthy and able to enjoy life is our greatest reward. I have never measured my worth by my penis. I am much more than that, and my partner would agree.