MINOR
SIDE EFFECTS OF SURGERY
Most
men are aware of the major side effects (technically termed morbidity) - incontinence
and erectile dysfunction, but some of the minor effects are not as well known.
Here are three:
CLIMACTURIA:
This refers to the leakage of urine at climax for men who are able to achieve
sexual activity after surgery. This is not discussed very often on prostate cancer
sites and this can lead men to believe that they are one of the few men to have
this problem.
There
are few studies on the subject, but one, titled Climacturia
following radical prostatectomy: prevalence and risk factors concludes
:
Climacturia
is a common clinical entity, occurring in almost half of all patients after radical
prostatectomy. It can be a significant problem with respect to urine volume loss,
associated bother and condom use. Patients must be informed about this complication
before undergoing radical prostatectomy.
A
second,
which deals with radical pelvic surgery - mainly bladder removal - but which includes
RP (Radical Prostatectomy) says in relevant part:
Orgasm associated incontinence occurs in a fifth of men (96 of 475) following
radical pelvic surgery. The incidence of orgasm associated incontinence is
greater with radical prostatectomy than with radical cystectomy and it is
unrelated to the type of prostatectomy performed (open vs laparoscopic). Orgasm
associated incontinence is more likely to be reported within year 1 following
surgery and in men who complain of orgasmic pain and/or penile shortening
This
issue is not regarded as a serious problem by many couples, provided that the
man has emptied his bladder before the sexual activity and reduced the amount
of urine that might be expressed. Some couples actually welcome it as a substitute
for the ejaculate which is no longer expelled. There is no danger associated with
the urine, assuming there is no bladder infection.
PEYRONIE'S
DISEASE: From time to time, men who have been diagnosed with prostate cancer,
and specifically those who have chosen surgery, mention that they have been diagnosed
with Peyronie's Disease or Peyronie's Syndrome. This condition is one where the
erect penis acquires a 'bend' or deflection. The vast majority of Peyronie cases
are very mild. It is believed most men don't report it to their doctors or even
their partners and their partners will be quite unaware of it in normal sexual
intercourse, although the situation is different if oral sex is involved. It is
difficult to know how many cases there are - or if these are linked to surgery
or other treatment for disease like prostate cancer. With the advent of the internet,
more men are discussing this in the 'privacy' or 'anonymity' of the internet and
the number of cases is becoming more apparent. It appears however that specialists
around the world are now determining that there are many more cases than they
thought due to under-reporting ( a common men's problem).
There are varying
experiences reported. The variations may be due to the degree of deflection and
the direction - there are lateral, vertical and multiple deflections. Some are
very subtle - a 'mild condition' is considered a deflection (usually to left or
right but sometimes vertically) of 5-25 degrees, intermediate 25 -35 degrees,
etc. Some men have reported that these can heighten their partner's sexual experience.
Grotesque deformities can be 90 degrees or more and in such extreme cases penetration
is impossible. Others report pain, even in the simple process of erection, and
acute pain during masturbation or intercourse.
It seems unlikely that the
condition is directly caused by a disease, or that it has any direct link with
prostate cancer. In fact, the likely reason this condition was originally called
syndrome and not disease is that in the original case studies by Peyronie he determined
that the condition was largely caused by sexual misadventure. A common cause occurs
where the female assumes the superior position and moves up and down on the penis.
The penis is accidentally released on an upward stroke and she comes down on the
penis in the next downstroke, bending it double. A very small number of deformities
are caused by trauma (accidents) to the pelvic area.
Although the traumatic
event is often extremely painful at the time, the condition may not manifest itself
until later - sometimes months, more often years. It is caused by the blood failing
to circulate through the injury. It's not really much different from many other
injuries, especially sporting injuries that occur, are dealt with at the time,
but show up later.
Simply put, erections are caused by two 'sacks' one
on either side of the penis filling with blood. When the penis is bent or suffers
other trauma the tissue in/around the sacs is damaged. It may take some time for
it to deteriorate. This theory is apparently supported by studies involving large
numbers of men who reported such traumas. It also appears to be supported by the
fact that surgery to restore the blood flow in the affected area invariably finds
the tissue damage synonymous with these traumas. Recently, researchers, private
individual and some doctors have suggested that the condition could be caused
by other factors - such as surgical procedures. This is relatively new thinking
as limited blood flow in the penis itself was originally attributed as the sole
cause. Now researchers are also considering blood flow in the delivery to the
penis and nerve damage that activates the blood flow. However one of the persistent
problems in determining causal factors is that the condition rarely if ever occurs
immediately after the trauma or surgery. So linking the two events is difficult.
The
condition may be operable, depending on degree. Various methods including opening/restoring,
insertions etc. A general appraisal of reports seems to indicate that if the condition
doesn't rapidly deteriorate within 12 months, then it won't at all. Care should
be taken in selecting any offer to 'cure' this condition. There are many cases
to found in Internet searches of men who have had completely unsatisfactory experiences
with so-called 'treatments' or 'cures'. The general consensus seems to be that,
so far anyway, successful 'rectifications' are rare.
Dean
Hill, Administrator/CEO, Peyronies Disease Society has set up a number of sites
dealing with this issue. The main site is PEYRONIES
DISEASE SOCIETY, whilst there are also two Forums for discussion.
The general open Forum is PEYRONIES
DISEASE SOCIETY SUPPORT FORUM and the second, closed forum for
women only is WOMEN'S
PEYRONIES DISEASE FORUM.
LOSS
OF SIZE: The question of penile shrinkage is always said to be debatable,
with some leading surgeons denying that it occurs or, if it does occur initially
after surgery, that any loss of size will be recovered when erections are attained
again.
One
study in 2004 - A prospective
study measuring penile length in men treated with radical prostatectomy for prostate
cancer - states very clearly
Our
findings support observations of decreased penile length after radical prostatectomy.
Men should be counselled before radical prostatectomy that penile shortening may
occur.
A
study in 2007 - A
pilot study on the early use of the vacuum erection device after radical retropubic
prostatectomy concludes:
Initiating
the use of a VED (Vacuum Erection Device) protocol at one month after RP (Radical
Prostatectomy) improves early sexual function and helps to preserve penile length.
