The prostate is one of the only organs in a male’s body that never stops growing. This growth is slow and continual throughout your life and many doctors don’t fully understand why it happens. In some instances, the prostate grows larger than your body can accommodate, and the result is benign prostatic hyperplasia or enlarged prostate. While this isn’t life threatening, it can lead to an array of uncomfortable symptoms. There are treatment options for benign prostatic hyperplasia, with the most invasive being surgery. Some men will also develop prostate cancer during their lives. While prostate cancer has one of the highest curability rates, it needs to be diagnosed early so that surgery can eradicate the cancer completely. Regardless of why you need prostate surgery, certain instances can lead to problems such as infertility. In this article, we’ll explore everything you need to know about the prostate and how to cope with infertility after prostate surgery.
Important Information About the Prostate
The prostate is a golf-ball sized reproductive organ in males that surrounds the urethra. Its main purpose is making seminal fluid to assist in the fertilization of female eggs. As we mentioned, the prostate continues to grow throughout your entire life and can suffer from problems like benign prostatic hyperplasia or prostate cancer. Luckily, when prostate cancer is caught early, it has close to a 99% cure rate. However, this usually means that you will need to have either some or all of your prostate removed. Prostate cancer is extremely common and hundreds of thousands of prostate surgeries are performed every year.
Understanding Prostate Surgery
Prostate surgery is performed for a number of reasons. When you get surgery for the partial or complete removal of the prostate it’s called a prostatectomy.1 The most common reasons for males to undergo prostate surgery are benign prostatic hyperplasia (BPH) and prostate cancer. The underlying goal of prostate surgery is to either eradicate the cancer or treat enlarged prostate so you’re no longer suffering from side effects or complications of BPH.
Depending on your circumstances, there are two primary approaches to open prostate surgery: radical retropubic and radical perineal.
Radical Retropubic
Radical retropubic prostatectomy is when the surgeon makes a cut from your bellybutton to your pubic bone to fully remove the prostate.1 If the cancer has spread, they may remove lymph nodes for a biopsy, or they may stop the surgery so that other treatment options can be performed. Your doctor will talk you through potential outcomes of a radical retropubic so that you fully understand what will happen when you go under the knife.
Radical Perineal
With a radical perineal approach, the cut is made in the space between your rectum and scrotum.1 This approach is used if you have other medical conditions that could complicate radical retropubic surgery, but your surgeon will be unable to access anything other than the prostate.1 This surgery is often performed in less time, but it does put you at a higher risk of erectile dysfunction, which can further complicate fertility.
In some cases, your surgeon may be able to complete prostate surgery laparoscopically, which is minimally invasive and has a faster recovery time. Laparoscopic surgery uses tiny cuts where surgical instruments are inserted and manipulated using a camera to project the field of vision onto a screen. In some instances, laparoscopic surgery can include robotic interfaces, which can improve precision and decrease healing time. Make sure that you fully understand your treatment plan for a smooth transition from the hospital back home.
How Prostate Surgery Affects Fertility
Each type of surgery has different risks, but after a full prostatectomy, you will no longer create seminal fluid and therefore, will be unable to conceive a child naturally. Most prostatectomies also remove seminal vesicles, as they’re directly connected to the prostate and therefore have no use when the prostate is gone. Since you will no longer be able to make semen, you’ll experience infertility after prostate surgery. This doesn’t mean you will no longer be able to orgasm; however, they will be what are considered “dry orgasms” that produce no semen. Dry orgasms still produce the same feeling of sensation of pleasure that result in an orgasm, the only difference is there will be no semen. While this can create a period of adjustment, over time many men get used to it and can’t tell a difference. In some cases, men have even reported that their orgasms feel stronger or more pleasurable.
In some cases, prostate surgery can also lead to damaged nerves that interfere with the ejaculation process. This means that semen will either no longer be made or it won’t be able to leave the body naturally. Retrograde ejaculation is also a possible side effect in certain prostate surgeries, so always talk to your doctor beforehand to better understand your risks and what to expect.
Post-Treatment Fertility Options
If you know that you’re going to undergo prostate surgery and want to father children in the future, there are options for you to take. Talk to your doctor to learn more about sperm banking and testicular sperm extraction before surgery so you can better understand your options.
Sperm Banking
Sperm banking is the freezing (cryopreservation) of sperm done before surgery to be used at a later time.2 It’s one of the most successful ways to ensure that you’re able to father biological children after any type of prostate surgery. Sperm collected for banking can often last up to 10 years or longer, depending on individual factors. Sperm is collected through masturbation and is kept until you need them. This process doesn’t cause damage to your sperm and can provide you with options even if you’re uncertain of what you want in the future. If you have problems ejaculating, there are stimulation options that can help collect a sample.
Testicular Sperm Extraction
Another option is testicular sperm extraction. This is an option for men who cannot ejaculate, but still have sperm in their testicles. During testicular sperm extraction, a surgeon will remove small pieces of testicular tissue while you’re sedated or under a local or general anesthesia.2 If the tissue contains sperm, it is then frozen or used immediately to fertilize an egg. This option can be done either before or after prostate surgery but should be done sooner rather than later to increase your chances of having sperm in the testicular tissue. The longer you wait, the less sperm will be available in the testicles. Testicular sperm extraction and fertilization has a much lower success rate than when you use sperm banking, so it’s a good idea to provide one or more samples of semen for sperm banking and not have to rely on extraction.
Coping with Infertility
Copping with infertility is different for everyone. If you already have children and know that you aren’t planning to have anymore, undergoing prostate surgery is similar to a vasectomy. Since most cases of prostate cancer or benign prostatic hyperplasia occur in older men, infertility isn’t always a cause for concern. However, as screening technology is improving, prostate cancer is being detected earlier on and affecting men of all ages. If you want to have children and know that you’re going to undergo prostate surgery, it’s a good idea to consider sperm banking. This will give you the opportunity to father a child using fertility treatments with your partner. There are also options for adoption or using a sperm donor. Always talk with your partner about your options to better determine the best course of action. It’s better to be prepared for your future and have a strong understanding of what you want prior to undergoing prostate surgery. Talk to your doctor about the risks of infertility based on your prostate surgery. There are also plenty of support groups available to help you cope with infertility and connect with other men who have gone through the same thing.
Conclusion
Even though prostate cancer is so common and often curable, surgery will leave you infertile. If you have severe cases of BPH, the same result occurs. Always talk to your doctor about your risk factors and make sure to get screened early by scheduling yearly appointments with your urologist or doctor. If you need any urological supplies or educational resources, visit our educational support page or our product selection guide. Byram Healthcare is proud to offer full-service urological care and we have all the high-quality urological supplies that you need. If you need to order any urological supplies, all of your orders can be discreetly delivered to your home, at any time of the day. If you have any urological questions or need personalized, confidential services, our teams of knowledgeable urological customer service specialists are here to help.
Sources:
1 https://www.healthline.com/health/prostate-surgery#recovery
2 https://zerocancer.org/learn/current-patients/side-effects/infertility/
