Many men who have prostate surgery experience a decline in sexual function. This may be as a result of surgery, or it can happen over time.
Some operations damage nerve bundles that control the prostate gland and seminal vesicles. This stops men from ejaculating. This is called dry orgasm.
There are several ways to fix this problem, but it’s not always possible.
Testicular Biopsy
Testicular biopsy involves taking a sample of the tissue in your testicle, which is examined under a microscope. The procedure is usually done to find the cause of male infertility when semen analysis shows abnormal results or when other tests have failed to identify the problem. It may also be performed when testicular self-examination reveals a lump.
During open biopsy, your doctor makes a small surgical incision in the scrotum and takes a sample of the tissue in your testicle. The samples are examined in the laboratory to find sperm cells, which can be used for artificial insemination or IVF procedures. The sperm can also be frozen for future use.
The testicular biopsy is also commonly done for men who have had prostate cancer treatment. Radiation to the prostate and seminal vesicles causes a loss of semen that can affect fertility by making it impossible for sperm to travel from the testes to the urethra during ejaculation. Testicular biopsy can determine whether the condition can be treated with additional radiation or surgery.
Another type of testicular biopsy is PESA or peritoneal semen aspiration (PESA). This method uses a needle to remove healthy sperm from the fluid inside the testicles, which are then injected into a woman’s egg for in vitro fertilization. The procedure can be painful and uncomfortable. If you choose to have PESA, you should avoid aspirin and medicines containing aspirin for 1 week before the procedure.
Transperineal Biopsy
A radical prostatectomy removes the prostate gland and a pair of tubes called the seminal vesicles that make semen. It can also remove the vas deferens, a tube that carries sperm from the testicles to the prostate. This makes it impossible for sperm to leave the body. In addition, the surgery can cause a man to stop producing semen completely. If a man wants to father a child after a prostatectomy, he may need to have a vasectomy reversal.
During the procedure, doctors can sample tissue from different parts of the prostate through a technique called transperineal ultrasound-guided biopsy (TPP-biopsy) or free-hand TPP-biopsy. With free-hand TPP-biopsy, a needle is guided through the perineum into the prostate using knowledge of surface anatomy and TRUS imaging to redirect it. This reduces the risk of urethral penetration compared to traditional transrectal biopsy and is considered a clean procedure (6).
After prostatectomy, most men no longer ejaculate semen because the prostate and seminal vesicles have been removed. However, some of the sperm cells continue to be produced in the testicles. Sometimes this leads to an orgasm without ejaculation, which is called retrograde ejaculation. This is not harmful but it can be frustrating for a man who wants to father a child. However, many men will gradually recover their ability to ejaculate, although it may take up to three years (7).
Robot-Assisted Keyhole Surgery
After a prostatectomy, men no longer make semen because the prostate gland and 2 glands called seminal vesicles are removed. Your testicles can still make sperm cells, but they are reabsorbed back into the body instead of coming out through your urethra during ejaculation. Ejaculate is a mixture of the fluid made in your prostate gland and the sperm from your testicles. The sperm only make up about two to five percent of ejaculate.
If you have prostate cancer, you may have surgery to remove your entire prostate (radical prostatectomy). Prostate cancer treatment can affect sexual function in different ways depending on the type of procedure you have and whether it affects nerves that control erections. Your urologist can talk to you about this and discuss your options including nerve sparing surgery.
During robot-assisted surgery, a surgeon uses 3D endoscope and image processing equipment to get a clear view of delicate structures, such as nerves and blood vessels. They also use wristed instruments that have a range of motion far greater than the human hand.
Nerve-sparing surgery has a higher chance of preserving erectile function after prostatectomy than open surgery. Your doctor can recommend a specialist urologist who does this type of surgery. Some men who have prostate removal experience a return to erectile function months after the procedure, but others might never regain this ability.
Bilateral Pelvic Lymph Node Dissection
Men who are concerned about sexual function after a prostatectomy can get help from an andrology urologist (a specialist doctor who deals with male reproductive problems). In the past, this was only done to increase fertility, but now it may also be used for cosmetic reasons. Men can choose to have malleable implants put into their penis during a short operation. These are 2 flexible rods which can be positioned up for sexual intercourse or down to pass urine.
Surgery that removes the prostate and seminal vesicles will make it impossible to produce semen (sperm-carrying fluid). Radiation almost always impairs fertility and can cause the nerve bundles that control the bladder, urethra and prostate area to be damaged. This can stop the valve that opens during ejaculation from closing properly. This is called retrograde ejaculation and means that when men have an orgasm, the semen goes back into their bodies rather than out of their penis.
Lymph nodes are part of the lymphatic system, which is the body’s drainage network made up of a series of tubes and nodes. These filter the fluid that drains off our cells and then carry it to the lymph glands where white blood cells can kill bacteria, old cells and cancer cells. During pelvic lymph node dissection, surgeons remove the enlarged lymph nodes from your pelvis in a stepwise fashion: proximally – the common iliac artery; caudally – the circumflex iliac vein and Cooper ligament; laterally – the lateral pelvic side wall; dorsally – the obturator nerve and obturator fossa.
