Prostate Surgery For Prostate Enlargement Concerns

You may have heard about the side effects of radical prostatectomy often associated with prostate cancer treatment, such as incontinence, impotence, and changes in sexual function. While these concerns are valid for many cancer-related procedures, if you’re seeking treatment for an enlarged prostate—also known as benign prostatic hyperplasia (BPH)—the outlook is often much more reassuring.  

Treatments for BPH are typically less invasive and come with fewer side effects, focusing on alleviating urinary symptoms and restoring comfort without the extensive risks. In this article, Mr Andrew Ballaro, Consultant Urological Surgeon, offers information on what you can expect from BPH-specific prostate surgeries and touch upon the general fears when it comes to the common concerns of prostate surgery. 

Treatment Options for BPH

At St John & St Elizabeth Hospital, we provide a range of effective treatments for benign prostatic hyperplasia (BPH), specifically designed to minimize side effects and improve quality of life. Each treatment has unique advantages, and our specialists work closely with you to determine the best approach based on your individual needs. Here is an overview of the options available:

Aquablation Therapy

Our most advanced treatment for BPH, Aquablation Therapy, uses high-velocity water delivered with robotic precision to remove excess prostate tissue. This minimally invasive procedure is tailored to preserve urinary and sexual function by minimizing impact on surrounding structures. Unlike radical prostatectomy for prostate cancer, Aquablation therapy for BPH typically preserves ejaculation ability, allowing men to maintain a sense of normalcy in sexual health. Aquablation is especially effective for men with larger prostates and offers relief with minimal recovery time and reduced discomfort compared to other options.

Holmium Laser Enucleation of the Prostate (HoLEP)

HoLEP is a trusted laser-based procedure that uses high-powered lasers to remove excess prostate tissue while reducing bleeding risk. HoLEP is the recommended treatment for men with bladder outflow obstruction and very large prostates. HoLEP provides long-lasting symptom relief by enucleating all obstructing tissue for a more comprehensive solution. Unlike more invasive cancer-related surgeries, HoLEP is designed to minimize the chance of incontinence by precisely targeting tissue without impacting surrounding areas. This procedure is performed under general or spinal anesthesia, requires a short hospital stay, and allows most patients to resume daily activities within a few days.

Transurethral Resection of the Prostate (TURP)

A well-established procedure for BPH, TURP uses a resectoscope to remove excess prostate tissue through the urethra, effectively improving urinary flow and reducing BPH symptoms. Although it requires a short hospital stay and may involve a slightly longer recovery period than Aquablation, TURP remains a reliable and effective treatment for moderate to severe BPH cases, without the heightened risks often associated with prostate cancer treatments.

Additional Support: Pelvic Floor Clinic

Alongside surgical options, our Pelvic Floor Clinic offers specialized pelvic health physiotherapy, instrumental in managing and reducing urinary symptoms associated with BPH. Pelvic floor exercises strengthen the pelvic floor muscles, which significantly improve bladder control and reduce incontinence risk. Our physiotherapists will help you develop a tailored exercise program to support recovery and overall pelvic health, either as a standalone measure or as part of post-surgical care.

Each of these treatments aims to relieve symptoms, restore comfort, and enhance quality of life. By offering a range of options, our approach to managing BPH is comprehensive and grounded in advanced, patient-centered care, ensuring minimal side effects at every step.

The Common Concerns of Prostate Surgery

Incontinence

What is Incontinence?

Urinary incontinence refers to the involuntary leakage of urine, where control over bladder function is partially or fully lost. This can occur as a temporary or, in rare cases, a longer-term issue following prostate surgery.

How Might Incontinence Affect You After Surgery?

Following surgery, men may experience incontinence after prostate surgery, which can manifest as urinary leakage, especially when sneezing, laughing, or lifting heavy objects. This type of incontinence is often referred to as “stress incontinence” and can range from light leakage to more noticeable issues that may affect daily life and confidence.

Can Incontinence Be Prevented or Managed?

Fortunately, most men regain bladder control within a few months of surgery. Pelvic floor exercises, often known as Kegel exercises, are one of the most effective ways to strengthen the muscles around the bladder and reduce incontinence. Your specialist can guide you on starting these exercises before surgery to prepare, as well as incorporating them into your recovery plan to build back control over time. Additionally, medications or, in more persistent cases, specialised incontinence treatments can be discussed with your healthcare provider if further support is needed for treating urinary incontinence.

Impotence

What is Impotence?

Impotence, or erectile dysfunction (ED), is the difficulty in achieving or maintaining an erection firm enough for sexual activity. This can be a temporary or, in some cases, a lasting effect of prostate surgery due to the impact on nerves responsible for erections. 

How Might Impotence Affect You After Surgery?

Many men experience some level of erectile dysfunction in the initial months after prostate cancer treatment surgery. This can vary widely from mild issues to more significant challenges, impacting intimacy and possibly affecting confidence and mood.

Can Impotence Be Prevented or Managed?

Impotence after prostate surgery is often temporary, and recovery of erectile function may continue over 12 to 24 months. Options to support recovery include medications, such as phosphodiesterase inhibitors (e.g., sildenafil or tadalafil), vacuum erection devices, or penile injections, which may be recommended based on individual needs. Nerve-sparing surgery, a technique that aims to protect the nerves responsible for erections, is another option in suitable cases and can help improve the chances of regaining erectile function. Discussing these with your specialist is an excellent way to understand the personalised options available.

Loss of Ejaculation Ability

What is the Loss of Ejaculation Ability?

Loss of ejaculation, medically termed “anejaculation,” is the inability to release semen during orgasm. This is a common side effect of radical prostatectomy, given the role of the prostate and surrounding tissues in producing and transporting semen.

How Might This Affect You After Surgery?

For men, the absence of ejaculation may feel unusual and impact their sense of sexual fulfilment. It does not, however, prevent orgasm or affect the sensation associated with climax. While anejaculation does not physically impact sexual function, it can lead to emotional and psychological adjustments.

Can Loss of Ejaculation Ability Be Prevented or Managed?

There are currently no known methods to preserve ejaculation after complete prostate removal, as this is a natural outcome of removing the prostate and seminal vesicles. However, an understanding of this impact prior to surgery can help set expectations, and many men find that other aspects of sexual function, such as arousal and intimacy, remain fulfilling.

Strength of Erection and Orgasm

What Changes in Strength of Erection and Orgasm May Be Expected?

Post-surgery, men often wonder if their erections and orgasms will feel the same, and whether they might experience stress urinary incontinence. While nerve-sparing techniques can help preserve erectile function, the experience of an erection and orgasm may still feel different. Some men describe a change in the intensity or strength of their orgasm, which can be due to physical or psychological adjustments after surgery.

Can Changes in Erection and Orgasm Strength Be Prevented or Managed?

Though individual experiences vary, open communication with a specialist can help you find ways to adapt and enhance satisfaction. Erectile strength can often be supported with medication or devices, as well as by focusing on rebuilding confidence and intimacy in new ways with your partner.

Prostate Surgery and Aftercare with St John & St Elizabeth Hospital

Facing prostate surgery can be daunting, particularly with concerns about incontinence, impotence, and changes in sexual function. These fears are valid, and understanding each potential impact is an essential step in preparing for a successful recovery. Knowing that most of these effects—such as incontinence and erectile dysfunction—are temporary and can be managed or treated provides a measure of reassurance. From pelvic floor exercises to nerve-sparing surgical techniques, there are several options designed to support recovery and maintain quality of life.

Our team at St John & St Elizabeth Hospital is here to offer compassionate and expert care through every stage of your journey, from initial testing to post-surgery support and, if needed, personalised BPH treatments. By seeking professional guidance, you can approach prostate surgery with confidence, equipped with the knowledge to make informed decisions and supported by our dedicated specialists.

• Telephone number: 020 7806 4060
• Email address: info@hje.org.uk