Jul
17
DANGERS AND SIDE EFFECTS
Let’s take a closer look at TURP and the statistical dangers and side effects.
1. Retrograde Ejaculation. This is in effect defacto sterilization. There is no other way to describe it. A vital part of the reproductive system in the male is contained in the prostate and other elements are injected into and flow through the urethra situated inside the prostate.
When most or all of the prostate is removed, the fluid that the prostate produces to lubricate and carry the sperm down the urethra is also gone. Now when orgasm takes place, muscular contractions propel the spermatozoa and fluid from the prostate and seminal vesicles into the prostatic urethra.
At the same time this happens, the neck of the bladder closes so the fluids must go down the urethra and out the penis. But after TURP surgery, this bladder neck closure is usually cut away to provide more space for the urine flow.
With the bladder neck open, the sperm and the fluid take the path of least resistance and are propelled into the bladder instead of out the penis.
This is called retrograde ejaculation. The sensation of the orgasm is the same for the man, there just isn’t any outside ejaculation.
With many TURP patients this is not a problem. Most men in the good TURP surgery candidate pool are no longer interested in fathering children. In most of the cases when a patient is told about this drawback and result of the TURP, he will not have any major problems with it. The trouble comes when a patient is not told about retrograde ejaculation and finds out on his own and is furious that he wasn’t informed before the operation.
In the extreme case where fatherhood is still desired, the ejaculate can be retrieved after the next urination after the orgasm, and the semen gathered and preserved and used in an insertion procedure into the woman’s vagina, the same as any artificial insemination. It works.
2. Bleeding. TURP involves a lot of cutting of tissue and the enclosed blood vessels. Bleeding is a natural course of events. Most of the bleeding is stopped during the operation by cauterization.
As with any cut or wound, a scab develops. This should stay for two or three weeks and then fall off. By then the blood vessel should be healed. If the scab falls off sooner bleeding usually begins and shows up in the urine.
This happens in only about one percent of all TURP patients and is often caused by straining to pass a stool. Usually this bleeding can be helped by a patient drinking lots of fluids to cleanse the area. Only rarely is there a need for the patient to be readmitted to the hospital to correct the condition.
3.1ncontinence. (The inability to control voiding of urine.) This is one of the big fears of a TURP surgical patient. It is embarrassing and distressing, and can lead a patient to total social isolation.
Incontinence happens to from one to four percent of all TURP patients. Many urologists claim it is less frequent, and say it can be the result of the normal surgical risk factor.
The problem comes when the electric knife cuts too near the sphincter voluntary muscles which control the flow of urine. If these muscles are damaged then the patient may become incontinent.
The other means of continence is the external urethral sphincter. Damage here can lead to a stress type of incontinence.
Incontinence after a TURP operation does not have to be permanent or irreversible. There are drugs that can be used to relieve the situation. Another possibility here is the use of an artificial sphincter.
At any rate this is one of the areas that you should discuss with your doctor prior to any prostate operation.
4. Impotency. Experts in this field say about five percent of all TURP patients come out of the operation and are impotent even though they were not that way going in.
Impotency is simply a man’s inability to achieve an erection, or to maintain it long enough for vaginal penetration.
The “manliness” of a male is a highly subjective area, and statistics on this element may be dramatically wrong in either direction. Many men may say they are able to achieve an erection and have intercourse when they are 70, 75, even 80. But age and other problems may have reduced that libido drastically so that even they were not totally cognizant of their ability to achieve a working erection. Time and age does this to all men.
Sometimes such an operation is a handy whipping boy for the sudden realization of impotency.
In any case, impotency is a fact of life for some of the men who have TURP operations, and you should know about it now. There is one sure way to develop impotency in a TURP patient. That is to damage one or both of the nerve bundles that are on each side of the prostate. These bundles are outside of the true capsule of the prostate. That means they are well outside of the area a surgeon’s electric knife should be operating to remove the prostatic tissue clogging the urethra. This is to say that a TURP properly carried out, should not harm these nerve bundles and that should not be the reasons for any impotency.
Some psychologists say that sex is at least 75% mental. This is why the cause of impotency, especially in men from 60 to 90 is extremely difficult to tie down. It may have been there before the operation and not recognized. The operation might create a psychological block preventing the erection. A now and then lack of a man’s ability to “get it up” is not uncommon even in younger men. The trauma of the operation, even the thought of some danger to a patient’s “manhood” and a negative spousal situation all can combine to create a psychosomatic impotency. This may be of a short or long duration.
There are drugs that can be used to help this impotency, and several devices that will be covered in a later chapter. Impotency, while not a large factor, is one that the surgery candidate for TURP should be well aware of.
Jul
7
LIES, MYTHS AND OLD WIVES TALES ABOUT PROSTATITIS
This is a good time to start debunking some of the wild stories and myths and gossip that usually makes the rounds about the lowly prostate. Here are a list of the top ten. You may have heard of some more:
1. Prostate surgery always causes a man to become impotent.
This is simply not true. In the past it was more true than it is today, but now there are newer techniques used in surgery that do not disturb the nerve bundles that run on either side of the prostate. These nerves control a man’s ability to have an erection and intercourse. In cancer surgery, doctors have learned to remove the prostate usually without damaging these nerve bundles. However, some patients still suffer impotency. In the BPH surgery, only five percent of patients suffer any impotency.
2. An enlarged prostate, BPH, is a leading cause of prostate cancer.
Absolutely not. The enlargement of the prostate is in no way connected to the development of prostatic cancer. The cause of the enlargement is not known, but the cause of cancer is and the two are not linked. This myth may have come about because during some surgeries for the relief of BPH, the prostate is found to be cancerous when it had not been so diagnosed before. This actually can be one of the hidden benefits of such surgery.
3. Prostate surgery automatically sterilizes you.
In one half to two-thirds of the patients who have prostatic surgery where some or all of the prostate is removed, the normal course of the semen and other fluids usually ejaculated is disrupted. The fluid takes the course of least resistance and flows upward into the bladder instead of down the urethra and out the penis. To a man 60 or 65 this is usually not so important. However if children are wanted, the semen can be captured from urination soon after the orgasm and used for artificial insemination.
4. Prostate problems turn a man into a wimp.
If this happens it isn’t the result of the prostate problems. There is no loss of manhood, physical or psychological from any of the prostatic problems. There may be psychological side effects by various individuals, but these are mental in nature and could be casued by any number of reasons.
5. Prostate disorders are embarrassing to talk about because they mean a man is oversexed and having sex far too often.
A pure fantasy. Prostate problems and their treatments should not be embarrasing to talk about. Indeed a woman should realize an intelligent and understanding attitude toward prostate testing and evaluation, could save her husband’s life.
6. Orgasm for the man after prostate surgery isn’t the same, isn’t satisfying.
Simply not true. In case after case, the men report that the feeling at the time of orgasm and ejaculation is unchanged from what it was before surgery. Whether the ejaculation fluids go back into the bladder or out the penis, the feeling is exactly the same for the man. If there is a change, it is psychological and unfounded.
7. “Damn, man. Your sex life is over after BPH surgery.
Again, not factual. Any man’s sex life changes as he gets older. In his sixties and seventies a man has sex less frequently than when he was twenty. For at least ninety-five percent, a man’s sex life will be the same after BPH surgery as it was before. For the other five percent, there will be some problems with impotency—but that can be dealt with.
8. Incontinence is an automatic result of BPH surgery.
Researchers show us that only four percent of all BPH surgeries will result in the patients having trouble retaining their urine. That’s twenty-five to one odds, not bad.
9. There are lots of over the counter remedies that will cure my prostate without surgery.
By the end of 1990, the FDA took all such advertised remedies off the market. Previously the Postal Inspectors had closed down dozens of mail order houses who sold them. We will talk about the compounds in these products. Many people believe they are effective in reducing symptoms of BPH. Most do not say they can cure prostatic problems.
10. Prostate is a dirty word and a gentleman never mentions it in mixed company.
Ridiculous. In this more enlightened age, when women are encourged to examine their breasts for lumps, men must be encouraged and badgered into having at least yearly prostate examinations. The best way to do this is through education, and talking about the problem. Talking to the wives of the target men is often the most effective method.
Now, let’s move on to an in depth look at the ailment that affects nearly all older men, BPH.