How to Avoid Buyer's Remorse After Your Prostatectomy

According to the National Cancer Institute, nearly half of all men diagnosed with prostate cancer in the U.S. choose surgery.

A study published in the journal Research and Reports in Urology found that the rate of prostatectomy-related regret increases over time, with up to 47 percent of men reporting regret five years after surgery.

My favorite article about regretting prostate surgery is titled, "I Want My Prostate Back." I suspect most men who've had prostate surgery can relate to the following paragraph from that article:

"Now, almost 2 years later, I'm not going to say, 'thank god they caught it in time ... I'm so blessed, each new morning is a miracle...Blah blah blah blah.' No, what I'm thinking is more along the lines of: I want my prostate back."

I've spent some time wishing I had my prostate back. Did you?

Multiple reasons explain why a significant number of men who choose robotic surgery experience buyer's remorse. The first source of buyer's remorse comes from believing exaggerated and unsubstantiated claims.

A 2011 study by Johns Hopkins School of Medicine found that 164 hospital robot-surgery websites surveyed “overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer.”

A second source of buyer's remorse comes from miscommunication between the surgeon and the patient about regaining urinary control. When a surgeon states that more than 90 percent of his patients regain urinary control, what are they saying and what's left out?

Some surgeons define urinary control as using one pad a day. Others say living without a pad is regaining urinary control. What the patient hears is that his pre-surgery level of urinary control will return.

What's left out of the discussion is the issue of leaking. Statistically, I'm counted among those who regained urinary control because I don't use a pad. In order to live pad-free, I'm constantly vigilant about the state of my bladder.

If my bladder is full, a sneeze, a cough, or lifting something heavy will cause me to leak urine. The volume of urine I leak depends on the fullness of my bladder. It's something I constantly monitor during my waking hours. This doesn't feel like a return of urinary control — it's more like leak management.

There's another place I leak urine and I hate it. Every man who agrees to prostate surgery should receive written information about this possibility. If you leak urine before or during orgasm you're coping with climacturia.

According to the International Society for Sexual Medicine, "An estimated 22% to 43% of men experience climacturia after prostatectomy. It can be a distressing situation for both men and their partners."

The shame, embarrassment, or disgust about leaking urine during sex are deal breakers for many couples. Couples give up their sexual relationship. Some single men give up on dating and marriage.

Climacturia is one of the factors that explain why Dr. Claus Roehrborn, a professor and chairman of the urology department at University of Texas Southwestern Medical Center in Dallas, told the Australian Financial Review: “A year after a radical prostatectomy, 15 per cent of men will still be leaking urine in some way, and of those who enjoyed full potency before the operation, only one in six will have resumed sexual activity."

Pause for a moment and wonder why so many men post-surgery who are capable of achieving an erection give up on sex.

The third source of buyer's remorse occurs during the discussion about the return of erectile functioning. Men enter this discussion thinking that a return of sexual functioning means a return to their pre-surgery abilities and sex life. Unfortunately, that's not what it means.

Here's a list of potential post-surgery changes:

• All prostatectomies cause the loss of ejaculation. No one told me this would happen. Initially, this loss took all of the pleasure out of experiencing an orgasm. I experienced this as a devastating loss.
• The majority of men will experience a temporary bout with impotence. Few of these men and couples receive information, help, or support with an issue that causes an earthquake in their relationship.
• Some men require a vacuum pump, ED medication, or penile injections in order to achieve an erection.
• Changes in the intensity of your orgasm. For some it's more intense, for others like myself, it's severely diminished.
• Penile shrinkage. Some men experience a noticeable reduction in the length of their penises.
• Climacturia is defined by leaking during orgasm.
• Changes in the desire for sex. Some men experience a diminished desire for sex, and some lose their desire for sex.
• A change in the level of hardness. Many men achieve a hardness that allows for penetration, but their level of hardness is nowhere near pre-surgery levels.

These changes can diminish a man's self-esteem, manhood, and sexuality. Relational difficulties also arise.

Whether you choose surgery or a different treatment modality, it's important for you to understand the quality of life issues and changes you'll experience with each of your treatment options.

Note: This article appeared in Prostate Cancer News Today 

Rick Redner and his wife Brenda Redner wrote two award-winning books. The first:

I Left My Prostate in San Francisco-Where's Yours?

provides men and couples with information and support before, during and after prostate surgery.

Their second book was written for couples living with!erectile dysfunction. After living with erectile dysfunction for four years, Rick chose penile implant surgery. The couple share how implant surgery changed their lives and relationship.

The title of their book is:

Everything You Never Wanted to Know About Erectile Dysfunction and Penile Implants.