Prostate Home > BPH Surgery

Inability to Control Urination (Incontinence)
As the bladder returns to normal, you may have some temporary problems controlling urination, but long-term incontinence rarely occurs. Doctors find that the longer problems existed before BPH surgery, the longer it will take for the bladder to regain its full function after the operation.
In the first few weeks after transurethral BPH surgery, the scab inside the bladder may loosen and blood may suddenly appear in the urine. Although this can be alarming, the bleeding usually stops with a short period of resting in bed and drinking fluids. However, if your urine is so red that it is difficult to see through or if it contains clots or you feel any discomfort, be sure to contact your doctor.
Sexual Function After BPH Surgery
Many men worry about whether BPH surgery will affect their ability to enjoy sex or cause impotence. Some sources state that sexual function is rarely affected, while others claim that it can cause problems in up to 30% of all cases. However, most doctors say that even though it takes awhile for sexual function to return fully, with time, most men are able to enjoy sex again.
Complete recovery of sexual function may take up to 1 year, lagging behind a person's general recovery. The exact length of time depends on how long after the symptoms appeared that BPH surgery was done and on the type of surgery. The following is a summary of how surgery is likely to affect the aspects of sexual function:
  • Erections. Most doctors agree that if you were able to maintain an erection shortly before surgery, you will probably be able to have erections afterward. BPH surgery rarely causes a loss of erectile function (known as erectile dysfunction or ED). However, BPH surgery cannot usually restore function that was lost before the operation.
  • Ejaculation. Although most men are able to continue having erections after BPH surgery, a prostatectomy frequently makes them sterile (unable to father children) by causing a condition called "retrograde ejaculation" or "dry climax."
During sexual activity, sperm from the testes enter the urethra near the opening of the bladder. Normally, a muscle blocks off the entrance to the bladder, and the semen is expelled through the penis. However, the coring action of prostate surgery cuts this muscle as it widens the neck of the bladder. Following BPH surgery, the semen takes the path of least resistance and enters the wider opening to the bladder rather than being expelled through the penis. Later it is harmlessly flushed out with urine. In some cases, this condition can be treated with a drug called pseudoephedrine, found in many cold medicines, or imipramine. These drugs improve muscle tone at the bladder neck and keep semen from entering the bladder.
  • Orgasm. Most men find little or no difference in the sensation of orgasm, or sexual climax, before and after BPH surgery. Although it may take some time to get used to retrograde ejaculation, you should eventually find sex as pleasurable after surgery as before.
Many people have found that concerns about sexual function can interfere with sex as much as the operation itself. Understanding the surgical procedure -- and talking over any worries with the doctor before surgery -- often helps men regain sexual function sooner. Many men also find it helpful to talk to a counselor during the adjustment period after surgery.
Written by/reviewed by:
Last reviewed by: Arthur Schoenstadt, MD
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