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Most men are aware of the major side effects (technically termed morbidity) - incontinence and erectile dysfunction, but some of the minor effects are not as well known. Here are three:

CLIMACTURIA: This refers to the leakage of urine at climax for men who are able to achieve sexual activity after surgery. This is not discussed very often on prostate cancer sites and this can lead men to believe that they are one of the few men to have this problem.

There are few studies on the subject, but one, titled Climacturia following radical prostatectomy: prevalence and risk factors concludes :

Climacturia is a common clinical entity, occurring in almost half of all patients after radical prostatectomy. It can be a significant problem with respect to urine volume loss, associated bother and condom use. Patients must be informed about this complication before undergoing radical prostatectomy.

A second, which deals with radical pelvic surgery - mainly bladder removal - but which includes RP (Radical Prostatectomy) says in relevant part:

Orgasm associated incontinence occurs in a fifth of men (96 of 475) following radical pelvic surgery. The incidence of orgasm associated incontinence is greater with radical prostatectomy than with radical cystectomy and it is unrelated to the type of prostatectomy performed (open vs laparoscopic). Orgasm associated incontinence is more likely to be reported within year 1 following surgery and in men who complain of orgasmic pain and/or penile shortening

This issue is not regarded as a serious problem by many couples, provided that the man has emptied his bladder before the sexual activity and reduced the amount of urine that might be expressed. Some couples actually welcome it as a substitute for the ejaculate which is no longer expelled. There is no danger associated with the urine, assuming there is no bladder infection.

PEYRONIE'S DISEASE: From time to time, men who have been diagnosed with prostate cancer, and specifically those who have chosen surgery, mention that they have been diagnosed with Peyronie's Disease or Peyronie's Syndrome. This condition is one where the erect penis acquires a 'bend' or deflection. The vast majority of Peyronie cases are very mild. It is believed most men don't report it to their doctors or even their partners and their partners will be quite unaware of it in normal sexual intercourse, although the situation is different if oral sex is involved. It is difficult to know how many cases there are - or if these are linked to surgery or other treatment for disease like prostate cancer. With the advent of the internet, more men are discussing this in the 'privacy' or 'anonymity' of the internet and the number of cases is becoming more apparent. It appears however that specialists around the world are now determining that there are many more cases than they thought due to under-reporting ( a common men's problem).

There are varying experiences reported. The variations may be due to the degree of deflection and the direction - there are lateral, vertical and multiple deflections. Some are very subtle - a 'mild condition' is considered a deflection (usually to left or right but sometimes vertically) of 5-25 degrees, intermediate 25 -35 degrees, etc. Some men have reported that these can heighten their partner's sexual experience. Grotesque deformities can be 90 degrees or more and in such extreme cases penetration is impossible. Others report pain, even in the simple process of erection, and acute pain during masturbation or intercourse.

It seems unlikely that the condition is directly caused by a disease, or that it has any direct link with prostate cancer. In fact, the likely reason this condition was originally called syndrome and not disease is that in the original case studies by Peyronie he determined that the condition was largely caused by sexual misadventure. A common cause occurs where the female assumes the superior position and moves up and down on the penis. The penis is accidentally released on an upward stroke and she comes down on the penis in the next downstroke, bending it double. A very small number of deformities are caused by trauma (accidents) to the pelvic area.

Although the traumatic event is often extremely painful at the time, the condition may not manifest itself until later - sometimes months, more often years. It is caused by the blood failing to circulate through the injury. It's not really much different from many other injuries, especially sporting injuries that occur, are dealt with at the time, but show up later.

Simply put, erections are caused by two 'sacks' one on either side of the penis filling with blood. When the penis is bent or suffers other trauma the tissue in/around the sacs is damaged. It may take some time for it to deteriorate. This theory is apparently supported by studies involving large numbers of men who reported such traumas. It also appears to be supported by the fact that surgery to restore the blood flow in the affected area invariably finds the tissue damage synonymous with these traumas. Recently, researchers, private individual and some doctors have suggested that the condition could be caused by other factors - such as surgical procedures. This is relatively new thinking as limited blood flow in the penis itself was originally attributed as the sole cause. Now researchers are also considering blood flow in the delivery to the penis and nerve damage that activates the blood flow. However one of the persistent problems in determining causal factors is that the condition rarely if ever occurs immediately after the trauma or surgery. So linking the two events is difficult.

The condition may be operable, depending on degree. Various methods including opening/restoring, insertions etc. A general appraisal of reports seems to indicate that if the condition doesn't rapidly deteriorate within 12 months, then it won't at all. Care should be taken in selecting any offer to 'cure' this condition. There are many cases to found in Internet searches of men who have had completely unsatisfactory experiences with so-called 'treatments' or 'cures'. The general consensus seems to be that, so far anyway, successful 'rectifications' are rare.

Dean Hill, Administrator/CEO, Peyronies Disease Society has set up a number of sites dealing with this issue. The main site is PEYRONIES DISEASE SOCIETY, whilst there are also two Forums for discussion. The general open Forum is PEYRONIES DISEASE SOCIETY SUPPORT FORUM and the second, closed forum for women only is WOMEN'S PEYRONIES DISEASE FORUM.

LOSS OF SIZE: The question of penile shrinkage is always said to be debatable, with some leading surgeons denying that it occurs or, if it does occur initially after surgery, that any loss of size will be recovered when erections are attained again.

One study in 2004 - A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer - states very clearly

Our findings support observations of decreased penile length after radical prostatectomy. Men should be counselled before radical prostatectomy that penile shortening may occur.

A study in 2007 - A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy concludes:

Initiating the use of a VED (Vacuum Erection Device) protocol at one month after RP (Radical Prostatectomy) improves early sexual function and helps to preserve penile length.