Does Prostate Removal Cause Sterility?
Yes, radical prostatectomy causes complete sterility in 100% of cases due to obstructive infertility. 1
Why Radical Prostatectomy Causes Sterility
During radical prostatectomy, the entire prostate gland, seminal vesicles, and ampulla of the vas deferens are surgically removed 2. This anatomical removal creates a complete mechanical obstruction to sperm transport, making natural conception impossible. The seminal vesicles and prostate normally contribute the majority of seminal fluid volume and provide the medium for sperm transport during ejaculation. Without these structures, even if sperm production continues in the testicles, there is no pathway for sperm to reach the ejaculate.
Critical Counseling Points
Patients considering radical prostatectomy who desire future fertility must be counseled about this permanent consequence before surgery. This is particularly crucial for younger men who may not have completed their families. The sterility is immediate and permanent following the procedure.
Fertility Preservation Options
For men who wish to preserve fertility potential:
- Sperm cryopreservation should be offered before surgery as the most cost-effective strategy for fertility preservation 1
- This must be done preoperatively, as post-surgical sperm retrieval is not possible due to the anatomical changes
- Cryopreservation represents the only preemptive option to preserve fertility in these patients 1
Important Distinctions
Sterility should not be confused with erectile dysfunction, which is a separate complication of radical prostatectomy. While erectile function depends on neurovascular bundle preservation, patient age, and preoperative function (with potency rates ranging from 7.5% to 76% depending on these factors 3), sterility occurs universally regardless of nerve-sparing techniques or surgical approach.
Clinical Pitfall
A common oversight is failing to discuss fertility implications with younger patients during preoperative counseling, particularly when the focus is on cancer cure and other complications like incontinence and erectile dysfunction. Urologists must proactively address fertility concerns when discussing treatment options with patients of reproductive age 1, as this represents an irreversible consequence that cannot be remedied after surgery.