Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists
We have excellent reviews from patients and their partners. Information for out-of-state and international patients. Find out our office hours or directions to our office.
We offer affordable appointment prices with or without insurance. We offer weekday, weekend, and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist and specialist in the treatment of urinary problems in men. He is one of the few urologists who offers a full range of treatment options for BPH . He specializes in all aspects of care for men with an enlarged prostate and urinary problems, including frequent urination at night, difficulty emptying the bladder, urinary urgency, and incontinence. He has successfully treated thousands of men with urinary problems, including urinary retention, painful urination, and frequent urination.
Read Also: Is Beet Juice Good For Prostate
Effect Of Tadalafil On Cavernosal Tissue After Cavernosal Nerve Injury
Tadalafil, a potent PDE-5 inhibitor, is effective from 30 min after administration and efficacy can be maintained for up to 36 h. The T1/2 of tadalafil is 17.5 h, longer than several other PDE-5 inhibitors, and it is not affected by food . Several animal studies investigated the effect of PDE-5 inhibitors on cavernosal tissue after cavernosal nerve injuries. Kovanecz and colleagues investigated the effect of chronic tadalafil on cavernosal tissue in rats undergoing a unilateral or bilateral cavernosal nerve resection. The authors showed that using 45 days of daily tadalafil restored intracorporeal pressure, preserved smooth muscle content, increased smooth muscle to collagen ratio, and reduced the penile apoptotic index . Lysiak and colleagues examined penile tissue at 2, 4 and 6 weeks after bilateral cavernosal nerve resection in an animal study. They found that using tadalafil decreased the number of apoptotic cells and increased the phosphorylation of the two survival-associated kinases Akt and extracellular signal-regulated kinase 1/2 via an apoptotic-related mechanism. In addition, they showed the amount of apoptotic cells further increased 4 and 6 weeks after nerve resection .
Why Is Rehabilitation Important
Whether you are single, or in a relationship, you should have the opportunity to discuss penile rehabilitation with your doctor or specialist nurse. Self pleasuring is important for many people and this can play a part in rehabilitation. This might help to give you confidence and to become aware of the changes that your treatment might have caused.
It might still be worth talking to your doctor even if you are not sexually active, or dont plan to be. This is because penile rehabilitation has benefits in terms of keeping the penis healthy.
Ideally, rehabilitation should start soon after your prostate cancer treatment, or in some situations before treatment. For example, you should start rehabilitation within 3 to 6 months of starting hormone therapy or radiotherapy. Or within the first 3 months of surgery to remove the prostate gland.
You May Like: How Do You Know You Have Prostate Problems
What Is The Problem
Some 6,500 radical prostatectomies are performed every year in the UK . In a negative association, an increase in one quantity corresponds to a decrease in the other. Association does not necessarily mean that one thing causes the other. More of Urological Surgeons, 2019). While approximately half of these men have pre-existing erectile dysfunction, over 50% of the other half can expect to lose natural erections after prostatectomy surgery, especially if their cancers are locally advanced and require wide clearance to ensure removal of the whole tumour.
Can You Have Sex After Prostate Removal
The good news is that sex after prostate removal is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.
Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.
Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.
Even though ejaculation will cease, you will still be able to enjoy sex after prostate surgery, as it is further explained.
Recommended Reading: Newest Prostate Cancer Treatment Options
How To Cope With Ed After Prostate Surgery
Even when you know that erectile problems are temporary after surgery, it is not easy to experience such a change.
It can turn into a significant burden for your relationship and yourself.
Thus, knowing how to cope with erectile dysfunction is useful, even if you dont experience a complete lack of erections.
Dealing With Erectile Dysfunction: For You And Your Partner
The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.
Also Check: Is Peanut Butter Good For Prostate
Things You Should Expect After Prostate Surgery
Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.
In the immediate hours after surgery:
Dont Miss: How To Massage A Mans Prostate
Sex After Prostate Removal What Orgasm Changes Can You Expect
- Ejaculation will cease:Without a prostate gland or seminal vesicles, you will no longer experience ejaculation. Even though your orgasm may feel different, it will still be pleasurable.
- Leaking urine during sex:This is possible but does not happen to all men. Its harmless and temporary.
- Performance anxiety:Dont underestimate the emotional roller coaster of prostate cancer surgery and recovery. Its normal to worry about sex after prostate cancer. Being open and honest with your partner will help.
Keep in mind that your overall health, age, and present ED status are all factors in your recovery to sex after prostate surgery.
Less commonly, the prostate cancer tumor may bulge to one or both sides of the prostate gland, making nerve-sparing surgery extremely difficult or impossible.
Dr. Samadi will help you understand your exact prostate cancer status and the position and size of your tumor. In some cases, a nerve graft can be performed to regenerate the penile nerves for sex after prostate surgery.
- Changes in mood and libido:The psychological impact of surgery can be significant this will leave you tired and irritable, not in the mood for sex so you will need to move towards intimacy slowly and your desire will return back to normal.
Recommended Reading: Herbal Treatment For Enlarged Prostate
What Are The Risks Of Radiation Treatment
Radiation treatment for prostate cancer may increase a man’s risk for having another cancer later in life, such as bladder or rectal cancer.
Some radiation side effects, like urinary problems, are usually short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:
- Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
- In one study, 67 out of 100 men had erections firm enough for intercourse before they had radiation. Six years later, 27 out of 100 men who had radiation had erections firm enough for intercourse.footnote 4
For men with intermediate-risk or high-risk prostate cancer, radiation treatment may be given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
Your doctor might advise you to have surgery if:
- You are healthy enough to have major surgery.
- Radiation therapy isn’t a good option for you because you have had previous radiation therapy to your pelvic area or you have a serious bowel disease such as ulcerative colitis.
Your doctor might advise you to have radiation if:
- You want to avoid the side effects of surgery, such as leaking urine and erection problems.
- You have other health problems that make surgery too risky.
When Can I Return To Sexual Activity
Let the surgery heal for three to four weeks before attempting anything. After one month after the robotic prostatectomy, it is recommended that you resume sexual activity. Stimulation of the nerves is thought to be a first step on the journey back to potency. Remember that you can still experience the pleasures of orgasm and other sensual stimulations without full erections. The average time to recovery for erections adequate for intercourse is 6-12 months, but in some men it is even longer. You should also be performing kegel exercises regularly to help your return to potency.
Also Check: Supplements To Reduce Prostate Size
Who Should Not Take Cialis Or Generic Cialis
Do not take CIALIS® or generic CIALIS® if you:
- Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
- Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
- Take any medicines called nitrates
- Use recreational drugs called poppers like amyl nitrite and butyl nitrite
- Take any medicines called guanylate cyclase stimulators, such as riociguat
- Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients
Who Has Nerve Preservation
Patient who are potent are understandably keen to retain this and so are we. As well as allowing erections following surgery, nerve preservation also allows an earlier return to continence so we always practice nerve preservation whenever the cancer control allows it, which is in about 80% of men. When the cancer is close to one of the nerves we might partially nerve preserve on that side if it is safe to do so and will discuss this with you beforehand if this seems likely.
The decision to nerve preserve is taken after considering the patients existing erections, PSA level, biopsy report, MRI scan, rectal examination under anaesthetic immediately before the operation starts and the way the NVB looks and feels during the operation. It is always discussed with patients before surgery.
Recommended Reading: What Does Prostate Surgery Entail
Sexual Performance After Prostate Cancer And Getting Back To Enjoyable Sex After Prostate Surgery Is Possible Heres How:
1. Masturbate solo sex is a great way to help you relax, build confidence, and find out how your body will respond after surgery.
2. Kegel exercises mastering these pelvic floor exercises before surgery can actually improve your orgasm after surgery. They may even help you achieve multiple orgasms. Bonus they help strengthen urinary control, too.
3. Involve your partner remember that sex is best as a team sport so the sooner you work together, the better. Use physical and emotional intimacy to build up to penetration.
4. Stay ahead of Erectile Dysfunction oral medication for ED is a great way to speed sexual recovery. Using prescriptions such as Viagra or Cialis, even for a short time, can give you the confidence and sexual potency you need.
5. Have sex the more sex you have, the more sex youll have. Meaning, penile rehabilitation through touching, intimacy, and erectionpractice will actually get you back in the game faster.
Role Of Tadalafil In Pr
A recent study investigated the efficacy of daily 5 mg of tadalafil on erectile function compared with placebo after robotic prostatectomy. A total of 92 patients were divided into the tadalafil and placebo groups. At 6 months following surgery, mean IIEF-5 score was 10.3 ± 3.4 and 7.0 ± 4.0 for the tadalafil and placebo arms respectively. Furthermore, in all five domain scores the daily tadalafil group demonstrated a significant increase compared with the placebo group, in which no significant increase in any of the domain scores at 1 year was reported .
You May Like: Prostate Cancer Stage 2b Prognosis
Viagra Useful For Impotence Following Prostate Surgery
Nov. 30, 1999 â Men with prostate cancer who have their prostate removed are usually free of cancer, but the procedure often comes with a cost â impotence. A new study, however, shows that Viagra , the popular medication for erectile dysfunction, can restore impotency lost in surgery. Whether men respond, however, depends on how much nerve damage occurred during surgery.
Each year some 200,000 men are diagnosed with prostate cancer and, of those, 50,000 will have to undergo surgical removal of the prostate.
âIncontinence and impotence are the two most common side effects. A large number of patients, even with nerve-sparing techniques, end up with erectile dysfunction,â Milton Lakin, MD, who leads the medical urology section at Cleveland Clinic Foundation, tells WebMD. âThe first thing want to do is a very good cancer operation. Cancers are being discovered early enough that in many cases it is possible to spare both nerves, or at least one.â
The new study, which appears in the November Journal of Urology, was completed by physicians at Baylor College of Medicine in Houston. It involved about 80 men who ranged in age from 47 to 76 years old. All were prescribed Viagra following prostate removal surgery. Based on their responses to a series of questionnaires, 53% had improved erections and 40% had improved ability to have intercourse.
Sex After Prostate Surgery And Achieving Orgasm
Sex after prostate surgery is an important concern for most men. The total removal of the cancerous tissues is the primary goal, but the quality of life after prostate surgery is also important. Worrying about ED makes men be nervous and anxious when thinking about undergoing radical prostatectomy. Restoring the sexual function after prostate surgery is essential to enjoying life to the fullest!
However, whilst most patients focus on erectile dysfunction, orgasm is somehow under-considered. But is it possible to achieve orgasm after prostatectomy? Erections and orgasm are equally important for a healthy sex life.
First of all, bear in mind that the radical prostatectomy is the surgery performed to remove the prostate gland and sourrounding affected tissue. This is the most recommended treatment for prostate cancer. However, many men wonder if they would be able to have sex after prostate surgery as they did before.
Also Check: Robotic Prostate Surgery Side Effects
Treatments For Erection Problems And Penile Rehabilitation
Different treatments work for different people and they can have side effects. Talk through your options with a doctor or nurse with expertise in this area. Ask them to refer you to your local Erectile Dysfunction Clinic if they are not able to give you this specialist advice.
As well as causing erection difficulties, surgery and radiotherapy can cause a shortening in the length and width of the penis. So treatments for erection difficulties are part of a programme called penile rehabilitation. This is also called erectile dysfunction rehabilitation.
The aim of penile rehabilitation is to:
- maintain blood flow to the penis
- reduce damage to the muscle and tissue in the penis
- provide a stimulus for erections
Using and stimulating the penis keeps the tissues active and prevents them from becoming inflexible
This can hopefully help you to adapt to changes in your sexual function and relationships.
A penile rehabilitation programme includes:
- counselling and sex therapy
- pellet injections into the shaft of the penis
- healthy living such as exercise, weight control not smoking and pelvic floor exercises
Restoring Erectile Function After Prostatectomy
In todays world, the overall mortality for almost every cancer is falling. In many cases, the incidence of various cancers is also declining.
However, for prostate cancer, the incidence has been steadily rising since the advent of the Prostate Specific Antigen test. 1
Considering that the American Cancer Society lists the 10 year survival rate for prostate cancer at 98 percent, this poses a problem. Is the 10 year survival rate due to excellent early detection and treatment, or was treatment not needed?
For many years, the medical paradigm for all cancer, including prostate cancer, has been to find and treat it early to effect a cure. It is well-known that prostate cancer can be very slow-growing and that some prostate cancer is of an indolent type that may never rise to a level of a significant problem.
Early detection and treatment of indolent prostate cancer that will likely never become life-altering are often more damaging than allowing natural disease progression. This is especially true regarding a mans quality of life.
In autopsy studies of men that died from causes other than prostate cancer, many were found to have long-term, undetected cancer in their prostates. This overdiagnosis and overtreatment can cause more harm to a man than living with the disease.
Also Check: Mayo Clinic For Prostate Cancer
Surgically Induced Erectile Dysfunction
Unfortunately, many men have unrealistic expectations for sexual recovery after surgery. In many cases, treatment for prostate cancer, especially with radical prostatectomy, has permanent side effects.
Long-term and potentially permanent sexual dysfunction is a common consequence of radical prostatectomy. This can be a massive issue for both a man and his partner.
Even when a mans doctor is quite candid concerning reduced or non-existent sexual function, many men still expect improvements in sexual functioning one or more years after surgery. 4
It is a given that a man might be capable of recovering usable erections after surgery. However, it is also a given that sexual sensations after a prostatectomy will never be the same as they were before surgery.
In most cases, sensation after surgery is significantly altered. Therefore, if a patients expectation for success means recovery to the physical action and sensations prior to surgery, he is destined to be, at the very least, disappointed.
Loss of erectile function often causes a devastating blow to a man used to having sexual performance. Due to a lack of communication with his doctor, he may also be rather surprised about how total the loss is. This loss may also be perceived quite strongly by his partner.
Since complete surgical erectile dysfunction is a very real possibility, any man considering a radical prostatectomy, must, if he values his sex life, also consider other options very seriously.