Life After A Radical Prostatectomy: A Real
Reposted from Greater Boston Urology.
Less cancer was localized, meaning it was contained within the prostate gland itself. He didnt need further treatment for prostate cancer after the surgery, only regular monitoring of his PSA.
Q: So lets get right to it: You were dealing with incontinence after your radical prostatectomy?Les: The thing about any kind of prostate procedure is youve got to deal with incontinence. This was a big issue for me for a while. I had purchased padded undergarmentsa whole case of them, because I didnt know how long this was going to last.
Men wonder why this particular side effect happens. The prostate gland is the primary organ for controlling urinary flow in normal physiology. When you are rising frequently during the night, and/or having difficulty starting urination, these are signs that the prostate is beginning to grow in size and interfere with this specific function. Every mans prostate gets larger with age it does not necessarily have anything to do with having cancer. It is a separate reality.
Women dont have a prostate. What do they use? Kegel muscles!
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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.
The aim of penile rehabilitation is to:
- provide a stimulus for erections
This can hopefully help you to adapt to changes in your sexual function and relationships.
A penile rehabilitation programme includes:
- counselling and sex therapy
- healthy living such as exercise, weight control not smoking and pelvic floor exercises
Q: Does Prostate Removal Surgery Cause Erectile Dysfunction
A:Yes. Erectile dysfunction can and often does occur after a radical prostatectomy the complete removal of the prostate gland. Thats because the operation can sometimes injure tiny nerves, muscles and blood vessels involved in getting an erection.
If you develop ED after undergoing surgery, the problem isnt necessarily permanent. Many men regain full sexual function over time, usually within a year, though for some it can take a few years.
If problems continue, medicines and devices can help. Your doctor may also prescribe medicines and devices during recovery to help bring back erection.
You are more likely to develop ED following surgery for prostate cancer if:
- You are 60 or older
- You had some evidence of erectile dysfunction before surgery
- You are in poor health
Its important to also point out that there are different types of treatments for prostate cancer and many men who are diagnosed dont need to be treated right away. If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. Watchful waiting involves monitoring changes in your symptoms and tumors.
Each treatment option for prostate cancer has different benefits and risks. Talk to your doctor about what option is best for you.
For more information about Mount Sinai South Nassaus Center for Prostate Health, .
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Sex And The Prostate: Overcoming Erectile Dysfunction When You Have Prostate Disease
Erectile dysfunction can have many causes, including some forms of prostate disease and medications and surgery for prostate cancer. Fortunately, in many cases, this problem can often be effectively addressed. Some men find relief by taking medications to treat erectile dysfunction. If these arent effective for you, a number of other options, including injections and vacuum devices, are available. The possibility of finding the right solution is now greater than ever.
This article explores why men may develop erectile dysfunction as a consequence of some prostate diseases, and details the current treatment options to restore sexual functioning.
The Prostate Gland And Prostate Cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.
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When Is Nerve Preservation Not Done
The term nerve preservation or nerve sparing during radical prostatectomy refers to preservation of this second set of nerves . When these nerves are not preserved it is not because they have been accidentally damaged, but because either one or part of one has been removed to ensure that the cancerous cells are fully removed. This is known as cancer control.
You can see how the location of the prostate cancer on the left side of the prostate specimen below allowed full nerve preservation on this side whereas the tumour on the right side of the prostate was invading the NVB, which meant that NVB removal on this side together with all of the tissue surrounding it was necessary for good cancer control.
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Can A Man Have A Normal Sex Life After Prostate Surgery
The question is loaded what is a normal sex life anyway? Most men will experience a slowing down or drop off in their sexual activity as they get older.
That said, it is still a source of pleasure and intimacy amongst older couples, and for those for whom it is an important part of their relationship, they are keen to understand what sex after surgery will look and feel like.
The majority of men with a diagnose of localized prostate cancer will undergo a conservative approach known as active surveillance, but some of them will require surgery at some point.
The surgeons will excise the growth, or in some cases remove the entire prostate. There are also less invasive surgeries, such as the TURPs and other non-surgical therapies such as radiation therapy.
With careful intervention, most men will be able to resume a healthy sex life after the initial recovery period.
If you have had a radical prostatectomy without a nerve-sparing technique, theres a high chance you will experience a significant reduction in your sexual sensation and libido
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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:
Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
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How May Erectile Dysfunction Affect My Sexual Relationships
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a mans self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance . All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
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Percentage Of Men Obtaining Full Erections 2 Years After Open Prostatectomy
As one can see, the chance of regaining potency diminishes with age and with the number of nerves damaged. Even though it is usually technically possible to spare the nerves, sometimes the nerves themselves are cancerous and must be removed since the primary goal of the surgeon is to remove the prostate cancer. If the cancer has not reached the nerves controlling erection, the da Vinci Robot has the visual capabilities and the precision necessary to spare these nerves in most cases, thus it is possible that using the robot may add to the chances of being potent after surgery. However, there is no way to guarantee this due to variability in patient anatomy and condition. It is important to realize that some men never regain the ability to maintain an erection after robotic prostatectomy.
As mentioned above, medical therapy may aid in return to erections, but this has not as of yet been fully substantiated. Usage of sildenafil and newer erectile medications may potentially increase the potency percentages in the table above but this has not been proven. A recently presented study found that daily doses of 50mg or 100mg sildenafil for 9 months increased full erections by 7 fold when compared with a group who did not receive any medication.
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Making Changes To Your Sex Life
After prostate surgery and during this recovery period, you might need to make a few changes.
Certain sex positions require a very hard erection to work.
Others will do the trick, even if you cant maintain an erection. The downward doggy, the morning spoon, and the reverse cowgirl are just a few examples.
Just be creative and try something new.
This moment can also become an occasion to learn about yourself and experience sex differently.
You can try new types of stimulation, sex toys, and various kinds of non-penetrative sex.
The whole idea behind this is to enjoy the moment and feel satisfied even if nothing goes as expected.
Remember that sex is much more than penetration, and you can feel pleasure in many ways.
Patients with severe psychogenic erectile dysfunction sometimes need to take this approach.
They need to stay clear from penetrative sex for a while.
This period will allow them to look for alternative methods and other types of stimulation.
Then, resuming penetrative sex feels more satisfying than ever, and erectile dysfunction starts to resolve.
Questions To Ask Your Doctor Or Nurse
- How could my prostate cancer treatment affect my sex life?
- How soon after treatment can I masturbate or have sex?
- Which treatments for erection problems would be best for me? Can I get them on the NHS?
- Is there anything I can do to prepare myself before I start my prostate cancer treatment?
- What happens if the treatment doesn’t work? Are there others I could try?
- What other support is available to me?
- Can my partner also get support?
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What You Can Do Now
Sexual side effects from prostate cancer treatment are often temporary, especially if your doctor used nerve-sparing surgery. While your body recovers, you can try a few things to maintain your sex life:
- Let your doctor know about any sexual problems youre having right away. Although it can be hard to talk about sex, being open and honest will help you get the treatment you need.
- See a therapist. Couples therapy can help you and your partner understand and deal with sexual issues.
- Take care of yourself by exercising, eating a well-balanced diet, reducing stress, and getting enough sleep. Looking and feeling your best will give your self-esteem and mood a boost.
What Do We Know About Potency After A Robitic Prostatectomy
The return of potency is dependent on several factors:
- Previous sexual function before surgery. Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery. It will not improve upon what you already had before surgery.
- Age. Theyounger you are, the better your chances. Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
- How many nerves are spared. As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections. However,even men with no nerve sparing can regain erectile function.
Ejaculation will no longer occur in any patient. This is because the seminal vesicles and the vas deferens , are removed and cut during the surgery. This means that you will no longer be able to father children
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How Will Prostate Cancer Affect My Sex Life
Prostate cancer can affect your sex life in three overlapping ways – your mind, body and relationships.
Finding out you have cancer can make you feel down or anxious, changing your feelings about sex.
Treatment can damage the nerves and blood supply needed for erections. Hormone therapy can affect your desire for sex.
Coping with cancer can change your close relationships, or your thoughts about starting one.
Some common worries
- You cant pass on cancer through sex.
- Having sex won’t affect how well your treatment works.
- Having sex has no effect on your cancer or the chance of it coming back after treatment.
- It’s safe to have an erection if you have a catheter in.
Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
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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 .
Tips For Talking With Your Partner
Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:
- Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
- Listen to your partners concerns, too. Remember that this issue affects both of you.
- See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
- If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.
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