Options After Initial Pde
The options for nonresponders to PDE-5 inhibitors include injection therapy, intraurethral prostaglandin, vacuum erection devices, and penile implants. The concomitant use of the PDE-5 inhibitors is discouraged in the regulatory documents for all 3 PDE-5 inhibitors. Nonetheless, there is a rationale for combination therapy. Corpus cavernosum smooth muscle relaxation, and hence penile erection, is regulated in part by increases in smooth muscle synthesis of the second messengers cyclic adenosine monophosphate and cyclic guanosine monophosphate . Intraurethral or intracorporeal prostaglandin E1 increases both second messengers. Therefore, in men with failure of PDE-5 inhibition or prostaglandin therapy, a synergistic effect might occur with combination therapy.
Along those lines, in my practice, I also combine sildenafil with intracorporeal injections in men after radical prostatectomy who are experiencing failure of intracorporeal injection therapy. The combined use of sildenafil with injection or MUSE therapy, though logistically cumbersome, has allowed some patients to avoid implant therapy.25
Sex And The Prostate: Overcoming Erectile Dysfunction When You Have Prostate Disease
If you are concerned about erectile function, its important to understand what erectile dysfunction really is. Failing to have an erection one night after youve had several drinks or even for a week or more during a time of intense emotional stress is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.
Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesnt get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, its time to talk to your doctor.
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.
What Is Prostate Enlargement
Enlargement of the prostate occurs when the prostate gland cells begin to multiply and cause the prostate gland to swell. This swelling tends to compress the urethra, limiting urine flow and causing symptoms known as lower urinary tract symptoms . BPH is a condition that many men encounter with aging.
Most of the symptoms of BPH are associated with urinary function. They are:
- Frequent need to urinate
- Urinary retention inability to empty the bladder
- An intense urge to urinate, even shortly after urinating
- A weak urine stream or an interrupted urine stream
- Difficulty starting or stopping urination
While BPH itself is not a directly linked cause of sexual problems, most men that suffer from it do indeed find it affects sexual performance. Some common sexual side effects of BPH are:
- Inability to maintain an erection
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Why Does Prostate Surgery Cause Erectile Dysfunction
An erection is caused by the brain sending sexual arousal signals to nerves in the penis which stimulate muscles to relax. This allows blood to flow to tissue in the penis, which causes it to become erect.
Erectile dysfunction refers to a condition that occurs when a man cant achieve an erection or maintain an erection for sexual intercourse. Many factors can contribute to erectile dysfunction including problems with the nervous system, blood vessels and hormones.
Prostate cancer is commonly a slow-growing cancer. Doctors will recommend surgery if they believe that the cancer is contained in the prostate gland and hasn’t invaded the surrounding areas. One surgery used to remove the prostate gland is called a radical prostatectomy. Your surgeon will remove your prostate gland, the surrounding tissues and the tubes that carry semen.
There are two small clusters of nerves which control erections that are located on both sides of the prostate. These nerves may become injured during the operation. Your surgeon may also purposefully remove these nerves if there’s a chance that the cancer has invaded them. If these set of nerves are removed, then you wont be able to become erect without being assisted by medical devices.
There is also a type of prostate surgery called nerve sparing prostatectomy, where both bundle of nerves around the prostate are avoided. However, not everyone is suitable for this surgery, and eligibility also depends on the size and location of the cancer.
Finding Help For Erectile Dysfunction
Discussing sex-related conditions or prostate health can be uncomfortable, but understanding these conditions and how they affect overall health is critically important for every patient experiencing ED. Once a health care provider knows that the patient has this problem, they can prescribe medicines that often take immediate effect or refer the patient to a specialist for other treatment options.
Even if you choose not to treat the ED with direct therapies, going to the doctor will help you uncover any of these underlying medical problems. Identifying the organic cause and prostate cancer treatment can help relieve the symptom of ED.
Treatments for prostate cancer that may also indirectly improve ED include surgery, radiation therapy, systemic therapy and focal therapy. Detailed information about treatment options is available through Siteman Cancer Center.
Treating Prostate Cancer and ED at Washington University
Washington University Division of Urology and the Washington University cancer specialists at Siteman Cancer Center help treat patients experiencing these related conditions. Washington University offers a multidisciplinary approach, which employs the combined expertise of urologists, interventional radiologists, endocrinologists and psychologists when it comes to making a diagnosis and developing a treatment plan for ED. Siteman has a number of innovative treatment options for prostate cancer.
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Pde5 Inhibitors: Viagra Levitra And Cialis
Approved by the FDA in 1998, sildenafil revolutionized the way we think about and treat erectile dysfunction, largely because it is so easy to use and effective. Since then the FDA has approved three closely related drugs, vardenafil , avanafil and tadalafil .
All four drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. Of course, its important to realize that none of these drugs is an aphrodisiac. Youve got to feel sexually stimulated in order for them to work.
The main differences between the drugs have to do with timing: how quickly they begin to work, and how long their effects last . Levitra may start working slightly faster than Viagra although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Some studies suggest that Levitra may help some men who dont respond to Viagra. And while some doctors are skeptical about this claim, theres no harm in trying Levitra or Cialis if Viagra doesnt work for you.
Cialis has also been approved to treat men with both erectile dysfunction and BPH. The dose is lower, usually 5 milligrams per day.
What Are The Current Expectations With Regard To Outcomes After Radical Prostatectomy
Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes. Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 inhibitors within 2 years.
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How The Test Will Feel
During the procedure you may feel:
- Mild discomfort while the probe is inserted
- A brief sting when a sample is taken with the biopsy needle
After the procedure, you may have:
- Soreness in your rectum
- Small amounts of blood in your stools, urine, or semen, which may last for days to weeks
- Light bleeding from your rectum
To prevent infection after the biopsy, your provider may prescribe antibiotics to take for several days after the procedure. Be sure you take the full dose as directed.
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Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
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Sex After Prostatectomy: How To Have A Healthy Sex Life After Surgery
Medically reviewed by Kristin Hall, FNP
Prostate health issues such as benign prostatic hyperplasia and prostate cancer affect hundreds of thousands of men in the United States every year.
If youve been diagnosed with a serious prostate issue, your healthcare provider may suggest a prostatectomy a surgical procedure in which your part or all of your prostate gland is surgically removed from your body.
Prostate removal surgery is usually highly effective at treating cancer and prostate enlargement , but it can potentially lead to complications.
These include some sexual performance issues, such as erectile dysfunction and difficulty ejaculating normally.
Although these effects can change your sexual experience, many men are still able to enjoy a fulfilling, satisfying sex life after prostate surgery by making certain lifestyle changes and using medication.
Below, weve talked about what to expect if youre scheduled to undergo a prostatectomy and want to maintain an active sex life after surgery.
Weve also explained how you can have a healthy sex life after a partial or complete prostate removal, whether through exercises to improve sexual functioning, medications, devices or a combination of different approaches.
Can You Get Erections After Prostate Cancer Treatment
If you have ever wondered whether you’ll be able to have an erection after prostate cancer treatment, you are not alone. Many men who are facing a prostate cancer diagnosis, or who have undergone prostate cancer treatment, are worried about whether or not they will be able to have an erection after prostate cancer.
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How Do Doctors Perform Prostate Removal
During prostate removal the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. A prostatectomy takes about two hours and is performed under general anesthesia.
There are two approaches used for a prostatectomy:
- Robotic surgery
- Minimally invasive procedure with faster recovery time
- Uses smaller incisions and robotic technology
The surgical process is as follows:
- The doctor will make a small incision to gain access to the prostate
- The prostate is removed
- The bladder is reconnected to the urethra
- A catheter is connected to the bladder to allow urine to drain while the area heals
Talking About Orgasm Problems Is Important
Men and their partners have become much more open about talking erectile dysfunction, in general and as a consequence of prostate cancer treatment, notes Dr. Kacker.
Whatever you think about all those ads for Viagra and Cialis, they have made it easier to talk about ED and helped remove some of the stigma around the condition.
We should be having the same frank, open discussions about orgasm, says Dr. Kacker. Orgasms can bring a couple together and allow them to maintain sexual intimacy in the difficult period around diagnosis and treatment of prostate cancer.
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Common Reasons For Needing Prostate Surgery
First, lets discuss some of the reasons why someone might need to have prostate surgery.
The two most common culprits that require surgery are prostate cancer treatment and prostate enlargement .
Cancer.org estimates that there will be about 248,530 new cases of prostate cancer in the United States in 2021. TheCDC states that aside from skin cancer, prostate cancer is the most common form of cancer among men in the US.
Benign prostatic hyperplasia, on the other hand, affects about 50% of men between the ages of 51 and 60 according toNIH. TheUrology Foundation says that it will increase to 90% for men 80 years old and above.
Both conditions might require partial or full removal of the prostate otherwise known as a prostatectomy. There are several reasons why a doctor will recommend prostate surgery:
How Long Is Recovery After An Mri Fusion Prostate Biopsy
The prostate biopsy, whether performed with imaging fusion or as a traditional systematic biopsy, is typically an outpatient procedure with a short recovery period. In fact, patients are usually able to drive themselves to and from the procedure without restriction. Dr. Kasraeian may recommend restricting strenuous physical activity for a few days after prostate biopsy, though most patients can return to light desk work almost immediately. During your initial consultation for an MRI prostate biopsy in Jacksonville, FL, Dr. Kasraeian will discuss what to expect during your procedure, including how long recovery may take in greater detail.
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Vacuum Erection Device Therapy
In rats after cavernous nerve crushing, vacuum therapy showed to improve intracarvernosal pressure using nerve stimulation and to help preserve penile size in comparison with controls . Furthermore, vacuum erectile devices reduced hypoxia-inducible factors and increased endothelial NO synthase expression and smooth muscle/collagen ratios in these rodent studies .
Two randomized trials have tested VED after RP.
The first study from Kohler et al. randomized 28 men in an early or a delayed treatment group after unilateral or bilateral nerve-sparing RP. Starting 4 weeks after surgery, the early treatment group had to use VED daily for two consecutive 5-min intervals . The delayed treatment group had to use VED before intercourse . Both groups were offered PDE5Is in addition. Significantly higher IIEF scores were seen in the early treatment group at 3 and 6 months. However, no difference was seen between the groups after 1 year . PDE5I usage did not significantly differ between the groups. Spontaneous erections adequate enough for intercourse were not reported in either group after 1 year follow-up.
In conclusion, VED may be offered as a supportive measure in the period after RP, increasing chances of successful intercourse, especially when used next to a PDE5i. Conclusions about efficacy on penile rehabilitation cannot be drawn with the current literature.
Restoring Sexual Function After Prostate Surgery
Prostate cancer affects nearly 1 in 7 men. Fortunately, its a very treatable condition, especially when its caught early. One of the most common treatments for prostate cancer or having an enlarged prostate is to undergo prostate surgery, also known as a prostatectomy. This surgery comes with a very high success rate, boasting a 10 year survival of nearly 90%, but just like any other surgery it will come with potential risks and side effects.
According to the Prostate Cancer Foundation, one of the most common side effects of a prostatectomy is erectile dysfunction. Luckily, there are plenty of ways to fight back against erectile dysfunction and restore sexual function while recovering from prostate surgery.
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Help For Ed After Prostate Surgery: The Basics
Whats the secret to having a good sex life after prostate cancer? Its very simple, says Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Also, having a loving and understanding partner always helps. Theres also the vacuum erection device . It is not a first-line treatment for ED because theres a high drop-out rate, Bivalacqua says. However, the VED can play a very important role in another aspect of surgical recovery: penile rehabilitation .
First, the pills: When one of my patients leaves the hospital after a radical prostatectomy, he takes home a prescription for Viagra, says Bivalacqua. Does he take it every day, like a vitamin? No. Although some doctors prescribe the pills this way, its not what physicians call an evidence-based practice that is, the medical literature doesnt back it up conclusively. Instead, Bivalacqua tells his patients to take it as needed. It is very difficult for me to tell a man that he should spend $600 a month to take a daily erection drug, because the evidence of a quicker return of erections is just not there. However, he adds, taking a pill daily may provide a benefit, and a lot of prostate cancer patients want to take a proactive approach. If thats the case, then I encourage them to go ahead.
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.
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