Erectile Dysfunction Following Radical Prostatectomy
Assuming the management of erectile dysfunction requires expert diagnosis and treatment.
Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.
Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.
Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins’ noted Sexual Behaviors Consultation Unit.
How Long Does Erectile Dysfunction Last After Prostate Surgery
Is erectile dysfunction a possibility after prostate surgery?
Many patients are concerned about it and prefer other prostate cancer treatments.
However, they should know that most erectile issues are temporary and improve after a while.
These patients usually recover from this problem after a few months.
In this article, we cover sexual function after prostate cancer surgery thoroughly, tell you how long ED can last, and how to cope with erectile problems.
Sexual Dysfunction After Prostate Surgery Is More Common Than Previously Reported Says Hutchinson Center Study
Media briefing: A media briefing will be held at 1 p.m. PST Tuesday, Jan. 18 at the Centerâs Metropolitan Park East Campus, 1730 Minor Ave., between Olive and Howell streets. A Media Relations representative will greet you in the lobby and escort you to the briefing room. Free parking is available in an underground garage entrance off Minor Ave. A map of the site is available upon request.
B-roll available: A related video news release, including sound bites and b-roll of Dr. Janet Stanford and a Seattle-area prostate-cancer survivor, will be available via satellite feed twice on Tuesday, Jan. 18: first between 6 and 6:30 a.m. PST and again between 11 and 11:30 a.m. PST .
SEATTLE â Sexual dysfunction among men who undergo prostatectomy appears more prevalent than previously reported, according to a multi-center study led by an investigator from the Fred Hutchinson Cancer Research Center in Seattle.
The results will appear in the Jan. 19 issue of the Journal of the American Medical Association.
Funded by the National Cancer Institute, the Prostate Cancer Outcomes Study is the first comprehensive, population-based assessment of sexual function and urinary continence among men treated with radical prostatectomy for early stage, localized prostate cancer. It is also the first study to examine the sexual and urinary side effects of such surgery in minority populations.
Age and education also had an impact on the frequency of impotence.
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What Can I Expect Before And After Robotic Prostatectomy
If after consulting with Dr. Engel, becoming educated on the topic of prostate cancer, potentially seeking other opinions, and being presented all options, a patient opts for robotic prostatectomy, he will then be taken extensively through what to expect. Dr. Engel currently performs robotic surgery exclusively at George Washington University Hospital, and a date and time will be scheduled for surgery there. The patient will generally be urged to see his internist for a pre-operative physical, although this can also be accomplished at the hospital itself. Tests to rule out spread of cancer such as a bone scan and CT scan, looking for spread to bones and lymph nodes, may be performed in higher risk cases. The patient will be given detailed instructions regarding a bowel preparation regimen and the patient must follow this strictly. The purpose of the bowel prep is not only to create more space in the abdomen, but also for safety in the very unlikely event that there is an inadvertent injury to the intestine or rectum during the surgery. If this occurs, a bowel prep will likely keep this from being a life threatening problem.
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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.
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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.
A Comparison Of Medications For Inducing Erections After Prostate Surgery
HomeNews & MediaNewsA comparison of medications for inducing erections after prostate surgery
04 February 2020
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Surgery to remove a prostate tumour can have devastating effects on a mans ability to have sex. Many men try devices and medications such as Viagra to help them have sex after surgery. This weeks research blog discusses the help available to achieve erections and the latest research comparing erection medications.
Surgery for prostate cancer reduces erections
Treatment for localised prostate cancer can have terrible consequences for a mans sex life. Soon after surgery, most men find that achieving and maintaining an erection is difficult. For some men, this gradually improves over 12 months or more. Unfortunately, many have long term problems having sex. Radiotherapy for prostate cancer can also affect a mans sex life, but these effects are usually delayed.
Its believed that these issues are caused by damage occurring during surgery. Damage to the nerves and blood supply to the penis and surrounding tissue reduces erections. The nerves connecting to the penis are very close to the prostate gland. So surgery in this area can easily affect them. Even if nerve-sparing surgery is performed, the nerves need to be separated from the prostate in order to remove the gland. This causes damage through bruising and inflammation. Over time, this damage can heal, leading to improvements for some men.
Improving erections
Vacuum erection devices
Penile rings
Also Check: What Are The Effects Of Having A Prostate Removed
Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery
Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.
Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.
Is It Advisable To Take Viagra After The Procedure
Since erectile dysfunction is one of the major side effects of the operation, patients are wondering whether or not they can take Viagra after prostatectomy. In fact, many of them are even asking, can I use the blue pill right after the surgery? Or is there a waiting period?
What is Viagra in the first place? Simply put, it is another medication for erectile dysfunction. You can find it under the generic name Sildenafil.
If you have been taking Viagra before the surgery, you must inform your surgeon as some of its ingredients may affect the anesthesia.
So can a male undergoing prostatectomy use Viagra after the medical procedure? Yes, the blue pill can help restore erection . However, using it right after the surgery is not advisable since the body also needs some time to recuperate.
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What Is The Importance Of Preserved Erectile Function
In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function. This matter is frequently important to young men who by age status are more likely to have intact erectile function than older men however, for all men having normal preoperative erectile function irrespective of age, preservation of this function is understandably important postoperatively.
How Are Prostate Cancer And Erectile Dysfunction Related
If you have issues with your prostate, a general workup can include urine tests, bloodwork, and a physical exam. This exam usually consists of a digital rectal exam , where a doctor will feel your prostate from inside your anal cavity. If the prostate feels smooth and round, thats generally a sign that you probably only have BPH. Otherwise, you may need to undergo further testing, and cancer may be a concern. Men who are diagnosed with prostate cancer worry about many areas of their health. I have heard many of these questions over the years: How bad is it?, What options do I have?, and What are possible complications of treatment?
Currently, the mainstays of treatment for prostate cancer are anti-testosterone therapy, surgery, and radiation therapy. Each of these has pros and cons related to treatment success and long-term effects on the body. However, one of the most common complications for all three of these options is erectile dysfunction. We talked about how anti-testosterone therapy can affect erections when we discussed BPH treatments above. Lets now look at prostate surgery and radiation therapy.
Also Check: How Long Can One Live With Prostate Cancer
Is Robotic Prostate Surgery Better
traditional prostate surgery has a clear winner. With robotic surgery, patients have a shorter hospital stay and recover more quickly. Doctors have a better chance of not leaving behind parts of a malignant tumor. And this type of surgery is actually easier to master than the traditional open variety.
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.
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Can You Have An Erection After Prostatectomy
When you have a radical prostatectomy, you have surgery to remove your prostate gland. These nerves, blood vessels, and muscles may be weakened when you have surgery for your prostate cancer. For a period of time after surgery, many men are not able to get an erection. This time is different for each man.
Q: What Are The Differences Among Viagra Levitra And Cialis
A: These drugs all belong to a class of medication known as phosphodiesterase inhibitors and work by the same mechanism. Choosing one drug over the other depends on their onset of action, duration, contraindications, and other individualized preferences. However, because they are similar, if you are unable to see results with one, it is unlikely that another in the same class would work.
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Black Men With Large Penis
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Prostatectomy Procedures Linked To A Decline In Male Testosterone Levels
Despite having a high success rate and allowing countless men to regain full control of their bladder, recent studies have revealed a potential downside when it comes to prostatectomies, insofar as some men have experienced a decline in testosterone following surgery. One study, in particular, which was published by Johns Hopkins Medicine, explains in great detail the relationship between the two.
However, before diving into the details of the study, we should first take a moment to familiarize ourselves with how the prostate works. Contrary to popular belief, the production of testosterone, the primary male sex hormone, does not start in the testes but rather the brain, namely the pituitary gland.
From there, the pituitary gland produces a separate hormone known as the luteinizing hormone, which regulates heat in the testes. When the testes become warm, testosterone production increases further and stimulates the prostate gland, which plays a critical role in the male reproductive system. Because the prostate surrounds the urethra, it also plays a role in the male urinary system.
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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.
What Determines Erection Recovery After Surgery
The most obvious determinant of postoperative erectile dysfunction is preoperative potency status. Some men may experience a decline in erectile function over time, as an age-dependent process. Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include older age, comorbid disease states , lifestyle factors , and the use of medications such as antihypertensive agents that have antierectile effects.
Also Check: Prostate Cancer Prognosis By Age
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.