Erectile Dysfunction After Prostate Surgery
For the study, Schiff and colleagues examined the medical records of 138 men who underwent radical prostatectomy and were evaluated for erectile function at follow-up visits to the doctor.
At each visit, the men were asked to rate their level of erectile function on a 5-level scale, where 1 corresponded to normal functioning and 5 to no erections.
Prior to surgery, two-thirds of the men said they had normal erectile functioning . The others put themselves at level 2, meaning “diminished erections, routinely sufficient for intercourse.”
At subsequent follow-up visits, five of these men had normal functioning and 11 recovered enough to have intercourse, although they had diminished erections.
And 87 men said they had level 4 or level 5 erections, corresponding to partial erections not sufficient for intercourse or no erections, respectively, two years after surgery.
Of these men, one recovered normal erections and nine recovered diminished erections, routinely sufficient for intercourse. Eleven recovered partial erections occasionally satisfactory for intercourse.
After about three years, though, men with the most severe erectile dysfunction showed almost no improvement, Schiff says. But men who had partial erections that were occasionally sufficient for intercourse continued to make progress for up to four years after surgery.
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.
Erectile Dysfunction After Radical Prostatectomy
The prostate is a pingpong ball-sized gland inside your groin between the base of your penis and rectum. It delivers part of the semen, which helps sperm migrate and survive. On each side of the prostate, thereâs a grouping of nerves and blood vessels that manage your erections.
If youâve had a radical prostatectomy, you may have trouble getting or keeping an erection firm enough for sex . This is due to injury to the nerves that send electrical signals from your brain and spinal cord throughout your body, a condition called neuropraxia.
Neuropraxia happens after direct damage to the nerves, swelling, or a lack of blood flow to the groin area. It can lead to the growth of scar tissue and the death of nerve cells, which can also cause shortening of the penis.
Researchers report that 30%-80% of men have ED after prostate cancer surgery. Without treatment, it can last for up to 2 years after surgery. But there are steps you can take to help regain your sexual health.
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Identifying Men Concerned About Ed After Prostate Cancer Treatment
ED can have a significant impact on men’s perceived masculinity, self-esteem and quality of life, which in turn may be associated with depression and anxiety. It is important to be aware that in addition to patients themselves, ED can also impact on their partners, who will equally benefit from the support to try to restore intimacy and sexual function. Nearly all men will experience some form of ED after prostate investigation and treatment but the full extent of the problem may not be fully appreciated because it is often under-reported and consequently undertreated.- Best practice is to perform a holistic needs assessment at regular intervals after treatment. Nurse-led survivorship programmes have been set up in various hospitals with great levels of engagement achieved . The holistic approach identifies men’s priorities and enables early signposting to obtain support. Some centres run education classes to increase awareness of management options after treatment.,
Following prostate cancer treatment, men who prioritise their sexual function, feel ready to pursue sexual activity and wish to undergo treatment for ED should have treatment initiated or be referred to a specialist service for review. They should be managed by a healthcare professional with experience in andrology, if available.
New Treatment For Ed After Prostate Surgery Being Developed Researchers Say
April 19 — Men undergoing surgery for prostate cancer may no longer have to live with erectile dysfunction afterward, thanks to an innovative new treatment, researchers said in a paper published Monday by JCI Insight.
The treatment, developed at Albert Einstein College of Medicine in New York City, involves the surgical implantation of a topical drug that regenerates and restores the function of erectile nerves damaged by radical prostatectomy, they said.
When applied to the nerves immediately after injury sustained during surgery, the drug significantly improved erectile function in rats within three to four weeks, according to the researchers.
The treatment still must undergo clinical trials in humans, which means it could be five to seven years before it is available for use, the researchers said.
“What puts people off to getting radical prostatecomy is the associated side effects, including ED,” co-author David J. Sharp told UPI in a phone interview.
“What we found is that we can regenerate these nerves,” said Sharp, a professor of physiology and biophysics at Einstein.
Radical prostatectomy, or the surgical removal of the prostate gland, is the most commonly used — and, to date, most effective — treatment for prostate cancer, according to the American Cancer Society.
“There are also a lot of nerve injuries that this could be useful for,” he said.
What Is Prostate Cancer
Prostate cancer develops in the prostatea small gland that makes seminal fluid. It is the second most common type of cancer in men. Prostate cancer usually grows over time and in the beginning stays within the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
Prostate cancer that is caught early has a better chance of successful treatment.
Cancer Treatments And Erectile Dysfunction
Following surgery, many men experience erectile dysfunction , but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. Another factor is the surgeons skill level for performing the nerve-sparing technique, which if done correctly, may improve patients likelihood of retaining erectile function, says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapybrachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
When you compare surgery with radiation, both may affect erections, says Dr. Shelfo. Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over timemonths or, sometimes, yearssexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.
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Management Of Erectile Function
Whats the secret to having a good sex life after prostate cancer? In an interview with the Prostate Cancer Foundation Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. summed it up this way You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Theres also the vacuum pump.
Erectile Dysfunction Medications Viagra® , Cialis® , and Levitra® work by relaxing the muscles in the penis which allows blood to rapidly flow to achieve an erection. About 75% of men who undergo nerve-sparing prostatectomy or radiation therapy can successfully achieve erections with these medications.
Muse® is a medicated pellet about half the size of a grain of rice that when inserted into the urethra through the opening at the tip of the penis stimulates blood flow into the penis. About 40% of men have reported successfully achieving erections after using this drug.
End to End nerve grafting is a new technique recently reported to be effective in improving erectile function.
Injection therapy requires sticking a tiny needle into the base of the penis so Tri-mix which contains three drugs can be injected. The success rate is between 70 and 80% and each shot costs about $7. The specific formulation of drugs is based on the type of erection achieved with test dosages in the doctors office and the doctor teaches the patient how to self-inject.
Beyond Drugs And Rehabilitation
Sometimes, even with all the best efforts by the doctor and his patient, there is no improvement in erectile function over several years, and a man may decide it is time to review other methods.
- Prostaglandin : One of these can be direct penile injections. While most men initially balk at the thought of injecting a needle into their penis, once the psychological hurdle is overcome, it is a viable method that many men use successfully for years. Prostaglandin is a hormone-like substance that has a strong effect on the penis. It relaxes the penile vascular smooth muscle in and around the corpus cavernous of the penis. This causes penile arteries to dilate and is instrumental in producing a natural erection. When injected, with or without other chemicals, directly into the penis, it will cause an erection, regardless of the mans sexual arousal state.
- Misoprostol: For men that are absolutely opposed to a penile injection, misoprostol can be inserted in liquid form into the urethra. This method requires that the user dissolve the misoprostol tablet in water, place a restrictive band on the head of his penis, and then insert, via an eyedropper or similar device, a measured solution of the chemical into his urethra. The restrictive ban is removed after allowing about 10-15 minutes for the chemical to take effect. Because the drug does not depend on functional erectile nerves, it can be very useful for men with nerve damage that does not respond to other ED drugs.
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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.
How Is Erectile Dysfunction Treated
Current treatment options for erectile dysfunction for men who have received treatment for prostate cancer include:
- Oral medications, such as tadalafil , vardenafil , avanfil , or sildenafil
- Injections of medicine into the penis before intercourse
- Use of a vacuum constriction device to draw blood into the penis to cause an erection
- Drugs taken as a suppository placed in the penis prior to intercourse
- Penile implants
How Long Ed Lasts After Prostate Surgery
But theres good news despite the high rate of symptoms. The same data shows that as many as half of men affected will have returned to their normal, pre-treatment function within a year, and up to 60 percent after two years.
Its important to note that one of the key indicators of potential to return to normal function is normal function prior to surgery previous or existing ED could mean a longer road to recovery.
Recovery rates are still dependent on a multitude of factors, but there are a variety of treatments to help in recovery, regardless of the severity of sexual dysfunction post surgery.
Your Thoughts And Feelings
Changes to your body and your sex life can have a big impact on you. You may feel worried, unsatisfied, angry and some men say they feel like they’ve lost a part of themselves. There are ways to tackle these issues and find solutions that work for you.
If you are stressed or down about changes to your sex life, finding some support may improve how you feel. There are lots of different ways to get support.
You are not alone. A lot of men, with and without prostate cancer have sexual problems. Talking to other men who have had similar experiences can help.
- Our sexual support service is a chance for you, or your partner, to talk to one of our Specialist Nurses with an interest in helping with sexual problems.
- Our one-to-one support service is a chance to speak to someone who’s been there. They can share their experiences and listen to yours.
- Our online community is a place to deal with prostate cancer together. You can talk about whatever’s on your mind. Anyone can ask a question or share an experience.
- Our Specialist Nurses can answer questions and explain your treatment options. You can also email or chat online with our nurses.
- Get in touch with your local prostate cancer support group.
Counsellors are trained to listen and can help you find your own ways to deal with things. Many hospitals have counsellors or psychologists who specialise in helping people with cancer – ask your doctor or nurse if this is available.
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Management Of Erectile Dysfunction
Oral medications relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 36 hours.
About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.
Theme : Importance Of Education/comprehensive Information
The men in our study spoke about the importance of education and comprehensive information before and throughout the process of prostate cancer treatment. Many men who were dissatisfied with their care were upset when they were given misinformation or they felt the information about sexual dysfunction after prostate cancer treatment was not accurate. Although the men who were most unhappy about sexual dysfunction after prostate cancer did not feel well-prepared in terms of their understanding of the impact of prostate cancer treatment on sexual function, the men who had come to terms with their sexual dysfunction felt they had been well-prepared for the sexual side effects of treatment. Men recommended that information be repeated before, during, and after treatment due to challenges in terms of readiness to learn immediately after the cancer diagnosis. They also talked about the challenges of dealing with a stigmatized topic such as sexual dysfunction. The participants said the following:
Man 16: I was fully informed by everybody. All the doctors that were involved fully informed me that these were things that I was up against if they removed my prostate So definitely you definitely must keep everybody informed about whats going onIts really-thats extremely important
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I Don’t Have Erections After Surgery Am I Impotent For Life
Think of your erections as a well conditioned athlete, who has been injured. This injury is going to take time to heal. You should try to remain patient, and remember that this will be an ongoing battle for many months and even years. Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.
If you see any fullness in your erections in the months after your robotic prostatectomy surgery, this is a positive sign that some of the nerves are working or re-growing. You are taking the first steps down the potency recovery path. Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.