Radical Prostatectomy & Sexual Function

Prostate cancer often affects a man’s ability to have an erection.  While it doesn’t contribute to a man’s ability to have an erection, the prostate lies close to the structures that are important to erectile function and these can be damaged when prostate cancer is treated.

A series of fine nerves which assist in the ability to have an erection lie in bundles against the prostatic capsule.  Prostate treatment such as surgery or radiation treatment can cause damage to both the nerves and the blood vessels that are important for strong erections.

 

Radical Prostatectomy

 

During the operation the entire prostate gland, urethra (tube that carries urine from the bladder to the penis) and the seminal vesicles is removed.

 

 

While every effort is made to spare the nerves surrounding the prostate, often they have to be removed due to cancer involvement. Most men will lose the ability to have erections immediately after the operation due to the damage to the nerves and blood vessels.
Over time there can be a gradual improvement this may take up to two years as nerves can rejuvenate.  The return of erections may depend on the extent of the damage to the nerves and surrounding blood vessels.

 

There is evidence that suggest the early use of medication, vacuum erection pumps and injection therapy can minimise the risk of tissue shrinkage in the penis (loss of length).  Tissue shrinkage or loss of length is due to surgery and the inability to spontaneously erect due to nerve damage.

 

TREATMENT OPTIONS

 

MEDICATION

• VIAGRA
• CIALIS
• LEVITRA

SIDE EFFECTS

 

• Facial flushing
• Blocked nose
• Indigestion
• Headache
• Muscle aches

The use of oral therapy may be your urologist first choice of treatment but in many cases due to the nerve damage oral therapy is often unsuccessful.

People with heart conditions should consult with there doctor before taking any of the above medications.

 

Vacuum Erection Devices
A Vacuum erection device is often used post surgery as a way of exercising the penis and is an important process in penile rehabilitation after surgery for prostate cancer. Following surgery for prostate cancer most men can experience some loss of length this can be due to surgery and also the loss of spontaneous erection.   Throughout a mans life the length of the penis has been maintained due to having erections (use it or lose it).   It is important that men preserve there length following surgery to avoid future incontinent issues due to loss of length.

 

The use of the Vacuum erection device can help maintain length if used regularly.  Used on a nightly basis men can use the device by placing the penis inside the rigid tube and creating a good seal by holding it close to the pelvis.  The pump like mechanism is used to create a vacuum which forces blood to flow into the penis.  Once erection is created leave the device on ensuring a tight seal. Leave your penis inside the tube for 15 minutes then release and remove the tube.  Here at East Coast urology we recommend using the vacuum pump as part of your penile rehabilitation. It’s basically physiotherapy for your penis that helps to maintain length.  The use of the Vacuum pump can also aid in the healing of the remaining nerves by creating a blood flow and oxygenation.
The Vacuum pump can also be used for sexual activity by helping to create an erection, a band can then be placed onto the base of the penis close to the pubic bone to keep the erection firm during sexual activity.  The band should not be worn for more than 30 minutes as it could cause damage to the penis.

 

INJECTION THERAPY

 

Injection therapy is the most commonly used and effective treatment.  The drug is injected into the side of the penis and causes the blood vessels to dilate with blood allowing the penis to become erect. Good technique is important and patients need to be taught how to inject themselves properly.  It is important to find a doctor or specialist nurse who can show you the right technique to inject yourself.

Side effects

• Priapism (painful erection)
• Scar tissue (long term use which can curvature of the penis)

A combination of using the Vacuum pump on a nightly basis for exercise and the use of the injection therapy for sexual activity is highly recommended as part of the penile rehabilitation program.

 

Penile Prosthesis

 

Choosing a penile prosthesis that is best for you is a very personal decision. Because each type of prosthesis offers unique features, you will want to discuss the choices with your doctor in order to choose the option that is right for you.

 

East Coast Urology has extensive experience with penile prosthetic surgery. A penile prothesis is a device that is surgically implanted into the penis and allows an erection to be created on demand.

Benefits & Risks of a Penile Prosthesis

Benefits
• Long-term solution
• Have an erection anytime you choose
• Allows for spontaneity – have sex when the mood strikes
• Maintain erection as long as you desire
• No ongoing costs for pills or shots
• Feels natural during intercourse2
• Doesn’t interfere with ejaculation or orgasm

Risks
• Will make latent natural or spontaneous erections as well as other interventional treatment options impossible
• If an infection occurs, the prosthesis may have to be removed
• May cause the penis to become shorter, curved or scarred
• May cause lasting pain
• There may be mechanical failure of the prosthesis

A penile implant is entirely concealed within the body and is designed to be simple and discrete to operate. It may offer a permanent, long-term solution to ED, and can help you return to an active, satisfying sex life.