How Do The Results Impact Penile Tissue
Fibrotic changes lead to shortening and decrease in girth of the penis following surgery. Venous leakage from damaged tissues is also thought to play a role in the development of erectile dysfunction after prostate surgery. Penile rehabilitation with a penis pump helps maintain penile length and girth. It also helps with nerve recovery and overall tissue health for quicker recovery.
The authors of a 2016 clinical study determined that the average loss of penile length after radical prostatectomy was 1.87 cm and 1.82 cm respectively. They further determined that men who use a vacuum erection device that no significant changes in penile length were observed in men using a vacuum erection device after surgery.
Penile Vibratory Nerve Stimulation
Penile vibratory nerve stimulation has been shown to stimulate the nerves of the pelvic floor. In up to 90% of men with spinal cord injuries, PVS could induce ejaculation . Fode et al. conducted a trial to examine the effect of PVS in the preservation and restoration of EF in conjunction with nsRP. It was hypothesized that PVS in the early postoperative period after RP may stimulate the cavernous nerves through the reflex arch and would help in the restitution from neuropraxia and improvement of long-term EF . A total of 68 patients were randomized between daily stimulation at the frenulum from a minimum of 1 week before the surgery and after catheter removal, for 6 weeks after nsRP. At all-time points after surgery, IIEF-5 scores were highest in the PVS group 53% of patients in the PVS group reached IIEF-5 scores of at least 18, compared with 32% of patients in the control group .
In conclusion, there may be a place for PNS in penile rehabilitation however, more trials are needed to affirm the existing evidence.
Recovering From Prostate Surgery
During the surgery, the doctor will insert a catheter into the patients penis. This thin, flexible tube will help to drain urine until the patient is healed enough to urinate on their own. The catheter will typically remain for about one or two weeks after the surgery.
The patient can usually leave the hospital within a day or two, but the incision site will likely feel sore for a few days after. The patient will most likely not be able to drive for at least a week, but should be able to return to normal activities within a few weeks.
During the recovery, the patient may experience several side effects including:
- Urinary tract infection
- Temporary loss of bladder control
- Infertility
- Ejaculatory dysfunction
- Erectile dysfunction
After the surgery, its possible to experience erectile dysfunction for a few weeks, a year, or even longer in some cases. This is because the surgery might potentially injure one of the nerves, muscles, or blood vessels that are involved with getting and maintaining erections. There are other factors that could influence the severity of the erectile dysfunction during recovery as well and so it can be difficult to predict how any specific person may recover from the surgery.
The Prostate Cancer Foundation has reported that about half of all men undergoing nerve sparing surgery will regain their pre-surgery function within the first year of the surgery.
- Age
- Sedentary lifestyle
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Prostate Surgery Side Effects And Medications
These drugs work by increasing blood flow to the vessels of the penis. As of late, these drugs have started a sexual revolution for men in theyre later years, proving quite reliable with a low rate of side effects.
Although they wont increase sex drive or libido, they do help increase the firmness of your erection. Success rates for prostate surgery impotence lie in the range of 60% to 70%.
Restoring Erectile Function After Prostatectomy
In todays world, the overall mortality for almost every cancer is falling. In many cases, the incidence of various cancers is also declining.
However, for prostate cancer, the incidence has been steadily rising since the advent of the Prostate Specific Antigen test. 1
Considering that the American Cancer Society lists the 10 year survival rate for prostate cancer at 98 percent, this poses a problem. Is the 10 year survival rate due to excellent early detection and treatment, or was treatment not needed?
For many years, the medical paradigm for all cancer, including prostate cancer, has been to find and treat it early to effect a cure. It is well-known that prostate cancer can be very slow-growing and that some prostate cancer is of an indolent type that may never rise to a level of a significant problem.
Early detection and treatment of indolent prostate cancer that will likely never become life-altering are often more damaging than allowing natural disease progression. This is especially true regarding a mans quality of life.
In autopsy studies of men that died from causes other than prostate cancer, many were found to have long-term, undetected cancer in their prostates. This overdiagnosis and overtreatment can cause more harm to a man than living with the disease.
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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.
Psychological Treatment And Therapy
Along with treating the physical symptoms of ED during sex after prostatectomy, its important to consider psychological treatments as well, including therapy.
Even after life-saving surgery, ED can wreak havoc on self confidence, relationships, and ED can be associated with a higher risk of depression.
Men suffering from ED avoid seeking medical help. Studies have shown that more than half of men could not accept that they had ED, and that the median time to pursue treatment was two years.
A study of men with and without prostate cancer found that only half of men were interested in seeking treatment, and its estimated that 50 percent to 80 percent of men discontinue treatment within a year.
If youre experiencing depression, anxiety or psychological distress associated with prostate cancer or the side effects of prostate cancer treatment, you should consider talking to a mental health professional.
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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
Treatment Options For Ed After Prostate Surgery
There are several treatment options for ED after radical prostatectomy, from medications and devices to further surgical options and even penile implants.
Each treatment option carries with it its own benefits and drawbacks, and different treatments may offer different results from one individual to another.
Its best to consult with a medical professional before beginning a series of treatments, to find the best treatment for you.
Here are some options that may be recommended.
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Why Is It Recommended To Start Using The Vacuum Device Before The Prostate Surgery
A penis pump or vacuum erection device consists of an acrylic cylinder that is placed around the penis. When air is pumped out of the cylinder, the vacuum that is created causes blood to flow into the penis, making it rigid and erect. Using a vacuum erection device before prostate surgery, therefore, improves blood circulation, which in turn helps to maintain a healthy penis.
Healthy tissue recovers faster from surgery. A common side effect of prostate removal is penile shrinkage in terms of both length and circumference. Penis pumps help maintain preoperative penis size and minimize the effect of shrinkage following surgery.
Where Does This Leave You
Increasing availability of these previously expensive drugs is a tremendous help for men who have undergone radical prostate surgery. Despite the uncertainty regarding penile rehabilitation, there is no doubt that real-time erections often improve while on Viagra and so straightforward access to these drugs is essential for a speedy return to a functioning sex life after cancer, for those who want it.
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Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
How Do Penis Pumps Help With Penile Rehabilitation After Prostate Surgery
The nerves in the penis that trigger erections may be damaged during the procedure to remove the prostate. The neuropraxia takes time to recover. This means that the ability to have spontaneous erections after surgery often returns slowly. In fact, it can take several months to years to regain sexual function after prostate cancer. During this time, men are unable to experience even nighttime erections.
Rather than waiting for erectile function to return on its own, doctors feel that regaining erectile function after prostate surgery can be helped along by a penile rehabilitation program. Penile rehabilitation is a type of physical therapy for the penis. Following prostate removal, a penis pump helps recover erectile function by regularly exercising the penis.
This keeps the penile tissue healthy and allows the nerves in the penis to regenerate so that eventually satisfactory erections can occur. Studies show that penis pumps are a safe, well-tolerated, and effective method of penile rehabilitation.
A penis pump creates negative pressure and increases blood flow to the penis. Engorgement of the penis with blood is necessary for strong and long-lasting erections. In addition, the blood flowing into the penis carries nutrients that are essential for a healthy penis. By mechanically pumping blood into the penis, a VED helps preserve the tissue and minimize damage while allowing the nerves time to heal.
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Who Should Not Take Cialis Or Generic Cialis
Do not take CIALIS® or generic CIALIS® if you:
- Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
- Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
- Take any medicines called nitrates
- Use recreational drugs called poppers like amyl nitrite and butyl nitrite
- Take any medicines called guanylate cyclase stimulators, such as riociguat
- Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients
Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
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How Prostate Surgery Affects Your Erectile Health
Prostate cancer surgery involves removing cancer-affected areas of the gland, but the nerves and blood vessels that facilitate erectile function can become affected.
There are effectively two forms of prostate surgery: radical prostatectomy, in which the whole prostate is removed, and simple prostatectomy, where only the part of the prostate causing urinary symptoms is removed.
These surgeries are typically designed to be nerve-sparing when possible, but regardless of nerve damage according to Johns Hopkins, nearly all men will experience some ED within the first months after treatment.
Erectile dysfunction from prostate cancer surgery can range in severity because a number of factors your age and previous function, the surgical techniques used and a 2015 paper showed wide variation from patient to patient.
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.
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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:
Theme : Frustration With Sexual Dysfunction
The men in our study spoke about their frustration with sexual dysfunction. The men described being upset with the change in their sexual functioning and the impact it had on their intimate relationships. Some men described feelings of loss and grief with changes in orgasm/climax. Three men in the study were pleased to have more intense climax after surgery. The participants said the following:
Man 12: If you have a lack of sensation you dont have any nocturnal erections. You dont wake up with an erection and I miss that. I miss it a lot. I miss the sensations of how I used to feel down there, how my body used to feel…I dont feel whole and I think about it every single dayIts the first thing I think about in the morning when I wake up and its the last thing I think about at night
Man 16: I have not I do not have any recall of having orgasm like I have now. And honest to God there has to be I mean sometimes I go into mini convulsions because the orgasm lasts and its so strong and lasts for probably two minutes.
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Theme : Treatment/provider Satisfaction/dissatisfaction
Some men reported dissatisfaction with the treatment they received, while others were happy with the treatment and the care they received around the treatment. The majority of men talked about being happy they were cancer free. Several men talked about their frustration with their providers sole focus on the surgery and the lack of resources or help with side effects from treatment. Men who were dissatisfied talked about the lack of support and help from their providers while men who were satisfied with their care commented on the support and help they got from the provider throughout treatment. Some men felt the provider did not really understand them in terms of their priorities and their feelings about sexual function. Some patients regretted the particular treatment they received or that they received treatment at all. The participants said the following:
Man 17: Uh, were alive, ok? I was Gleason 7. My statistical life expectancy would be about 12 years, you know, thats average. Could be less, could be more. If I did not get treatment. And, uh, my mentality– and still isI got it out, out of my body.
Man 1: I think back. Maybe I shouldnt have done it . And go with the shorter quality of life rather than a long life a longer life with the situation.