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.
Natural Remedies For Erectile Dysfunction
For many individuals, a physical examination and answering concerns are all that’s required for a doctor to identify impotence and advise a treatment. If you have chronic health conditions or your physician thinks that an underlying condition might be included, you may require further tests or a consultation with a professional.
A sample of your blood may be sent out to a laboratory to look for indications of heart problem, diabetes, low testosterone levels and other health conditions. Like blood tests, urine tests are utilized to try to find indications of diabetes and other underlying health conditions. This test is normally performed by a professional in a workplace.
It produces a video image to let your medical professional see if you have blood circulation issues. This test is often carried out in combination with an injection of medications into the penis to promote blood circulation and produce an erection. Your physician might ask concerns to screen for anxiety and other possible mental reasons for erectile dysfunction – erectile dysfunction.
What Should I Expect From A Prostate Biopsy
A prostate biopsy may be recommended if the results of a digital rectal examination or prostate-specific antigen test suggest that prostate cancer may be present. The most common approach for performing this diagnostic test is transrectal, in which a needle is carefully passed through the wall of the rectum to retrieve a prostate tissue sample.
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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.
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
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After Prostatectomy: What To Expect
At the hospital : You should expect to be in the hospital for one night. At Johns Hopkins, all rooms on the urology floor are private. Here, nurses help patients get moving shortly after surgery to prevent blood clots and other postoperative risks.
First few days at home : After youre sent home, you might find that regular ibuprofen or acetaminophen will be sufficient pain management for the first few days. If over-the-counter medications arent enough, your doctor can help you with alternatives.
One week after surgery : After your surgery site heals, your catheter will be removed. This is usually seven to 10 days after surgery. This can easily be done at your doctors office. Some people decide to take out their catheter at home. If thats the case, ask your doctor for instructions first.
This is also about the time your surgeon will call you with the final pathology results. He or she will discuss what you should know and whether further treatment is necessary.
One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.
- Urinary incontinence
- Erectile dysfunction
Recovery from surgery takes time. These side effects are often temporary. However, if they are affecting your quality of life, ask your doctor about options that can help.
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Effect Of Transrectal Vs Transperineal Prostate Biopsies On Erectile Function
- International Journal of Urology: Official Journal of the Japanese Urological Association
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The Basics: How An Erection Occurs
At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether.
Nerves talk to each other by releasing nitric oxide and other chemical messengers. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis .
Figure 1: Anatomy of the penis
The penis is made up of three cylindrical bodies, the corpus spongiosum which contains the urethra and includes the glans of the penisand two corpora cavernosa , that extend from within the body out to the end of the penis to support erection. Blood enters the corpora cavernosa through the central arteries.
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.
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Natural Cures And Treatments For Erectile Dysfunction
Alprostadil intraurethral therapy involves putting a small alprostadil suppository inside your penis in the penile urethra. You utilize a special applicator to insert the suppository into your penile urethra . The erection generally starts within 10 minutes and, when efficient, lasts between 30 and 60 minutes. Side results can include a burning sensation in the penis, minor bleeding in the urethra and development of fibrous tissue inside your penis.
In this case, testosterone replacement treatment may be suggested as the primary step or given up mix with other treatments. can a prostate biopsy cause permanent erectile dysfunction?. If medications aren’t efficient or proper in your case, your physician might advise a different treatment. Other treatments consist of: A penis pump is a hollow tube with a hand-powered or battery-powered pump – This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a stress ring around the base of your penis to keep in the blood and keep it firm. You then remove the vacuum gadget. The erection typically lasts enough time for a couple to have sex.
Bruising of the penis is a possible negative effects, and ejaculation will be limited by the band. Your penis might feel cold to the touch. If a penis pump is a good treatment option for you, your doctor may recommend or recommend a particular model. That method, you can be sure it matches your requirements and that it’s made by a reliable manufacturer.
Effects Of Prostate Biopsy On Voiding And Erectile Function
A new study from a German research group is likely to fuel concerns about some of the risks associated with prostate biopsy.
This newly published study by Klein et al. reports on the adverse effects associated with multiple core prostate biopsy, and most particularly the effects on voiding of urine and erectile function in the 3-month period immediately following biopsy. Additional commentary is also available in a Reuters Health report on the Yahoo News web site.
Klein et al. report on information gathered from a series of 198 men who received prostate biopsies with local anesthesia between September 2008 and January 2009. The patients were categorized into one of three groups:
- Patients in Group 1 all received a standard 10-core TRUS-guided biopsy.
- Patients in Group 2 all received a standard 10-core TRUS-guided biopsy but with a periprostatic nerve block .
- Patients in Group 3 all had a history of prior negative biopsy and received a 20-core saturation biopsy with a periprostatic nerve block .
Eighty of the original 198 patients were diagnosed with prostate cancer based on their biopsy results and were therefore excluded from further analysis of the complications of biopsy since most went on to receive some form of therapy that is known to affect erectile and voiding function .
The basic results of this study are therefore based on the 118 patients who had a negative biopsy, as follows:
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Prostate Biopsy At A Glance
- A prostate biopsy is the removal of tissue samples from the male prostate gland so a laboratory can examine the tissue for the presence of prostate cancer.
- A biopsy is generally recommended when a prostate-specific antigen screening, a digital rectal exam or an imaging test indicate a suspicious area that requires further examination.
- We will discuss our findings with the patient and the prospect of conducting a prostate biopsy to learn more.
- Urologists perform the removal of the tissue in our offices using transrectal ultrasound and a small needle to obtain cell samples from the prostate for a biopsy.
- The biopsies are sent to the pathology lab where they are stained and reviewed by a pathologist, with results typically available;within one week of the biopsy.
- Prostate biopsy is the only method of definitively diagnosing prostate cancer.
What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
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About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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How Effective Is Injection Therapy With Each Type Of Treatment
If oral erectile dysfunction drugs fail, injections into the penis can be an effective form of treatment for men who have undergone surgery or who have received radiation therapy for prostate cancer.
Overall, up to 80% of men will regain erections with the use of injection treatments. Side effects include occasional pain due to one of the drugs used for injection therapy, and the development of scar tissue.
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Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.;
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.;
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.;
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
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Things You Should Expect After Prostate Surgery
Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.
In the immediate hours after surgery:
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Can Anything Be Done For Erectile Dysfunction Caused By Prostate Cancer Treatment
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
- How good your erections were before your treatment
- Other medical conditions you have like high blood pressure or diabetes
- Some types of medicines you may take such as medicines for high blood pressure or antidepressants
- Things you do in your life such as drinking or smoking
- Your age
- The type of prostate cancer treatment you had
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include: