Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists
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Dr. Alex Shteynshlyuger is a board-certified urologist and specialist in the treatment of urinary problems in men. He is one of the few urologists who offers a full range of treatment options for BPH . He specializes in all aspects of care for men with an enlarged prostate and urinary problems, including frequent urination at night, difficulty emptying the bladder, urinary urgency, and incontinence. He has successfully treated thousands of men with urinary problems, including urinary retention, painful urination, and frequent urination.
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Cut Back Or Change Antidepressants
Another thing to think about is any other medications youre taking, notes Dr. Kacker. Many men are, unknowingly, taking medications that suppress orgasm. By far the number one offender is the SSRI class of antidepressants, which include fluoxetine and Paxil . By reducing the dose of these drugs or eliminating them entirely, or switching to a non-SSRI like bupropion , many men see an improvement in their ability to orgasm.
What Causes Ed After Prostate Surgery
Is it essential to know what causes ED after prostate surgery.
When you learn about it, you will know what to expect and what type of surgery you prefer.
There are different techniques to deal with prostate cancer and benign prostate hyperplasia .
Some are minimally invasive, while others involve complete prostate removal.
In general, the largest the extension of the prostate that is taken out, the higher the possibility to experience sexual dysfunction.
For example:
- Minimally invasive procedures such as transurethral incision of the prostate alleviate urinary symptoms. They have little to no adverse effects on sexuality.
- More invasive procedures such as transurethral resection of the prostate take out a portion of the prostate gland. Depending on the size, the patient may experience erectile dysfunction.
- Theres also a procedure known as radical prostatectomy. It involves the complete removal of the prostate. Thus, it has a higher chance of erectile problems.
So, the first step is asking your doctor what proportion of the prostate gland will be taken out.
It usually correlates with the chance of sexual dysfunction. But why is that?
The answer is simple: When the prostate gland is removed, the doctor needs to pull and create traction.
These movements drag along the nerves that run beside the gland.
The nerves could be either sliced altogether or simply scratched in the process.
These nerves go directly to the penile tissue and have a significant role in erectile function.
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What Is The Problem
Some 6,500 radical prostatectomies are performed every year in the UK . In a negative association, an increase in one quantity corresponds to a decrease in the other. Association does not necessarily mean that one thing causes the other. More of Urological Surgeons, 2019). While approximately half of these men have pre-existing erectile dysfunction, over 50% of the other half can expect to lose natural erections after prostatectomy surgery, especially if their cancers are locally advanced and require wide clearance to ensure removal of the whole tumour.
Ed And Prostate Surgery
The most common side effect of prostate surgery is erectile dysfunction : research has shown that as many as 85% of men whove had radical prostatectomy have problems with erections following the surgery .
There are two tiny nerve bundles running along the side of the prostate that control erections. For some men, their surgeon may be able to use a nerve-sparing approach during the procedure to avoid injuring these nerves. But for some people with cancer that has grown very close to these nerves, a nerve-sparing approach isnt an option. If both of these nerves have to be cut, you will no longer be able to have spontaneous erections. But some men are able to have erections again with the help of certain treatment strategies . If you only have to have the nerves on one side of the prostate removed, you may still be able to get spontaneous erections, but its less likely than if neither nerve bundle was cut .
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Can You Have Sex After Prostate Removal
The good news is that sex after prostate removal is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.
Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.
Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.
Even though ejaculation will cease, you will still be able to enjoy sex after prostate surgery, as it is further explained.
If You’re A Gay Or Bisexual Man
To be the active partner during anal sex you normally need a strong erection, so erection problems can be a particular issue. You could try using a constriction ring around your penis together with another treatment like PDE5 inhibitor tablets, to help keep your erection hard enough for anal sex.
If you are receiving anal sex, a lot of the pleasure comes from the penis rubbing against the prostate. Some men who receive anal sex find that their experience of sex changes if they have their prostate removed .
If you receive anal sex, then bowel problems or sensitivity in the anus may be an issue after radiotherapy. Its best to wait until your symptoms have settled before trying anal play or sex. If youve had permanent seed brachytherapy there is a risk in the first few months that your partner might be exposed to some radiation during sex. Talk to your doctor or nurse for further advice.
With all sexual changes you may be able to find ways to work through this.
Watch Martin’s story below for one gay man’s experience.
Watch other men’s personal stories about sex after prostate cancer.
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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.
Can Impotence Occur After Prostate Surgery
Consider your options
If youre undergoing prostate surgery, you may be concerned about how it will affect your sexual function. Erectile dysfunction is the inability to become sexually aroused and have an erection.
The condition has many complex causes. It can be caused by a physical problem, an emotional issue, or both. Regardless of the cause, ED can affect both you and your partner.
Many body systems play a role in sexual arousal. These include:
- nerves
- the brain
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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.
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Avoidance And Difficulty Sustaining Ed Treatments
Although there are effective treatments for ED, many men avoid seeking medical help for this condition. In a study of men who were found that have ED, 69% of men did not accept that they had ED and the median time to pursue treatment for ED was 2 years . In men with prostate cancer , a study found that only 50% of men who were interested in seeking treatment for ED actually took steps to find treatment . Of men who seek help to treat their ED, compliance is poor. It is estimated that 50 to 80% of men discontinue their use of ED treatments within a year of starting them . This applies to men with and without PC. Considering the importance of penile rehabilitation following PC surgery, the difficulty starting and sustaining treatment could have a negative impact on mens ability to recovery erections following RP.
Can A Man Still Ejaculate After A Prostatectomy
Some procedures, such as transurethral resection of prostate , will only remove a portion of the prostate gland. However, radical prostatectomy removes the entire prostate, plus the seminal vesicles and sometimes the pelvic lymph nodes. After this operation, a male will no longer be able to ejaculate.
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How Important Is Nerve
The short answer is very. All men in these studies had some form of nerve-sparing performed during their surgery so this review was not able to assess the effect of nerve-sparing on subsequent recovery of erections as there was no control group to compare to. Previous studies have convincingly demonstrated the critical nature of nerve-sparing . The decision to undertake nerve-sparing is made in advance by the surgeon and depends on the extent of cancer. Robotic surgery has allowed more precise and meticulous surgical dissection of the surrounding layers of the prostate. Indeed, 80% of UK prostatectomies are now completed with a da Vinci robot, the remainder split evenly between laparoscopic and open surgery. The outer layers of the prostate are a bit like an onion with several layers. The layer containing the nerves is like the brown skin on the onion and the surgeon can choose to cut inside this layer to leave the brown skin in place.
The outer layers of the prostate are a bit like an onion with several layers. The layer containing the nerves is like the brown skin on the onion and the surgeon can choose to cut inside this layer to leave the brown skin in place.
Can Erection Rehabilitation Be Applied To Improve Erection Recovery Rates
A relatively new strategy in clinical management after radical prostatectomy has arisen from the idea that early induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity. There is an interest in using oral PDE5 inhibitors for this purpose, since this therapy is noninvasive, convenient, and highly tolerable. However, while the early, regular use of PDE5 inhibitors or other currently available, “on-demand” therapies is widely touted after surgery for purposes of erection rehabilitation, such therapy is mainly empiric. Evidence for its success remains limited.
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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.
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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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.
But You Need To Remember
When talking about the role of erection pills such as Viagra in the erectile function, its crucial to bear in mind they only work when there is sexual stimulation. In other words, these pills only work when you are sexually stimulated and aroused . They do not create arousal for you.
The issue here is that lack of testosterone also lowers sexual desire. Hormone replacement therapy could help. Consult your doctor about the therapy and the use of erectile pills.
If you had both testicles removed and are taking hormone therapy, you shouldnt use erectile pills without discussing it with the doctor. This is particularly important if you consider using dietary supplements that are poorly regulated.
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Surgery For Prostate Cancer And Ed
Prostate cancer tends to be a slow-growing cancer. Surgery may be a good option if your doctor believes the cancer is contained in the prostate gland. Surgery is also dependent on age, overall health, and other factors.
A radical prostatectomy involves the removal of the prostate gland. The prostate gland is a donut-shaped gland that surrounds the urethra just below the bladder. The urethra carries urine and semen out from the body through the penis.
There are some risks associated with surgery. Two small bundles of nerves on either side of the prostate are vulnerable to injury during the operation. A type of operation called nerve sparing surgery may be possible. This depends on the size and location of the cancer.
Surgery may require removal of some nerves if theres a chance the cancer has invaded one or both sets of nerves. If both sets of nerves are removed, you may not be able to achieve an erection without the assistance of medical devices.