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.
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.
Biofeedback For Pelvic Floor Stimulation
Biofeedback aims at providing consciousness about activity, and hence maximizing the muscle contractions in the pelvic floor region while avoiding other muscle groups contractions. In order to do so, we translate the intensity of muscle contractions into visual signals that are provided back to the subject performing the contractions. The biofeedback itself consists of a subject receiving this visual information about his own contractions, and then using such visuals to control the next contractions. It is a well-known fact that the use of visual biofeedback can improve a persons ability to perform muscle activity, by visualizing the effects of his or her efforts and hence responding in a guided way in the following stages .
This is the reason why many urologists request physiotherapy urological sessions for perineal strengthening in prostate cancer patients before surgery. In fact, this process of bringing consciousness about pelvic muscles contractions improves strengthening of the specific desired muscles and helps reduce the UI and ED incidences . We have also observed that, even when UI and ED occur, patients who took part in biofeedback perineal strengthening protocols experience more ease in solving these problems later. In this paper, we wish to evaluate the first of these aspects.
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Are There Things I Can Do To Help Myself If I Have Erectile Dysfunction
Yes, there are changes you can make in your life that may help with your erectile dysfunction. Remember to speak with your doctor or healthcare team before making any of these changes.
Some changes you may want to consider are:
- Try to exercise on a regular basis.
- Try to eat a healthy diet.
- Drink responsibly. Long-term, heavy drinking lowers your ability to have an erection.
- Try to lower your stress and fatigue . Being diagnosed with prostate cancer and working in all the changes it brings to your life can be stressful. Stress and the tiredness caused by your prostate cancer treatment, can make it difficult for you to get in the mood. Many men going through prostate cancer treatment feel this way. Talking with your partner might help lower your stress. You may also speak to your doctor or healthcare team about how you are feeling. They are there to help you through this time.
- Stop smoking. Research studies show that smoking can harm your ability to have sex. If you need help to stop smoking, speak with your doctor or healthcare team.
- Practice your Kegel exercises. Kegel exercises help strengthen your pelvic floor muscles, which support your bladder and bowel. These muscles also help with erections. For more information, please see the IMPACT booklet, Kegel Exercises for Men.
What Can I As A Partner Expect
One of the effects of prostate cancer treatment is erectile dysfunction or impotence. This means that your partner may not be able to have erections that are hard enough for him to have sex with you or that he may not be interested in sex because of the medicine he is taking to treat his prostate cancer. This affects not only the man, but you, too, as his intimate partner. If you are the partner of a man with erectile dysfunction, it can be difficult to cope with changes in your sexual relationship. Sometimes men struggle to come to terms with changes in their body image or their ability to perform sexually. This can sometimes result in him staying away from intimate situations where he may feel under pressure to make love. As a partner you may feel rejected by what seems like a lack of sexual interest or intimacy. This may not have anything to do with his feelings for you, but is a result of his cancer treatment. Erectile dysfunction can be difficult for both of you. You may want to reassure your partner that:
- Sex is not as important as long as he is healthy and that he is no less of a man to you
- You will work through it with him
- You understand his feelings
- He is important to you
It may help if you explain to your partner how important nonsexual touching and intimacy such as kissing and cuddling is to you.
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How Long Does It Take For Nerves To Heal After Prostatectomy
How long does nerve regeneration take? Recovery of potency may be very rapid in younger patients and is sometimes immediate. However, for most patients the recovery is gradual and can take up to 3 years to plateau, although typically a patient sees a return to erectile function after about 12 months .
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Differences Between Hcp Opinions
Importantly, we found considerable differences between HCP opinions regarding lead roles in the initiation, monitoring and follow-up of ED management such confusion could easily lead to inadequate management and contradictory advice, as was evident from the mens survey results. These findings may reflect financial considerations and, in the case of nurses, whether or not they have a prescribing role. The increased role of primary care in the follow-up of patients with prostate cancer requires unified management guidelines and support from Clinical Commissioning Groups regarding GP prescribing of relevant treatments with local guidelines and shared care protocols. While urologists and specialist ED clinics were most commonly identified as being responsible for prescribing ED treatment, this management route inevitably leads to delays, due to the need for specialist referral and limited access to specialist ED clinics.
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Operation Successful Patient Left With Erectile Dysfunction
Peter was lucky to be fit and healthy. The operation was finished an hour earlier than planned. Radiation was not necessary, as the urologist had successfully removed everything. However, Peter continued to have regular check-ups: his blood was tested every year.
Two years after the surgery, his PSA value was slightly higher again. Could part of the tumour have been left behind? Examination showed that there was indeed something there. New treatment was started, during which Peter was irradiated 35 times. He did not suffer at all. He just drove himself to the treatment centre every time and felt physically fine. Years have gone by since and Peter is still feeling great. The only thing he suffers from is erectile dysfunction. He is unable to get an erection spontaneously.
Access To Treatments And Specialist Services
The finding in this study that many GPs did not prescribe treatments for ED is a matter for concern. Surprisingly, 44% of urologists did not have access to all ED treatments, despite the National Institute for Health and Care Excellence guidance. NHS prescribing of PDE5is is often limited to once-weekly use, which may not adequately support mens needs or specialist sexual rehabilitation programme aims. Stinting on effective treatments such as PDE5is can be a false economy, potentially resulting in treatment failure and the need for expensive secondary referrals. It is hoped that the recent availability of reduced cost generic sildenafil and tadalafil, and the lifting of restrictions on its daily use, will allow more men with ED to receive early treatment.
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Getting Treatment And Support
Speak to your GP or doctor or nurse at the hospital.
Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether its for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit.
Talking about sex
It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. It can also help you feel more positive and more in control.
You can ask about sexual problems at any stage before, during or after your prostate cancer treatment. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they dont then you may need to bring it up yourself.
Not everyone is used to talking about sex. You might need to bring it up more than once, or with a different person in your team. You can also ask to be referred to an expert in sexual problems or an ED clinic they will be used to talking about sexual problems.
Our sexual support service
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How To Cope With Ed After Prostate Surgery
Even when you know that erectile problems are temporary after surgery, it is not easy to experience such a change.
It can turn into a significant burden for your relationship and yourself.
Thus, knowing how to cope with erectile dysfunction is useful, even if you dont experience a complete lack of erections.
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How The Test Will Feel
During the procedure you may feel:
- Mild discomfort while the probe is inserted
- A brief sting when a sample is taken with the biopsy needle
After the procedure, you may have:
- Soreness in your rectum
- Light bleeding from your rectum
To prevent infection after the biopsy, your provider may prescribe antibiotics to take for several days after the procedure. Be sure you take the full dose as directed.
How Long Does It Take For The Erection Nerves To Heal After Prostate Surgery
There is a lot in your control .
However, the one part of recovery that is not in our control: the progression of erection nerve recovery .
Sometimes these erection nerves are damaged or have to be removed during the prostate surgery procedure, but even if they are sparred, the trauma from the light and the heat of the operation can make them go offline.
These erection nerves surrounding the prostate can take two years or longer to recover.
Currently, there is no way of measuring the state of those nerves post surgery, and there no known way of speeding along this part of recovery.
I really hope we do have this capability one day. Or treatment options that dont affect these nerves at all. But this is where we are right now .
See our Pleasure Masterclass for how to enhance sensation/orgasm post Prostatectomy.
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Making An Informed Decision
There are many things to consider when agreeing to proctectomy. Thus, one should ask healthcare providers various questions, from the cost of prostate cancer surgery to prostate cancer surgery after side effects.
During appointments or doctor visits, take more interest in prostate cancer treatment medications, supplements, how the process is done, whether the doctor would consider hormone therapy, other treatment options, sex life after prostatectomy, diet after surgery, rehabilitation, and more.
When agreeing to proctectomy, one should consider the risk and benefits and explore all non-surgical options. Once the prostate gland is removed, one will have to live with specific issues for a long.
The Regeneration Rate Of The Genital Tissues Depends On The Following Significant Factors:
- age and health status of men
- orrectness of surgical intervention
- level of erectile ability before surgical treatment.
The most effective way to treat erectile dysfunction after removal of the prostate gland is physiotherapy and the use of tonic medications based on Sildenafil, Tadacip or Vardenafil.
Men who survived a surgical intervention need to overcome the mental stumbling block. The patient for the adjustment of sexual life must feel confident in his abilities. To get rid of fear of failure and the syndrome of obsessive waiting will help support from the sexual partner and regular sexual activity.
Set of physical exercises will help to improve the power of sexual potency within the first year after the operation. This set designed to strengthen the muscles of the perineum and restore control over urination.
Doctors recommend to insert special candles into the urethra for additional relaxation of the muscles and optimal blood filling of the genital organs. In some cases, doctors recommend to undergo surgical treatment for impotence which has occurred after prostatectomy.
The doctor should explain to the patient and his partner all nuances concerning the loss of erection after prostatectomy and the importance of rehabilitation.
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What Is A Penile Implant
A penile implant, or penile prosthesis, is a treatment for erectile dysfunction .
This procedure is usually reserved for men who have tried other ED treatments without success. Most men who have the surgery are satisfied with the results.
Continue reading to learn about different types of penile implants, who is a good candidate, and what you can expect after surgery.
You may be a candidate for penile implant surgery if:
- You have persistent ED that impairs your sex life.
- Youve already tried medications such as sildenafil , tadalafil , vardenafil , and avanafil . These drugs result in erection appropriate for intercourse in as many as 70% of men who use them.
- Youve tried a .
- You have a condition, such as Peyronies disease, that is unlikely to improve with other treatments.
You may not be a good candidate if:
- Theres a chance ED is reversible.
- ED is due to emotional issues.
- You lack sexual desire or sensation.
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Patient And Partners Sexual Satisfaction And Mental Wellbeing
Seven studies evaluated patient sexual satisfaction and mental wellbeing . None of those included both patient and partner satisfaction and mental wellbeing. One study included sexual satisfaction for both patients and partners, but did not report on mental wellbeing . Regarding mental wellbeing, perception of body image , worry about daily life , feeling of anxiety and depression were the most commonly reported outcomes. Six of those studies included patients with MIBC and one NMIBC. Six studies included patients in the age range of 5065years and two included patients 6680years old. Overall, radical cystectomy was found to be associated with negative feelings regarding patients body image and consequently a negative effect in sexual satisfaction. Patients who underwent a bladder sparing technique had a better perception of their body and a better sexual satisfaction. There is no consistency in the measurements used for sexual satisfaction and/or mental wellbeing: interviews and semi-structured interviews, sexual function index questionnaire, QoL questionnaire and a functional assessment of cancer therapy questionnaire.
Table 3 Patient and partner sexual satisfaction and mental wellbeing
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What Is Prostate Enlargement
Enlargement of the prostate occurs when the prostate gland cells begin to multiply and cause the prostate gland to swell. This swelling tends to compress the urethra, limiting urine flow and causing symptoms known as lower urinary tract symptoms . BPH is a condition that many men encounter with aging.
Most of the symptoms of BPH are associated with urinary function. They are:
- Frequent need to urinate
- Urinary retention inability to empty the bladder
- An intense urge to urinate, even shortly after urinating
- A weak urine stream or an interrupted urine stream
- Difficulty starting or stopping urination
While BPH itself is not a directly linked cause of sexual problems, most men that suffer from it do indeed find it affects sexual performance. Some common sexual side effects of BPH are:
- Inability to maintain an erection
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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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