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.
Erectile Dysfunction Following Radical Prostatectomy
Assuming the management of erectile dysfunction requires expert diagnosis and treatment.
Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.
Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins’ noted Sexual Behaviors Consultation Unit.
Erectile dysfunction following radical prostatectomy for clinically localized prostate cancer is a known potential complication of the surgery. With the advent of the nerve-sparing radical prostatectomy technique, many men can expect to recover erectile function in the current era.
However, despite expert application of the nerve-sparing prostatectomy technique, early recovery of natural erectile function is not common. Increasing attention has been given to this problem in recent years with the advancement of possible new therapeutic options to enhance erection function recovery following this surgery. Visit Dr. Burnett’s Neuro-Urology Laboratory
When Is Nerve Preservation Not Done
The term nerve preservation or nerve sparing during radical prostatectomy refers to preservation of this second set of nerves . When these nerves are not preserved it is not because they have been accidentally damaged, but because either one or part of one has been removed to ensure that the cancerous cells are fully removed. This is known as cancer control.
You can see how the location of the prostate cancer on the left side of the prostate specimen below allowed full nerve preservation on this side whereas the tumour on the right side of the prostate was invading the NVB, which meant that NVB removal on this side together with all of the tissue surrounding it was necessary for good cancer control.
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Talking Counselling And Sex Therapy
Talking to your partner about your erection difficulties can help. Or it may help to talk to a close friend if you are not in a relationship.
Not talking to those close to you could be one of the main barriers to coping with this side effect. You might then find it easier to consider ways that could help.
Counsellors or therapists can help if youre worrying about anything to do with your sex life and sexuality. You can be referred by your GP to a counsellor or therapist within the NHS. You might need to go on a waiting list to see them.
Talk to your GP to find out what is available in your area. Your local hospital or your local Erectile Dysfunction Clinic might have this service.
The drugs used to treat erection problems include:
As drugs work best in men who have sexual desire, they might not help some men who are having hormone therapy. There is limited evidence to say these drugs work when having hormone therapy. But some specialists believe that they are still worth a try if you would like to give them a go.
Talk to your doctor about the best PDE 5 drug for you and the best way to take it. Tadalafil works for 24 to 36 hours, whereas the other drugs work for up to 4 to 6 hours. Its worth knowing that some men need to take 5 to 6 doses before they start to have an effect. You take a daily dose, or when you need them.
Possible side effects of PDE 5 inhibitors include:
- temporary problems with vision
Erectile Dysfunction And Penile Alteration
Several theories have been proposed for the cause of ED after RP, and these include cavernous nerve injury, vascular compromise , damage to nearby structures, local inflammatory changes relating to surgical and radiation effects, cavernosal smooth muscle hypoxia with ensuing smooth muscle apoptosis and fibrosis, and corporal veno-occlusive dysfunction causing venous leakage.4,5,10
Another common complaint among men who have undergone prostate cancer treatment is the loss of penile length and girth. Contemporary literature reports an approximate loss of 23 cm of stretched penile length at 12 months after RP.13 This loss of penile length is often accompanied by other penile deformities such as curvature .14 It is likely that the early loss of penile length after RP is attributed to parasympathetic neural trauma with subsequent sympathetic neural overdrive and the release of various neurotrophic factors, rather than urethral shortening,10 and that this phenomenon is potentially reversible. However, the delayed structural changes relating to underlying corporal cavernosal smooth muscle hypoxia, denervation-induced smooth muscle apoptosis and fibrosis, and the development of Peyronie’s disease, can be permanent.4,6
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Biofeedback For Incontinence After Protatectomy
Biofeedback is a widely used technique that helps people understand how to control their body functions, including the urinary control. It has proved its efficiency in helping many men regain their urinary control.
Biofeedback therapy uses computer graphs and audios to make it easier for you to locate the muscles you a are working on. It is a teaching tool that instructes you how to strengthen your muscles.
Your Emotions And Sex
Your prostate cancer and its treatment wonââ¬â¢t just affect your body. Theyââ¬â¢ll also have a serious impact on your emotions. Stress and anxiety can trigger your body to make adrenaline, which gets in the way of havingà sex. The more you worry, the worse the struggle. If youââ¬â¢re in a relationship, your partner will be going through many of the same feelings.
One of the most important things you can do is to talk to your partner. Have an honest conversation about your fears and expectations when it comes to sex. Don’t assume they know how you feel. Being open with each other will help you both feel supported and help you work together to make any adjustments that you may need to stay intimate. Ã
Talking with a mental health professional — either one-on-one or with your partner — can be a powerful way to help manage your emotions. A therapist can also prescribe medications that may ease stress and anxiety. A professional sex therapist can help you and your partner find ways to improve your sex life. It may also be helpful to join a support group where you can talk with others who share your experience.
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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.
How Can I Help Myself
Urinary problems can affect your self-esteem and independence, and affect your work, social and sex life.
Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.
- Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
- Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
- Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
- If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
- Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
- Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they cant find a toilet.
- Get our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
- Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
- If you often need to use the toilet at night, leave a light on in case youre in a hurry, or keep a container near your bed.
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Treatments For Erection Problems And Penile Rehabilitation
Different treatments work for different people and they can have side effects. Talk through your options with a doctor or nurse with expertise in this area. Ask them to refer you to your local Erectile Dysfunction Clinic if they are not able to give you this specialist advice.
The aim of penile rehabilitation is to:
- provide a stimulus for erections
This can hopefully help you to adapt to changes in your sexual function and relationships.
A penile rehabilitation programme includes:
- counselling and sex therapy
- healthy living such as exercise, weight control not smoking and pelvic floor exercises
What Causes Frequent Urination After Prostate Surgery
Q: Is frequent urination normal after a radical prostatectomy? A: Yes, but its usually only a matter of time before urination returns to normal. Bladder capacity is usually reduced somewhat by the surgery, but the main cause is that, after surgery the bladder wall is swollen and thickened and irritable.
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Erectile Dysfunction After Prostate Surgery
For the study, Schiff and colleagues examined the medical records of 138 men who underwent radical prostatectomy and were evaluated for erectile function at follow-up visits to the doctor.
At each visit, the men were asked to rate their level of erectile function on a 5-level scale, where 1 corresponded to normal functioning and 5 to no erections.
Prior to surgery, two-thirds of the men said they had normal erectile functioning . The others put themselves at level 2, meaning “diminished erections, routinely sufficient for intercourse.”
At subsequent follow-up visits, five of these men had normal functioning and 11 recovered enough to have intercourse, although they had diminished erections.
And 87 men said they had level 4 or level 5 erections, corresponding to partial erections not sufficient for intercourse or no erections, respectively, two years after surgery.
Of these men, one recovered normal erections and nine recovered diminished erections, routinely sufficient for intercourse. Eleven recovered partial erections occasionally satisfactory for intercourse.
After about three years, though, men with the most severe erectile dysfunction showed almost no improvement, Schiff says. But men who had partial erections that were occasionally sufficient for intercourse continued to make progress for up to four years after surgery.
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.
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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
- 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:
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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Penile Rehabilitation: Concept And Treatment Strategies
The concept of penile rehabilitation after RP was first introduced in the late 1990s15 and involves not only attempting to confer the ability to achieve erections sufficient for satisfactory sexual intercourse during the rehabilitation phase, but also to return erectile function to the pretreatment state . The clinical challenge is determining which treatment option is best for an individual patient, and each treatment has advantages and disadvantages.4,6 The potential benefits and limitations of treatment options are presented in Box 1. All treatment options should be presented to facilitate informed decision making. In this article, we propose a practical penile rehabilitation program for everyday clinical practice based on current understanding and treatment strategies . Offering rehabilitation and treating patients early postoperatively, before penile fibrosis develops, is of major importance for recovery of erectile function and sexual continuity.4–6
Recovery After Prostate Surgery
After a prostatectomy, you may experience ED for weeks, a year, or even longer. This is because of the trauma caused to the nerves responsible for erection during the surgery.
ED may take longer to recover during a radical prostatectomy compared to minimally invasive prostate surgery. If you had symptoms of ED before the surgery, they would not be resolved after the surgery.
Better techniques and approaches to prostate surgery have resulted in better outcomes for men. Men with a healthy erectile function before the surgery may heal faster after the surgery.
However, around half of the men who undergo this surgery regain their pre-surgery erectile functions within the first year post the surgery.
Men suffering from diabetes, cardiovascular disease, obesity, or those addicted to smoking or excessive alcohol consumption, may find it tougher to regain their erectile functions.
Old age is also a major factor affecting ED. The problems of ED can be combatted with a healthier lifestyle inclusive of regular exercise, a healthy diet, and low stress.
Doctors may suggest some ED medications to help you regain your erectile functions. However, these chemical drugs may have some side effects with regular use.
There are some other non-medical options too. Recovery after a prostatectomy is possible. You should talk to your doctor about the possible options. We have discussed the options in the section below.
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Who Has Nerve Preservation
Patient who are potent are understandably keen to retain this and so are we. As well as allowing erections following surgery, nerve preservation also allows an earlier return to continence so we always practice nerve preservation whenever the cancer control allows it, which is in about 80% of men. When the cancer is close to one of the nerves we might partially nerve preserve on that side if it is safe to do so and will discuss this with you beforehand if this seems likely.
The decision to nerve preserve is taken after considering the patients existing erections, PSA level, biopsy report, MRI scan, rectal examination under anaesthetic immediately before the operation starts and the way the NVB looks and feels during the operation. It is always discussed with patients before surgery.