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How To Speed Up Nerve Regeneration After Prostate Surgery

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Relationship Between Iief Score 18 Months After Surgery And The Cavernous Nitrite 3 Months After Surgery

What is Nerve Grafting/Regeneration Surgery? Will this help men after prostatectomy get erections?

Statistical analysis showed a close relationship between the degree of erectile function recovery 18 months after surgery and cavernous nitrite levels , as reported in .

Finally, the patient with biochemical relapse of the disease experienced erections before the treatment with androgenic blockage . His nitrite levels exceeded 500nmol/l.

What Happens When Your Nerves Are Damaged

One of the biggest issues we see after surgery is scarring around nerves . Think of a nerve as a garden hose. If you constrict one area, less water comes out the end. This is what happens when scar tissue forms around a nerve after surgery. The scar tissue constricts the nerve which reduces the transport of critical chemicals that the nerve needs to stay healthy.

A nerve can also be damaged by killing some or all of its fibers. The image to the left shows that a nerve is made up of many neurons that are bundled into fascicles and then bundles of these make up the bigger nerve . In addition, the nerve is surrounded by a fatty sheath that acts like an insulator covering a wire and when this gets damaged there can also be a problem with nerve function.

In summary, nerve damage is broken into neurapraxia , axontomeis , and neurontomesis .

Coping With Infertility After Prostate Surgery

The prostate is one of the only organs in a males body that never stops growing. This growth is slow and continual throughout your life and many doctors dont fully understand why it happens. In some instances, the prostate grows larger than your body can accommodate, and the result is benign prostatic hyperplasia or enlarged prostate. While this isnt life threatening, it can lead to an array of uncomfortable symptoms. There are treatment options for benign prostatic hyperplasia, with the most invasive being surgery. Some men will also develop prostate cancer during their lives. While prostate cancer has one of the highest curability rates, it needs to be diagnosed early so that surgery can eradicate the cancer completely. Regardless of why you need prostate surgery, certain instances can lead to problems such as infertility. In this article, well explore everything you need to know about the prostate and how to cope with infertility after prostate surgery.

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Help Seeking For Erectile Dysfunction

Asking for help in sexual matters is not easy for either the person who asks or for the person from whom help is sought. Most people consider sexual activity a private matter and feel awkward when discussing sexual difficulties, even within the couple. In a providerpatient relationship, the dynamics of help seeking can be burdensome, if one or both members of the partnership feel uncomfortable broaching the subject. A study by Matthews Nichols and Barret gives insight into the way in which physicians, while seeing responsiveness to their patients questions about sexual problems as a part of their role, feel unprepared in terms of knowledge base and comfort with the subject. As an echo of the physicians feelings of inadequacy, a study by Marwick highlights patients low expectations of their providers to whom they turn for help with sexual concerns.

Characteristics of men who seek help for erectile dysfunction

Approximately 59% of men with erectile dysfunction due to prostate cancer treatment seek medical help. Men are more likely to seek erectogenic treatments after prostatectomy than after radiation therapy, but few men try treatments and tend to discontinue them early.

Evaluation Of Patients By Iief Score

Nerve regeneration after radical prostatectomy

All patients showed potency at the preoperative examination, with an average IIEF score of 27.5.

At the first postoperative follow-up, after 3 months, none of the patients showed spontaneous erections but only tumescence none of them could have sexual intercourses.

Only 13 patients could be evaluated 18 months after surgery, because one of them had a relapse of the disease. Six patients presented severe to moderate erectile dysfunction , whereas in seven cases, sexual potency was either entirely or partially restored and patients could have sexual intercourses .

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Tell Me About The Use Of Viagra For A Prostatic Cancer Patient Who Is Taking Hormone Treatments And Casodex

Viagra is somewhat effective in patients who are receiving various forms of hormonal therapy especially hormonal therapy with antiandrogens, such as Casodex, that do not lower the plasma testosterone level. This type of potentially potency-sparing hormonal therapy does not interfere with sexual desire or erections as much as more complete forms of hormonal therapy, such as Lupron, Zoladex, or removal of the testicles. However, even patients on more complete forms of hormonal therapy have improved erections with Viagra. Their sexual desire is very low, and that also plays an important role.

Days Before Your Surgery

Follow your healthcare providers instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare providers instructions. Dont stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

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Perineural Invasion: What Is The Significance If Perineural Invasion Is Present And Identified In A Post Op Pathology Report

There are small nerve fibers that pass through the inside of the prostate gland. These nerves secrete a growth factor that attracts prostate cancer cells. Accordingly, in the great majority of prostate cancers, the cancer cells are seen to be lined up surrounding nerve fibers. This is called perineural invasion. Perineural invasion is so common as to almost be a diagnostic feature of prostate cancer. Its clinical significance is that when it is found in a needle biopsy specimen, there is a greater chance that the tumor will be found to have spread outside the prostate gland. If the tumor has spread outside the prostate, there is a higher chance for tumor recurrence. However, if the tumor has not spread outside the prostate gland, there is little or no prognostic significance to perineural invasion.

What You Never Lose: The Good News About Sexual Function

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While regaining erectile functiom is not possible for all men, it is important to remember that erection is just one part of a satisfying sex life. The other parts remain intact despite prostate cancer surgery. Sexual feelings, sexual fulfillment, climax and the sensation of orgasm are still available without erection.

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Introduction To Nerve Regeneration

Three sets of nerves are important when a man has sex:

  • The nerves of penile sensation.
  • The nerves that cause an erection.
  • The nerves that control climax.
  • Because of their location, sandwiched between the prostate and the rectum, the second set of nerves can be affected during radical prostatectomy. The other two sets of nerves cannot be affected. Regarding climax after surgery, roughly 80% of men describe climax as being equally satisfying after surgery as before, 10% say that it is better and 10% say that it is less intense.

    Intrafascial Interfascial And Extrafascial Dissection

    According to the guideline of the European Urological Association, intrafascial, interfascial and extrafascial dissection could be carried out to preserve the cavernous nerves. When the plane of dissection was closer to the prostate, and if the nerve-sparing procedure was carried out bilaterally, the functional outcome was better. Some researchers recommended another grading system of nerve-sparing procedures according to the vascular landmarks branched from the neurovascular bundles to carry out more precise nerve-sparing procedures.- Schatloff et al. used the landmark arteries for grading of the nerve-sparing procedures. The landmark arteries entered the anterolateral aspect of the prostate, and were identified by their large size and tortuosity . This grading of nerve-sparing procedures involved five grades according to the situation of the landmark arteries . However, landmark arteries were not found in all patients. In contrast, Tewari et al. recommended a grading system composed of four dissection planes based on the landmark veins ordinarily situated on the lateral aspect of the prostate .

    Fig. 1


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    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.

    What Causes The Penis And Testicles To Draw Up Into The Body 6 Years After Prostatectomy

    Vitamins to Promote Nerve Regeneration After Surgery ...

    Men normally have daily erections with highly- oxygenated arterial blood . Even male babies have erections every day. These infusions of well-oxygenated blood into the genital tissues keep these tissues healthy and robust and are critical for the propagation of the human species. Testosterone levels decrease with age, and if men are not having frequent erections, the genital tissues gradually undergo atrophy. This condition can be treated with testosterone- replacement therapy and with treatments that induce erections with arterial blood . I routinely incorporate this type of rehabilitation in my postoperative patients. See my article on erectile rehabilitation after radical prostatectomy in the Spring 2013 QUEST.

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    What Happens If There Is A Malfunction During The Da Vinci Robotic Surgery

    In the unlikely event of malfunction during the robotic surgery, or if the surgeon feels that it is not safe to continue with the robot, the da vinci system will be withdrawn and the surgery can proceed either via traditional laparoscopic means or via traditional open radical prostatectomy. The instruments and supplies necessary are kept on hand such that conversion, if necessary, can occur seamlessly. Dr. Ahlering was previously an expert in open radical prostatectomy such that good surgical results can still be obtained in this unlikely event.

    Devices For Identifying The Cavernous Nerves During Radical Prostatectomy

    Owing to the lack of visibility of the cavernous nerves during RARP, erectile dysfunction after surgery has remained the most crucial postoperative complication in the robotic surgery era., Thus, many novel methods for mapping the cavernous nerves during radical prostatectomy have been developed so far. Being able to recognize the cavernous nerves during radical prostatectomy might help in their preservation, leading to improved postoperative genitourinary function. In this section, the diagnostic technologies of intraoperative diagnosis of cavernous nerves during radical prostatectomy are reported. The summary of the advantages and disadvantages of these devices for identifying the cavernous nerves during radical prostatectomy is presented in .

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    Can I Have An Orgasm Without An Erection

    Yes. An erection is not necessary for orgasm or ejaculation. Even if a man cannot have an erection or can only get or keep a partial erection, with the right sexual stimulation you can experience an orgasm. Your orgasm has little to do with your prostate gland. As long as you have normal skin sensation, you can have an orgasm.

    Delaying Surgery: I Have Gleason 3 + 4 Prostate Cancer That Appears To Be Clinically Localized Is It Safe To Delay Surgery For 3 Months

    Nerve-sparing prostatectomy

    My practice is to wait for 6 weeks after the biopsy to allow any inflammation to resolve. Then the surgery should be performed as soon as it can be conveniently scheduled. Many patients who delay their surgery are found to have positive margins or extension of cancer outside the prostate and then need to have postoperative radiation. They often wonder whether if they had not delayed, the result would have been different.

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    My Husband Has Been Diagnosed With A Form Of Prostate Duct Cancer Which Has Spread Into The Neck Of The Bladder We Have Been Told This Cancer Is Rare And There Is Little Information On It What Can You Tell Us About It

    Prostatic ductal cancers are uncommon but not rare. Often they produce very little PSA or none at all. Ductal carcinomas generally are more aggressive than the more common prostate cancers that arise from the small glands in the prostate called prostatic acini (thus the typical prostate cancer is sometimes referred to more formally as an acinar adenocarcinoma.

    The most effective treatment for ductal cancers is radical prostatectomy if the cancer is contained within the prostate gland.

    The response to radiation therapy or hormonal therapy is not as good for ductal cancers as for acinar cancers. The most effective chemotherapy drug used for acinar cancers is docetaxel but little information is available on its effectiveness with ductal cancers.

    Is Surgery My Only Safe Option: I Have Been Diagnosed With Prostate Cancer Psa Level 64 Gleason 3+3 In 3 Of 10 Biopsy Samples Ranging From 15 25% By Volume The Cell Structure Still Showed Close Resemblance To Normal Cells In The Biopsy My Consultant Has Recommended Radical Prostatectomy I Am Very Concerned About The Post Operative Effects Of Impotency And As A Fit And Active Man Of 55 Yrs Is This Really My Only Safe Option If This Really Is My Only Course Of Action Would Waiting 6 Months For Surgery Be A Problem

    Because of your age and the features of your tumor, I believe that radical prostatectomy is your best option, but that is not to say that it is your only safe option. I would not advise waiting 6 months to be treated. The complications you fear can best be avoided by chosing a surgeon with considerable experience in radical prostatectomy.

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    Sexual Dysfunction After Prostate Surgery Is More Common Than Previously Reported Says Hutchinson Center Study

    Media briefing: A media briefing will be held at 1 p.m. PST Tuesday, Jan. 18 at the Centerâs Metropolitan Park East Campus, 1730 Minor Ave., between Olive and Howell streets. A Media Relations representative will greet you in the lobby and escort you to the briefing room. Free parking is available in an underground garage entrance off Minor Ave. A map of the site is available upon request.

    B-roll available: A related video news release, including sound bites and b-roll of Dr. Janet Stanford and a Seattle-area prostate-cancer survivor, will be available via satellite feed twice on Tuesday, Jan. 18: first between 6 and 6:30 a.m. PST and again between 11 and 11:30 a.m. PST .

    SEATTLE â Sexual dysfunction among men who undergo prostatectomy appears more prevalent than previously reported, according to a multi-center study led by an investigator from the Fred Hutchinson Cancer Research Center in Seattle.

    The results will appear in the Jan. 19 issue of the Journal of the American Medical Association.

    Funded by the National Cancer Institute, the Prostate Cancer Outcomes Study is the first comprehensive, population-based assessment of sexual function and urinary continence among men treated with radical prostatectomy for early stage, localized prostate cancer. It is also the first study to examine the sexual and urinary side effects of such surgery in minority populations.

    Age and education also had an impact on the frequency of impotence.

    # # #

    Changes To Orgasm And Ejaculation

    What is Nerve Grafting/Regeneration Surgery?

    After prostate cancer treatment you will still have feeling in your penis and you should still be able to have an orgasm, but this may feel different from before. Some men lose the ability to orgasm, especially if theyre on hormone therapy.

    If youve had radical prostatectomy, you will no longer ejaculate when you orgasm. This is because the prostate and seminal vesicles, which make some of the fluid in semen, are both removed during the operation. Instead you may have a dry orgasm where you feel the sensation of orgasm but dont ejaculate. Occasionally, you might release a small amount of liquid from the tip of your penis during orgasm, which may be fluid from glands lining the urethra.

    If youve had radiotherapy, brachytherapy, high intensity focused ultrasound or hormone therapy, you may produce less semen during and after treatment. With radiotherapy, brachytherapy and HIFU you may also notice a small amount of blood in the semen. This usually isnt a problem but tell your doctor or nurse if this happens. Some men on hormone therapy say their orgasms feel less intense.

    Some men leak urine when they orgasm, or feel pain. Others find they dont last as long during sex and reach orgasm quite quickly.

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    Tips For Talking With Your Partner

    Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:

    • Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
    • Listen to your partners concerns, too. Remember that this issue affects both of you.
    • See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
    • If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.

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