How To Treat Erectile Dysfunction After Prostate Surgery
Prostate surgery is challenging enough. But to make matters worse, such an operation may impact ones sex life. The prostate is a vital part of the reproductive system. Its responsible for producing fluids that carry sperm.
So when the prostate is affected, this can lead to conditions like erectile dysfunction.
What Have I Learned By Reading This
You learned about:
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
Study Design And Participants
An online cross-sectional survey of men experiencing ED after prostate cancer treatment was conducted between August 2014 and March 2015. The survey consisted of a maximum of 48 questions and participants were told it would take 1015min to complete. Survey questions explored the assessment and discussion of EF with HCPs and satisfaction with ED management. To recruit participants, a hyperlink to the open online survey was widely disseminated through Prostate Cancer UKs communication channels, including electronic newsletters and social media. Paper versions of the survey were also provided on request, and these results were manually entered into the data set.
Supplementary data
Online cross-sectional surveys of GPs, practice nurses, urologists and urology CNS were conducted between October 2014 and January 2015. The primary care survey consisted of a maximum of 16 questions, and the secondary care survey consisted of a maximum of 18 questions. All participants were told it would take 10min to complete. Survey questions explored confidence regarding knowledge of prostate cancer and ED , discussions about potential side effects of prostate cancer treatment, how EF is assessed, the involvement of partners, ED management options, and roles and responsibilities. Participants were invited via Doctors.net.uk and Nursing in Practice access panels, weighted on gender, age and location to be representative of the respective HCP populations.
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How Fast Will I Become Totally Continent After Prostate Surgery
During surgery for prostate cancer, the urethra is also affected and, depending on the experience of the surgeon, more or less of the continence function will be preserved. Due to the high precision of robotic surgery, the patient will have a catheter for roughly one week and the trauma to the urinary function will be minimum.
The discomfort that patients feel during this time is minimum, but you should expect the removal to make you feel uneasy. The catheter will be removed during a visit to your doctor, so do not try to do this at home, as it could cause infections. The degree of which the urinary function will be affected depends on how normal the function was before surgery, age and weight.
It is worth noting that most men will experience some degree of incontinence after prostate surgery, but control can be regained within several weeks or months to a year.
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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.
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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.
Erectile Dysfunction After Prostate Cancer Treatment
- Original: May 2, 2020
Erectile dysfunction is the most common side effect after prostate cancer treatment irrespective of precision dose and delivery of radiation therapy or if the nerves were spared during surgery. Sexual dysfunction occurs because the nerves and blood vessels that control the physical aspect of an erection are incredibly delicate, and any trauma or stress to them can result in temporary or permanent damage.
Within one year after treatment, most men with intact nerves that were not significantly damaged will see a substantial improvement in sexual function. The skill of the surgeon or radiation oncologist can have a significant impact on long term sexual function, so its important to select your treatment and team very carefully.
When selecting treatment make sure your doctor explains the type and probability of side effect from their treatment facility. Sometimes treatment selection will depend on which side effects are most tolerable for you age and lifestyle.
Age, obesity and the ability to spare the nerves are the major determinants of the type and severity of side effects. In general, it is more challenging to spare the nerves in men with higher risk disease because the prostate cancer may have already spread past the nerves outside the prostate capsule.
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Hormone Therapy Effects On Erections
Hormone treatment is commonly given for prostate cancer. Men given androgen deprivation therapy are at a high risk for sexual problems, including loss of sexual desire and erectile dysfunction. Erections may or may not recover when ADT is stopped. Erectile dysfunction drugs do not usually work in these cases because they don’t help with the loss of sexual desire.
How Effective Are Oral Erectile Dysfunction Drugs
- Following surgery, up to 70% of men who have had nerves spared on both sides of the prostate will regain erections with the use of one or more oral drugs for erectile dysfunction. Results are less favorable for men who have had a single nerve spared or no nerves spared.
- Following radiation therapy, overall, 50% to 60% of men regain erections with medication. However, current data are rather limited, especially for patients treated with radioactive seed implants.
- Hormone therapy. Men treated with hormone therapy do not respond well to any erectile dysfunction treatments, but data are limited.
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Availability Of Data And Materials
The datasets generated and/or analyzed during the current study are not publicly available due to the large size of the transcripts from each interview and sensitivity and specificity of some of the information from the interviews, but the demographic information and some of the de-identified descriptions can be made available upon reasonable request to the corresponding author.
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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 before intercourse
- Use of a vacuum constriction device to draw blood into the to cause an erection
- Penile implants
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Managing Erectile Dysfunction After Prostate Cancer Treatment
Victoria Stainer
Victoria Stainer is a Speciality Trainee in Urology at Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol
Rachel Skews
Rachel Skews is a Urology Nurse Specialist at Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol
Jonathan J Aning
Jonathan J Aning is a Consultant Urological Surgeon at Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol
Victoria Stainer
Victoria Stainer is a Speciality Trainee in Urology at Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol
Rachel Skews
Rachel Skews is a Urology Nurse Specialist at Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol
Jonathan J Aning
Jonathan J Aning is a Consultant Urological Surgeon at Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol
Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
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Why Is Rehabilitation Important
Whether you are single, or in a relationship, you should have the opportunity to discuss penile rehabilitation with your doctor or specialist nurse. Self pleasuring is important for many people and this can play a part in rehabilitation. This might help to give you confidence and to become aware of the changes that your treatment might have caused.
Ideally, rehabilitation should start soon after your prostate cancer treatment, or in some situations before treatment. For example, you should start rehabilitation within 3 to 6 months of starting hormone therapy or radiotherapy. Or within the first 3 months of surgery to remove the prostate gland.
Assessment Of The Patient With Ed Following Prostate Cancer Treatment
A thorough medical history should be taken, including checking risk factors for poor erectile function recovery, which include older age, smoking, high BMI, being less physically active and the presence of co-morbidities or medications that contribute to ED. It is important to establish whether the patient’s prostate cancer treatment plan is ongoing or has been completed, in addition to gaining understanding of the individual’s prognosis, to guide ED treatment approaches.
The operation notes or medical records of men who have undergone surgery should be checked to ascertain whether nerve-sparing surgery was performed and whether there was unilateral or bilateral neurovascular bundle preservation. If no documentation is available, men should be asked about the type of surgery they received.
Early in the review, it is critical to gain knowledge of baseline erectile function level before treatment because men with a good erectile function pre-prostate cancer treatment are likely to do better than those with poor function. Pre- and post-treatment information should be gathered regarding reported tumescence, and quality and/or presence of morning, masturbatory or spontaneous erections. It is important to enquire about the presence of penile deviation during tumescence. Clinical examination of the genitalia must be performed at the time of review.
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Prostate Cancer And Occurrence Of Sexual Dysfunction
A sudden reduction in sexual function in patients with prostate cancer frequently occurs because of psychological instability caused by the occurrence of the cancer, and, in particular, depression., The occurrence of prostate cancer also often has a negative effect on the mental status of the female partner, causing a decrease in sexual function in the female partner. Because a diagnosis of prostate cancer simultaneously causes fear and anxiety in married couples regarding the effects of prostate cancer on their lives, it also creates an unstable mental status in their sex life, resulting in reduced sexual activity.
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:
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Management Of Erectile Dysfunction
About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.
Masculinity And Sexual Function After Pc Treatment
PC treatment and subsequent ED, loss of libido, and/or potency was consistently described in qualitative studies as having an impact on, or being a threat to, mens sense of masculinity . Some men chose to undergo radiation therapy instead of RP because the former offered a better chance of preserving sexual function which in their view was equivalent to masculinity . In almost every study, the belief that masculinity was lost or somehow diminished was described , and this was a source of anxiety, depression, or embarrassment for men made them question their self-worth and created feelings of disempowerment and a fear that they may be stigmatised .
Other qualitative studies described masculinity as framing mens experiences and adjustment after PC treatment . In this regard, due to their sexual dysfunction some men believed that they could no longer live a normal life or respond appropriately in everyday interactions with women . Men also discussed the possibility that their wives would leave them because they could not satisfy them sexually or be an active partner . Men limited social activities which had the potential for sex adopted strategies that maintained the macho façade such as pseudo courtship or laughing at jokes about ED or used traditional masculine coping responses such as emotional restraint , stoicism , acceptance , optimism , and humour .
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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
Nerve Damage From Radiation
Some men who get radiation will notice that their erections change for the worse over the first year or so after treatment. This change most often develops slowly. Some men will still have full erections but lose them before reaching climax. Others no longer get firm erections at all.
As with surgery, the older you are, the more likely it is you will have problems with erections. And men with heart or blood vessel disease, diabetes, or who have smoked heavily seem to be at greater risk for erection problems. This is because their arteries may already be damaged before radiation treatment. Doctors are looking at whether early penile rehabilitation could help after radiation therapy, too.
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Nerve Damage From Chemotherapy
Some chemo drugs like cisplatin, vincristine, paclitaxel, bortezomib, and thalidomide can damage parts of the nervous system, usually the small nerves of the hands and feet. These drugs have not been found to directly injure the nerve bundles that allow erection. But some people have concerns because the drugs are known to affect nerve tissue, and there are many nerves involved in sexual function.
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
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