Monday, October 3, 2022

Will Nerves Regenerate After Prostate Surgery

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No Difference From Placebo At 6 Months With Short Course Of Neuroprotectant

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

byCharles Bankhead, Senior Editor, MedPage Today June 3, 2021

Perioperative treatment to preserve nerve function did not significantly improve erectile function after surgery for prostate cancer, a randomized, placebo-controlled study showed.

Six months after radical prostatectomy, patients treated with erythropoietin or placebo had similar scores on a validated scale of erectile function. In fact, the median score favored the placebo group . Investigators also found no significant difference between groups at 3, 9, and 12 months. Adjustment for nerve-sparing surgery, which was associated with recovery of erectile function, had minimal effect on analyses of primary and secondary endpoints.

The EPO group had significantly higher hemoglobin levels during treatment, consistent with administration of EPO, reported Hiten D. Patel, MD, of Johns Hopkins School of Medicine in Baltimore, and co-authors in the Journal of Urology.

“Unfortunately, ERECT did not confirm an independent benefit for erythropoietin as suggested by retrospective data and highlights the need for high-quality, randomized, placebo-controlled trials prior to widespread implementation of these types of adjuncts,” the authors said. “It is possible the lack of efficacy could be due to the target population destined to do relatively well regardless of additional interventions beyond surgical technique.”

Disclosures

Sexual Function After Prostate Surgery

Options for men with erectile dysfunction following prostate cancer treatment

Nearly all men will experience difficulty getting an erection for a period of time after undergoing robotic radical prostatectomy. The nerves responsible for an erection travel very close to the prostate gland and may be injured during removal of the prostate. However, most men recover with time.

First Reports On Nerve Grafts

Kim ED, Nath R, Kadmon D, et al. Bilateral Nerve Graft During Radical Retropubic Prostatectomy: 1-Year Follow-Up. Journal of Urology 2001 165:195056. PMID: 11371887.

Kim ED, Nath R, Slawin KM, et al. Bilateral Nerve Grafting During Radical Retropubic Prostatectomy: Extended Follow-Up. Urology 2001 58:98387. PMID: 11744473.

Kim ED, Scardino PT, Hampel O, et al. Interposition of Sural Nerve Restores Function of Cavernous Nerves Resected During Radical Prostatectomy. Journal of Urology 1999 161:18892. PMID: 10037395.

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New Treatment For Ed After Prostate Surgery Being Developed Researchers Say

April 19 — Men undergoing surgery for prostate cancer may no longer have to live with erectile dysfunction afterward, thanks to an innovative new treatment, researchers said in a paper published Monday by JCI Insight.

The treatment, developed at Albert Einstein College of Medicine in New York City, involves the surgical implantation of a topical drug that regenerates and restores the function of erectile nerves damaged by radical prostatectomy, they said.

When applied to the nerves immediately after injury sustained during surgery, the drug significantly improved erectile function in rats within three to four weeks, according to the researchers.

The treatment still must undergo clinical trials in humans, which means it could be five to seven years before it is available for use, the researchers said.

“What puts people off to getting radical prostatecomy is the associated side effects, including ED,” co-author David J. Sharp told UPI in a phone interview.

“What we found is that we can regenerate these nerves,” said Sharp, a professor of physiology and biophysics at Einstein.

Radical prostatectomy, or the surgical removal of the prostate gland, is the most commonly used — and, to date, most effective — treatment for prostate cancer, according to the American Cancer Society.

Devices For Identifying The Cavernous Nerves During Radical Prostatectomy

MP84

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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Where To Get Prostate Surgery In Nyc

At New York Urology Specialists, we offer specialized treatment for enlarged prostate for men. Same-day virtual video appointments and in-person appointments are available.

or make an appointment online.

We perform a cystoscopy, urodynamic testing, prostate and bladder ultrasound in our office. We offer Urolift procedure, Rezum water-vapor procedure in our office, and laser enucleation of the prostate in a hospital setting. We treat urinary and erection problems. We offer confidential appointments.

Our appointment costs are affordable with or without insurance. We offer free insurance verification.

Can Nerve Grafts Restore Erectile Function

Until 1981, urologists believed that the nerves responsible for erections ran through the prostate. But that year, Dutch urologist Pieter Donker showed that the nerves ran down the sides of the gland, not through it. That discovery got urologic surgeons thinking: perhaps a cancerous prostate could be removed without harming the nerves, preserving a mans erectile function.

The following year, the first so-called nerve-sparing radical prostatectomy was performed. Today, most surgeons aim to spare the neurovascular bundles when performing prostate surgery. This helps men who were potent prior to surgery regain erectile function, and some studies show that it may also minimize urinary incontinence.

Unfortunately, the surgeon, whose main goal is to eliminate the cancer, cant always spare the nerves. For example, the cancer might have grown through the prostate capsule and into the nerves, making their removal a must. Or the cancer might be at the edges of the gland, increasing the risk that a few cancerous cells might be left behind the surgeon might make a wider cut to ensure a cure but sacrifice erectile nerves in the process. In some cases, neither nerve bundle can be saved.

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Why Does It Take So Long To Recover Erections After The Very Best Surgery

A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma.

Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy

Nerve-sparing prostatectomy

The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.

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

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.

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.

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I Am A 57 Year Old Man Who Had A Rrp 6 Months Ago I Currently Have Sex 2

In my experience, erections usually begin to return as partial erections 3 to 6 months after surgery and then continue to improve for about 36 months after surgery, as the nerves recover from the trauma of surgery. It is currently believed by some experts in erectile dysfunction that taking agents such as Viagra, Levitra, or Cialis will hasten the return of erections.The basis for this belief is that, normally, men have erections every day. Therefore, the normal situation for the penis is to receive an infusion of well-oxygenated blood every day. This infusion helps to keep the intricate anatomical structures in the penis healthy.I dont know of any evidence to suggest that diet helps in this matter. Important factors are to take the erection enhancing medications on an empty stomach to allow them to become completely absorbed, to avoid smoking, alcohol, and, if possible, other medications that can interfere with erections. Keep diabetes under good control. Have regular sexual stimulation. And have patience.

Coping With Infertility After Prostate Surgery

Erectile dysfunction (Impotence) and urinary incontinence ...

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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Sex After Prostate Surgery And Achieving Orgasm

Sex after prostatectomy 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.

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.

The good news is that sex after prostate surgery 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.

Nerve Regeneration After Radical Prostatectomy

Filed in Life After Treatment

Nerve regeneration after radical prostatectomy usually does take some time, assuming that both nerve bundles around the prostate were able to be preserved by the surgeon. This is because the nerves and arteries that control erections need time to recover and heal. This article explains why this is the case, and what can be done to speed up the healing process.

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Going Home With A Catheter

You will be discharged from the hospital with a catheter in place to drain urine from your bladder into a bag. The doctor will remove this in the office in five to 14 days. Be sure to clean the catheter where it exits your penis twice a day with soap and water and to empty the bag frequently. The bag should always be positioned lower than your bladder.

On occasion, the catheter may irritate the bladder, causing bladder spasms that can be quite uncomfortable. If these occur, your doctor can prescribe medication that can help. Leakage of urine around where the catheter exits the penis also may occur and can be managed by wearing incontinence pads as described in the next section.

It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This also is common. If you see large clots â more than an inch in length â or if the catheter becomes plugged, contact your doctor. No anesthesia is required for catheter removal, and most patients experience only a little discomfort.

Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists

Nerve-Sparing NeuroSAFE Prostate Surgery

We have excellent reviews from patients and their partners. Information for out-of-state and international patients. Find out our office hours or directions to our office.

We offer affordable appointment prices with or without insurance. We offer weekday, weekend, and evening office hours.

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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Can You Recommend Specific Exercises That May Help With Obtaining Or Increasing Erections For Example I Have Read That Leg Presses Increase Blood Flow To The Penis Is There Any Literature On This Subject

Normally, men have one or more erections daily. Therefore, the normal physiology of the penis is to have an infusion of well-oxygenated blood several times each day. It is probably not healthy for the tissues of the penis for men to go for months without having any erections some experts have suggested that lack of erections can cause atrophy of important anatomic structures in the penis, such as the valves that trap blood in the penis during erection, and also results in fibrosis of the penile tissues.

Preoperative Planning With Multi

Multiparametric magnetic resonance imaging has gained widespread use in the workup of elevated PSA and diagnosis of prostate cancer via MRI-transrectal ultrasound targeted fusion biopsy. This technique has been shown to increase the detection rate of high-grade prostate cancer by 30% and result in lower detection of low grade prostate cancers by 17% . The recently published PROMIS trial evaluated the performance of mpMRI to the reference standard template prostate mapping biopsy and reported superior sensitivity for mpMRI compared to TRUS biopsy and negative predictive value , allowing 24% with negative MRI to safely avoid having to undergo biopsy .

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I Had A Radical Prostatectomy About Six Months Ago To Treat The Resulting Ed I Began Viagra Therapy One Month After Surgery And Injection Therapy Four Months After Surgery I Am Using A Trimix Cocktail I Have Been Surprised By How Exact The Dosage Level Must Be In Order To Achieve Adequate Rigidity Without Having The Erection Continue For Several Hours If I Took Viagra An Hour Before Injection Might I Be Able To Take A Lower Dosage Of Trimix And Have A Wider Range Of What Will Be Successful As It Is A Slight Underdose Or A Slight Overdose Is Very Unsatisfactory Though The Second Is To Be Preferred

It is complicated to mix Viagra with injection therapy. Viagra works by prolonging the effects of natural substances produced by your body, while Trimix contains drugs that directly cause the blood vessels to open up. Also, as nerves recover from surgery, there might be changes in the dosage of Viagra and Trimix needed to produce a rigid erection. In other words, you are working with a moving target. I would advise you to keep it as simple as possible. It is also less expensive that way.

The Controversy Surrounding Penile Rehabilitation After Radical Prostatectomy

[PDF] Cavernous Nerve Graft Reconstruction with a Novel ...

Jonathan Clavell-Hernández1, Run Wang1,2

1Division of Urology, Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA 2University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Contributions: Conception and design: All authors Administrative support: None Provision of study materials or patients: J Clavell-Hernández Collection and assembly of data: All authors Data analysis and interpretation: J Clavell-Hernández Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Abstract: Radical prostatectomy techniques have been refined in the last few decades. Despite nerve-sparing surgery, erectile dysfunction still seems to be affecting more than half of patients undergoing RP. Penile rehabilitation consists of understanding the mechanisms that affect erectile function and utilizing pharmacologic agents, devices or interventions to promote male sexual function before and after any insult to the penile erectile physiologic axis. There currently is a limited amount of clinical trials that assess treatments with the goal of recovering post-prostatectomy EF. The goal of this article is to assess a contemporary series of trials that study penile rehabilitation. Although the current evidence lacks to prove its irrefutable effectiveness, advancements in research and technology forecast a promising future in penile rehabilitation management.

doi: 10.21037/tau.2016.08.14

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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.

Ejaculation will no longer occur in any patient. This is because the seminal vesicles and the vas deferens , are removed and cut during the surgery. This means that you will no longer be able to father children

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