Sunday, September 25, 2022

Will Removal Of Prostate Cause Impotence

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Medical Treatments For Ed And Penile Rehabilitation Following Rp

Erectile Dysfunction Treatment Options | post Prostate Removal Surgery

There are currently a variety of treatments for ED. The first-line therapy for ED is using phosphodiesterase-5 inhibitors . Unfortunately, only about 12 to 17% of men will respond to these pills in the first six months following surgery . The mechanism for erections is the secretion of nitric oxide from the cavernous nerves that run bilaterally along the prostate. NO promotes smooth muscle relaxation in the penis, producing an erection. PDE-5 is a chemical that breaks down NO, and as their name implies, oral medications inhibit PDE-5, leaving more NO available to produce an erection. Despite nerve sparing surgical techniques , oral medications are generally ineffective early after surgery because the cavernous nerves are injured intraoperatively and can take 24 months to heal . Early in the healing process, there is reduced NO secretion which removes the mechanism of action for oral medications. As the nerves heal, they gradually start to secret NO and oral medications progressively become more effective.

Can Prostate Cancer Cause Erectile Dysfunction

Yes, prostate cancer can lead to erectile dysfunction. According to the organization About Prostate Cancer, prostate cancer can not only affect erectile dysfunction but also, ejaculation, libido , and orgasms.

The good news is, for men who have intact nerves, there is a substantial chance of improvement with treatment.

Nerve Damage From Surgery

The most common way surgery affects erections is by removing or causing injury to the nerves that help cause an erection. All of the operations listed above can damage these nerves. The nerves surround the back and sides of the prostate gland between the prostate and the rectum, and fan out like a cobweb around the prostate, which makes it easy to damage them during an operation.

When possible, nerve-sparing methods are used in radical prostatectomy, radical cystectomy, AP resection, or TME. In nerve-sparing surgery, doctors carefully try to avoid these nerves. When the size and location of a tumor allow for nerve-sparing surgery, more men recover erections than with other techniques. But even if the surgeon is able to spare these nerves, they might still be injured during the operation and need time to heal.

Even when the nerves are spared, research has shown that the healing process takes up to 2 years for most men. We dont know all the reasons some men regain full erections and others do not. We do know that men are more likely to recover erections when nerves on both the left and right sides of the prostate are spared.

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Life After Prostate Cancer Treatment

Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.

Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.

Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.

“It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.

What Are The Current Expectations With Regard To Outcomes After Radical Prostatectomy

Dealing with Prostate Impotence  Treatment Options ...

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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How Do Doctors Perform Prostate Removal

During prostate removal the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. A prostatectomy takes about two hours and is performed under general anesthesia.

There are two approaches used for a prostatectomy:

  • Robotic surgery
  • Minimally invasive procedure with faster recovery time
  • Uses smaller incisions and robotic technology
  • Open surgery
  • Uses traditional incisions and tools
  • May be used for more complex cases
  • The surgical process is as follows:

    • The doctor will make a small incision to gain access to the prostate
    • The prostate is removed
    • The bladder is reconnected to the urethra
    • A catheter is connected to the bladder to allow urine to drain while the area heals

    Prostate And Ed Problems: Does Prostate Cancer Cause Impotence

    Prostate cancer is a serious health problem that kills around 25,000 men a year in the United States alone. Although this disease can be deadly, prostate cancer generally doesnt affect male sexual function, but the treatments can. Benign prostatic hyperplasia is an enlargement of the prostate and is the leading cause of incontinence and prostatitis impotence in men over the age of 50.

    Some treatments for prostate cancer and other prostate and ED problems have sexual side effects. The prostate itself doesnt work to help men achieve erections. It simply produces an alkaline fluid that comprises over 50% of the seminal volume.

    How Prostate Cancer Treatments Affect Erectile Function?

    Prostate problems and impotence affect mens ability to sustain a satisfactory erection. Erectile dysfunction often occurs as a result of nerve damage and poor blood flow to the penis. There are bundles of penile nerves that help create engorgement of the penis, causing satisfactory erections.

    Nearly all men will experience some erectile dysfunction for the first few months after prostate cancer treatment. The severity varies on factors like contributing disorders, surgeons skill, and whether radiation therapy was used.

    In some cases, penile nerves are damaged during radical prostatectomy. As a result, it can severely affect sexual function and may lead to erectile dysfunction and impotence.

    Here are several treatments that can result in prostate and ED problems:

    Radical Prostatectomy

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    When Can I Return To Sexual Activity

    Let the surgery heal for three to four weeks before attempting anything. After one month after the robotic prostatectomy, it is recommended that you resume sexual activity. Stimulation of the nerves is thought to be a first step on the journey back to potency. Remember that you can still experience the pleasures of orgasm and other sensual stimulations without full erections. The average time to recovery for erections adequate for intercourse is 6-12 months, but in some men it is even longer. You should also be performing kegel exercises regularly to help your return to potency.

    What Happens To A Man When He Has His Prostate Removed

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    Prostate is a male reproductory gland located anterior to the rectum and inferior to the bladder surrounding the urethra. It is involved in the secretion of prostate fluid that forms an important constituent of semen. It also works in the propulsion of seminal fluid into the urethra and also blocks the connection between the urethra and the bladder by contracting at the time of ejaculation. The prostatic fluid constitutes about one third of the total seminal fluid containing various enzymes of which PSA is of specific importance, not only in thinning of the seminal fluid and helping proper motility of the sperm, but also in the testing procedure for prostate related diseases, such as BPH .

    The location of prostate is such that, if the patient experiences BPH then it might lead to urethral compression causing difficulty in urination and leading to LUTS . Unfortunately, BPH is a common problem in adult men and the chances of BPH drastically increases after the age of 60 years. A growth in size of prostate is also a sign of prostatic cancer.

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    Management Of Erectile Dysfunction

    Oral medications relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 36 hours.

    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.

    How Effective Is Medication For Treating Patients With Prostate Conditions

    Depending on the type and severity of the condition, prescription medications range in efficacy from dissolution of the condition to simple symptom management. With Prostatitis for example, antibiotics over a course of several weeks can reverse these problems.

    Several men prefer not or simply cannot take antibiotics for prostate conditions. Allergies, limited swallowing ability, and other previous conditions may limit the ability to consume medication. As a result, men have turned to GAINSWave for treatment.

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    Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery

    Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.

    Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.

    How May Erectile Dysfunction Affect My Sex Life

    FAQs: Impotence (Erectile Dysfunction) Frequently Asked ...

    Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.

    If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a problem shared is a problem halved. Not everyone wants a sexual relationship. Dont try to guess or assume what your partner wants. Have an open and honest discussion with your partner.

    This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.

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    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.

    Natural Treatments For Bph Induced Erectile Dysfunction

    As mentioned above, many doctors consider that BPH does not directly cause ED. However, most studies also show that men with serious BPH also suffer from ED.

    Both maladies are often a result of lifestyle and nutritional deficiencies. For example, many men, when tested, show a deficiency in the mineral Zinc. The prostate is an organ that requires zinc in order to function normally. Thus a zinc deficiency may result in prostate issues that span multiple symptoms, BPH and ED, among them.

    Many BPH symptoms can be helped by the use of herbal remedies, particularly saw palmetto and pygeum herbal extracts. Urinary issues can be helped using a flower pollen extract. Other natural prostate supplements include:

    • Rye Grass Pollen Extract
    • Turmeric
    • Ellagic Acid

    Erectile dysfunction can often be improved by the use of medications called PDE-5 inhibitors. This includes the trade names of Viagra, Cialis, and Levitra at present. However, while these medications may improve or facilitate sexual function, they do nothing to solve the underlying problem.

    Unfortunately, the dietary habits of the public do not foster healthy living. Poor eating habits tend to cause hormonal and nutritional disturbances. These imbalances add up. When severe enough, they can cause prostate enlargement, erectile dysfunction, or any one of a host of associated symptoms.

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    Erectile Dysfunction And Prostate Cancer Treatment

    It has been a well-recognized myth that the treatment of prostate cancer leaves the man with permanent erectile dysfunction thereby making their sex life difficult. Research and clinical study indicates that a man undergoing treatment for prostate cancer should always prepare himself for the possible erectile dysfunction and even though this treatment induced ED is not avoidable you can still ensure sexual pleasure in your life as well as intense orgasms with simple lifestyle modifications and therapies.

    Management Of Erectile Function

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    Whats the secret to having a good sex life after prostate cancer? In an interview with the Prostate Cancer Foundation Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. summed it up this way You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Theres also the vacuum pump.

    Erectile Dysfunction Medications Viagra® , Cialis® , and Levitra® work by relaxing the muscles in the penis which allows blood to rapidly flow to achieve an erection. About 75% of men who undergo nerve-sparing prostatectomy or radiation therapy can successfully achieve erections with these medications.

    Muse® is a medicated pellet about half the size of a grain of rice that when inserted into the urethra through the opening at the tip of the penis stimulates blood flow into the penis. About 40% of men have reported successfully achieving erections after using this drug.

    End to End nerve grafting is a new technique recently reported to be effective in improving erectile function.

    Injection therapy requires sticking a tiny needle into the base of the penis so Tri-mix which contains three drugs can be injected. The success rate is between 70 and 80% and each shot costs about $7. The specific formulation of drugs is based on the type of erection achieved with test dosages in the doctors office and the doctor teaches the patient how to self-inject.

    References:

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    Effective Treatment Of Ed After Prostate Removal Surgery And Radiation Therapy

    At New York Urology Specialists, we use the most advanced methods of ED treatment to help men recover erections after prostate cancer treatment with surgical removal of the prostate and radiation therapy , as well as HIFU.

    Our approach to the treatment of post-prostatectomy ED is very effective for men of all ages. We offer treatment for impotence for men who are planning to undergo surgery for prostate cancer, men who recently had surgery as well as men who have been living with ED for many years after prostate surgery.

    We treat men who are planning to or had radiation therapy or hormonal therapy for the treatment of prostate cancer and experience decreased erection hardness or inability to obtain and maintain erections sufficient for sexual intercourse.

    How Will Prostate Cancer Affect My Sex Life

    Prostate cancer can affect your sex life in three overlapping ways – your mind, body and relationships.

    Mind

    Finding out you have cancer can make you feel down or anxious, changing your feelings about sex.

    Body

    Treatment can damage the nerves and blood supply needed for erections. Hormone therapy can affect your desire for sex.

    Relationships

    Coping with cancer can change your close relationships, or your thoughts about starting one.

    Some common worries

    • You cant pass on cancer through sex.
    • Having sex won’t affect how well your treatment works.
    • Having sex has no effect on your cancer or the chance of it coming back after treatment.
    • It’s safe to have an erection if you have a catheter in.

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    Risk Of Erection Problems After Robotic Prostatectomy Depends On:

    • age the older the patient the more likely he is to experience erectile dysfunction after surgery. This is likely related to an underlying increased risk of vascular disease that occurs as people age. Vascular disease may be subtle enough not to manifest itself in other ways.
    • diabetesmen with diabetes are at higher risk for erectile dysfunction. The stress of surgery to remove the prostate may tip the balance over and lead to the earlier manifestation of the underlying problems that predispose to ED.
    • hypertension erectile dysfunction is a known problem in men with high blood pressure. High blood pressure affects small blood vessels that carry blood to the penis. All men with high blood pressure are at risk of developing erection problems. Prostate cancer treatment tends to accentuate the problem by affecting the nerves in addition to already affected blood vessels.
    • Coronary Artery Disease heart disease affects blood vessels to the penis the same way the heart vessels are affected.
    • the baseline quality of erections
    • the use of PDE-5 inhibitors
    • type of surgical procedure

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