Preserving & Recovering Erectile Function Post-Surgery
- While the possibility of losing erectile function after prostate cancer treatment is a serious concern, patients should know that there are multiple strategies to minimize this risk and multiple effective treatments available if erectile dysfunction occurs.
- From advanced surgical techniques like nerve-sparing approaches and amniotic membrane grafting to the wide range of post-operative treatments — oral medications, vacuum devices, injections, and implants — men have many tools to support their recovery.
- The extent of sexual dysfunction varies depending on the type of treatment, patient age, baseline function, and the presence of other health conditions such as diabetes or vascular disease.
- For men planning to undergo surgery, early discussions with a urologist about sexual function, preservation strategies, and realistic expectations are essential.
“Every surgeon who is doing robotic prostatectomies tries to achieve the trifecta — cancer cure, continence and sexual function,” Dr. Sanjay Razdan, a urologist at the International Robotic Institute For Prostate Cancer, tells SurvivorNet. “Do they always succeed? No. It depends on the skill level of the surgeon. It depends on the disease status of the patient and the health status of the patient.”
Read MoreMaintaining Sexual Function After Treatment
For many men, maintaining sexual function after treatment for prostate cancer is a significant concern. While the primary goal of treatment is to cure the cancer and extend life, the potential impact on quality of life — including sexual health — should not be underestimated.In particular, radical prostatectomy (surgery to remove the prostate gland), a common treatment for localized prostate cancer, can lead to significant changes in erectile function. The prostate is a gland located just below the bladder, and it plays an important role in sexual function. It surrounds part of the urethra and is located near the neurovascular bundles responsible for erection.
During a radical prostatectomy, these nerves may be injured or removed, especially if cancer is located close to them. This can lead to temporary or permanent erectile dysfunction.
Other treatments, such as radiation therapy or androgen deprivation therapy (hormone therapy), can also impair erectile function by damaging blood vessels and nerves or by reducing libido through hormonal suppression. The extent of sexual dysfunction varies depending on the type of treatment, patient age, baseline function, and the presence of other health conditions such as diabetes or vascular disease.
Factors Affecting Erectile Function
Recovery of erectile function following prostate cancer treatment depends on several factors, including:
- Age: Younger men are more likely to recover erectile function after surgery, partly because they are more likely to have had better function before treatment.
- Pre-existing medical problems: Patients with diabetes or hypertension may have diminished erectile function at the start and are more likely to have prolonged recovery of sexual function
- Pre-treatment erectile function: Men who had strong erectile function before treatment have a better chance of regaining function after surgery.
- Extent of cancer: If the cancer is close to or involves the neurovascular bundles, nerve-sparing surgery may not be possible.
- Surgical technique and surgeon experience: Outcomes can vary significantly depending on the surgeon’s skill and experience in performing the procedure.
Techniques To Reduce Risk Of Side Effects
Efforts have been made over the years to improve surgical techniques in order to minimize damage to the nerves responsible for erections. Two main strategies have emerged as promising tools for nerve preservation, nerve-sparing radical prostatectomy and amniotic membrane grafting.
Nerve-Sparing Radical Prostatectomy
The nerve-sparing approach aims to protect the neurovascular bundles that run along each side of the prostate. Depending on the location and extent of the tumor, the surgeon may be able to spare one or both bundles. Bilateral nerve-sparing (preserving both sides) is associated with a higher likelihood of preserving erectile function, while unilateral nerve-sparing may still offer some benefit.
This technique can be performed using open surgery, laparoscopic surgery, or robotic-assisted laparoscopic surgery. Robotic surgery, in particular, allows for high-definition magnified views and enhanced precision, which may improve the chances of nerve preservation.
Amniotic Membrane Grafting
In recent years, some surgeons have explored the use of amniotic membrane grafting as a means to reduce nerve inflammation and promote healing after prostatectomy. The amniotic membrane, derived from placental tissue, contains anti-inflammatory and regenerative properties that may help protect delicate nerve structures. Early studies suggest that this technique may aid in faster and more complete recovery of erectile function, although long-term data are still being collected.
“I’ve been using it for now over 10 years and with amazing outcomes in terms of return of erectile function,” Dr. Razdan says of this approach. “…it’s not just the nerve preservation, which we do a pretty good job at, but it’s also adding this extra layer of healing which affords better outcomes in terms of erectile function.”
Treatment Options For Dysfunction Post-Surgery
Despite best efforts, many men will experience some degree of erectile dysfunction following prostate cancer treatment. However, a variety of effective treatment options are available to help restore sexual function.
Some options include:
- Phosphodiesterase-5 (PDE5) Inhibitors: Medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are often the first line of treatment. These drugs enhance blood flow to the penis, helping men achieve and maintain erections. They are most effective in men who have had nerve-sparing surgery and who still have some residual erectile function. These medications are generally taken before sexual activity, although tadalafil can also be taken daily.
- Mechanical Vacuum Erection Devices (VEDs): A vacuum erection device is a non-invasive, drug-free option that uses a plastic cylinder placed over the penis. A manual or battery-powered pump creates a vacuum, drawing blood into the penis. Once an erection is achieved, a constriction ring is placed at the base to maintain the erection during intercourse. VEDs can be used in conjunction with medications or as part of rehabilitation programs. They also help prevent penile tissue atrophy by maintaining regular blood flow to the erectile tissue.
- Penile Injection Therapy: For men who do not respond well to oral medications, intracavernosal injection therapy can be a highly effective option. This involves injecting a medication such as alprostadil directly into the penis to stimulate an erection. The response is typically rapid and does not require nerve function, making it effective even in men with significant nerve injury.
- Penile Implants (Prostheses): When other treatments fail, a penile implant may be a permanent solution. These devices are surgically placed inside the penis and are typically considered when erectile dysfunction is severe and long-standing. There are two main types, inflatable implants and malleable (semi-rigid) rods.
Questions To Ask Your Doctor
- Based on my disease and overall health, what are the chances that I will regain erectile function?
- Are there steps we can take before surgery to reduce risk of side effects?
- What are my options if I have sexual side effects post-surgery?
- How often will I be monitored for these side effects?
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