ERECTILE PROBLEMS AFTER PROSTATE SURGERY

At London Andrology a step-wise, monitored approach has proven beneficial especially if the patient needs can be identified prior to surgery. This is also the basis for much international research we are conducting and contributing to in this setting. Our clinic has been at the forefront of treating men with erectile dysfunction after prostate or pelvic surgery. We have helped set up guidelines for treatment in cancer hospitals around the world and in the UK such as Guys & St Thomas to The Royal Marsden.

Erectile problems after prostate surgery

DIAGNOSIS

Nerves around the prostate may be affected during surgery and lead to erectile dysfunction. The prostate is a small gland in the pelvis about the size of a walnut that sits between the bladder and rectum at the base of the penis. During a radical prostatectomy, the primary surgery for prostate cancer, the whole prostate gland and some of the surrounding tissue are removed.

On either side of the prostate are bundles of nerves necessary for an erection. These nerves pass close to the prostate gland, and if one or both are removed or damaged during the surgery, it can lead to erectile dysfunction. If possible, doctors will perform a nerve-sparing surgery to preserve the penis’ erectile function. However, the nerves may need to be removed if the surgeon finds cancer nearby.

If loss of function lasts longer than two years, it's likely long-term erectile dysfunction. Erectile dysfunction lasting multiple years is likely permanent and may result from the surgeon removing one or both nerve bundles during surgery.

SYMPTOMS

How long does erectile dysfunction last after a prostatectomy? Erectile dysfunction affects almost all men within the first months of a prostatectomy. Most, though, will experience significant improvement within a year or so. However, for some men, it may take up to two years to fully recover and have regular erections.

The risk of erectile dysfunction after a prostatectomy increases with age. Men younger than 50 are most likely to avoid erectile dysfunction or recover more quickly.

When possible, the surgeon will perform a nerve-sparing prostatectomy to spare the nerves that pass close to the prostate. Men who receive nerve-sparing surgery may still experience erectile dysfunction after surgery, but they’re more likely to recover erectile function within two years.

TREATMENT

Penile rehabilitation is designed to preserve penile blood vessels and tissues so that they remain healthy and active. The therapy has the patient purposefully maintain an erection two to three times each week, often starting within a few weeks after surgery. Your surgeon may also prescribe a low-dose erectile dysfunction medication, designed to increase blood flow to the penis by relaxing the blood vessels.

The erectile dysfunction medication may take a while to work as the nerves recover, even in men who have undergone nerve-sparing surgery. Men with more severe nerve damage may not respond to the medication, while those with heart problems or who take alpha-blockers do not typically qualify for the medication.

If erectile dysfunction medications don’t work, other options may help, including:

  • Penile injections
  • Urethral pellets
  • A vacuum erection device
  • Surgical implants – if other treatments have not helped, three surgical implant procedures are available.

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