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What is Post Prostatectomy Erectile Dysfunction?

Post prostatectomy erectile dysfunction is a postoperative complication that is defined as the inability to attain and maintain a sufficient erection for satisfactory sexual intercourse post removal of a partial or complete prostate gland to treat prostate cancer. Even when your surgery is performed with a nerve sparing approach, up to 35% of men will experience new or worsened erectile dysfunction after radical prostatectomy.

Why does Erectile Dysfunction Occur Following Prostatectomy?

The prostate is a gland that rests around the urethra. The urethra is a tube that transports semen and urine to the outside of the body. The prostate gland is surrounded by blood vessels, nerves, and muscles required to achieve an erection and control the bladder. During a prostatectomy, the nerves and blood vessels that supply the penis may be damaged. As a result, post prostatectomy, many men will experience erectile dysfunction, which can improve over time. The ability to achieve an erection post prostatectomy depends on how close the prostate cancer was to the nerves that control the erections.

What are the Factors that Determine Adequate Erectile Function Post Prostatectomy?

The ability to have adequate erections post prostatectomy will depend upon:

  • Medical conditions you may have like diabetes or high blood pressure
  • How your erections were prior to prostatectomy
  • Types of medicines you may be taking such as antidepressants or high blood pressure meds
  • Lifestyle habits such as smoking or drinking
  • Your age

Treatment for Erectile Dysfunction Post-Prostatectomy

The types of treatment used for erectile dysfunction post prostatectomy include:

  • Oral Therapy: Four different medications are currently available in oral forms to treat erectile dysfunction. Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), and Avanafil (Stendra). Sildenafil, Vardenafil, and Avanafil are fast acting medications that are taken 45 minutes to 1.5 hours before an erection is desired. They should be taken on an empty stomach. Tadalafil may be used as a fast acting medication, taken several hours before and erection is desired, or it can be taken daily. All oral medications for ED require mental or physical stimulation to work. They enhance the response to sexual stimulation, they do not create it.
  • For men with low testosterone, addition of testosterone therapy can improve response to these medications, but testosterone alone hasn’t been proven to help erections.
  • Injectable Therapy: Generally more powerful than oral medication, injection therapy relies on direct injection of medications into the side of the penis using a very thin needle, similar to those used to give insulin. This type of therapy can be adjusted a great deal. Injectable therapies are made at compounding pharmacies and should be kept in the refrigerator when not in use.
  • Intraurethral Therapy: Insertion of a small, medicated pellet within the urethra can be an effective treatment for erectile dysfunction. The only system approved in the United States is called MUSE.
  • Vacuum Devices:Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. A constricting band in then placed at the base of the penis to keep the blood within the penis. Medical versions of these devices have a component called a “vacuum limiter”, which reduces the risk of injury to the penis. You should never use a non-medical penile vacuum device.

Surgical Treatment of Post- Prostatectomy Erectile Dysfunction

Surgical treatment of erectile dysfunction works by placing a mechanical device inside the penis to create erections on demand. This replaces the natural mechanisms of erections. These devices are called “penile prostheses”, but do not replace the penis, only the internal part of the penis that is defective in erectile dysfunction. Men who have had prostatectomies often get better results with surgical treatment than medical therapy.

  • Two types of penile prostheses are available. The first is the malleable or “semi-rigid” penile prosthesis. This is a paired set of devices that do not change in size, only direction. The penis remains permanently erect, but can be easily bent downward when not in use for sexual purposes.
  • The more popular type of implant is the inflatable penile prosthesis. Inflatable penile prostheses recreate the natural cycle of erection and detumescence (the return to the flaccid state after erection). This occurs by a pump device, which sits in the scrotum alongside the testicles. With an inflatable penile prosthesis you can have an erection on-demand, for as long as your need it, while remaining comfortably flaccid the remainder of the time.
  • Who is a candidate for penile prostheses?
  • Most men who are healthy enough to undergo radical prostatectomy are able to receive a penile prosthesis. An average degree of dexterity and hand strength is required to use an inflatable prosthesis, but all men can use a malleable prosthesis.
  • What are the risks of penile prosthesis?
  • The greatest risk related to penile prosthesis implantation is infection of the device, which occurs in less than 1% of patients. Patients with poorly controlled diabetes or other conditions that weaken the immune system are at higher risk for this. Other risks include erosion of the device through the surrounding tissue, mechanical failure, and general risks of surgery. Your doctor will discuss these risks with you before you decide if a prosthesis is right for you.
  • How long does a penile prosthesis work for?
  • Penile prostheses will usually work for 10-15 years before a risk of mechanical failure develops. If a prosthesis fails, it can be replaced with a similar surgery, or left in place if erections are no longer desires.
  • What will my penis feel like after the surgery?
  • Our patient rarely complain of any change in the sensation of the penis after the surgery. With inflatable prostheses the erection feels natural. In some cases, particularly with thin men, tubing may be felt in the scrotum, but this rarely bothers patients. All men who receive an inflatable penile prosthesis can feel the pump unit in their scrotum, which feels like a third testicle. It is usually difficult to impossible to visually tell that someone has a penile prosthesis.

Lifestyle Changes to Improve Erectile Dysfunction Post Prostatectomy

Changes that you make in your life post prostatectomy may help with erectile dysfunction. Some changes you should consider include:

  • Consuming a healthy diet
  • Exercising on a regular basis
  • Drinking alcohol responsibly as long-term heavy drinking can decrease your ability to achieve an erection
  • Trying to reduce fatigue and stress levels as it can cause low sex drive
  • Refraining from smoking as smoking has been linked to erectile dysfunction

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