Erectile dysfunction (ED) is a frequent side effect of surgical treatment of prostate cancer with the help of radical prostatectomy.
Will erectile dysfunction necessarily occur after a radical surgery on the prostate gland?
To some extent, yes. Radical surgery on the prostate gland always provokes ED. You cannot expect that after the surgery, an erection will remain the same. The quality of an erection after surgery primarily depends on the patient’s age and the quality of the erection before surgery. Men younger than 45 years have the best chance of maintaining the quality of erection after treatment of prostate cancer.
But the fact is that most men who are treated for prostate cancer are over 50 years old, and many of them have erectile problems before the surgery (the hardness of the erection has decreased, it is more difficult to receive and maintain an erection). Before surgery to remove prostate cancer, many men already have experience using such drugs as Viagra, Cialis, Levitra, and Stendra. Erections after surgery rarely remain as good as they were before, even with the use of such drugs.
Is erectile dysfunction after prostatectomy permanent?
After the surgery, many men manage to at least partially restore the erectile function, but many men need drugs to achieve an erection. Men of a younger age are more likely to restore sexual function.
It is important to understand that after radical prostatectomy for prostate cancer, most men need treatment for erectile dysfunction. When surgeons say they have high success rates while maintaining erectile function, it is important to understand that this often refers to “the ability to get an erection with medications such as Viagra and Cialis.”
Causes of erectile dysfunction after surgery to remove prostate cancer
In the course of radical prostatectomy, the nerves of the penis (cavernous nerves) are often traumatized, and sometimes they are removed along with cancer. The goal of nerve-sparing radical prostatectomy is to keep as many of these nerves as possible. Currently, most surgeries to remove prostate cancer are performed in a “nerve-sparing” mode.
However, patients with a dangerous, aggressive form of prostate cancer (Gleason score 7-10, high PSA, palpable or hard prostate) need to remove all cancer tissue, and sometimes it is necessary to remove the cavernous nerves in the nervously- vascular bundles around the prostate.
Duration of erectile dysfunction after nerve-sparing surgery
Usually, erectile dysfunction persists for 3-12 months, even after nerve-sparing prostatectomy. During this period, the patient may begin to experience spontaneous erections.
It is important to begin treatment of erectile dysfunction as soon as possible. There is no reason to delay treatment since such a delay can affect a patient’s attitude and self-esteem. Currently, there are many ED drugs, including innovative preparations with a minimum list of side effects, such as Viagra Professional (sildenafil).
Penile rehabilitation after radical prostatectomy
As practice has shown, the program of penile rehabilitation accelerates the restoration of sexual function in men. Typically, with the goal of restoring the sexual function soon after the prostate cancer surgery, patients use drugs such as Cialis and Viagra, penile injections with prostaglandin and Trimix, and vacuum erectors.
The risk of erectile problems after cancer treatment
The risk of problems with an erection after robotic prostatectomy depends on the following factors:
- age – the older the patient, the more likely the appearance of erectile dysfunction after surgery. Most likely, this is associated with an increased risk of vascular diseases with age. Vascular diseases can occur in a latent form and do not cause other symptoms;
- diabetes mellitus – men with diabetes have a higher risk of developing erectile dysfunction. Stress from a surgery to remove the prostate can break the delicate balance and lead to an earlier manifestation of the main problems provoking ED;
- arterial hypertension – erectile dysfunction is widespread among hypertensive men. High blood pressure affects small blood vessels that carry blood to the penis. All men with high blood pressure have a risk of developing problems with erection. Treatment of prostate cancer only exacerbates the problem: in addition to the affected blood vessels, nerves are also affected;
- ischemic heart disease (CHD) – heart disease affects the blood vessels of the penis the same way as the heart vessels;
- the initial quality of erection (is it easy for a patient to achieve and maintain an erection? Is an erection quite hard?);
- use of PDE-5 inhibitors (sildenafil, vardenafil, etc. before surgery);
- type of surgical procedure
Treatment of erectile dysfunction after surgery to remove prostate cancer
Many men who experience signs and symptoms of ED should begin its treatment of before radical prostatectomy.
There are 2 main methods of ED treatment:
- Non-surgical treatment;
- Surgical treatment
Non-surgical methods of ED treatment after prostatectomy
This treatment is based on pharmacological drugs. The following drugs may be effective (but only in patients who have undergone bilateral nerve-sparing surgery):
Penile injection therapy:
An intracavernous injection of prostaglandins or phentolamine helps to get an erection. This injection must be done every time before intercourse. The success rate of treatment is up to 80%. The study found that penile injections improve sexual function after prostatectomy through:
- improving erection;
- increasing satisfaction with relationships;
- increasing sexual confidence;
- nerve graft
Surgical treatment: effective treatment of ED with a penile implant
The most effective method of treating ED worldwide is the surgical method. Surgical treatment is recommended in cases where erectile dysfunction is caused by irreversible causes. These include:
- damage to the vessels of the penis;
- Peyronie’s disease;
- consequences of radiation injury or radiation therapy;
- consequences of injuries and surgeries on the penis, prostate gland, urethra;
- erectile dysfunction as a result of the so-called venous “leakage” (venous occlusive erectile dysfunction).
If ED is persistent and caused by the above organic causes, then it cannot be currently treated with non-surgical treatments.
The most effective treatment for ED is a penile implant. This is the “gold standard” for treatment of ED, which guarantees the restoration of a harmonious sexual life after surgery in 97-100% of patients.
The principle of surgery is based on restoring the rigidity (elasticity) of the penis and implies the implantation inside the cavernous bodies of paired elastic silicone rods or inflatable cylinders.