Our Summary

This research paper discusses the issue of erectile dysfunction (ED) that some men experience after undergoing a procedure called radical prostatectomy (RP), which is surgery to remove the prostate due to cancer. The researchers reviewed various studies to understand the best surgical techniques to help manage ED after this procedure.

Recent understanding of the male pelvis and prostate’s anatomy has led to changes in this surgery with the hope of preserving a man’s ability to have an erection after the operation. These changes revolve around preserving the blood supply to the prostate and the nerve bundles around it.

If this doesn’t work, a third option is the implantation of a penile prosthesis, a device inserted into the penis to allow an erection. This method has shown to be very successful with high patient satisfaction rates.

So, currently, the best ways to manage ED after RP are nerve-preserving surgery and penile implants. Other methods, like trying to preserve the accessory pudendal artery (a blood vessel that contributes to erections) or grafting nerves, don’t have enough evidence to support their effectiveness.

FAQs

  1. What is the issue of erectile dysfunction after a radical prostatectomy?
  2. What are the current best methods to manage erectile dysfunction after a radical prostatectomy?
  3. What is the role of the penile prosthesis in managing erectile dysfunction post-prostatectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about prostatectomy is to discuss the potential for erectile dysfunction after the procedure and the available options for managing it. It’s important for patients to have realistic expectations and to be aware of the different treatment options, such as nerve-preserving surgery or penile implants, that can help restore erectile function. Open communication with your doctor about any concerns or questions regarding sexual function post-prostatectomy is key in finding the best solution for you.

Suitable For

Patients who are typically recommended for prostatectomy include those with localized prostate cancer that has not spread beyond the prostate gland and is considered curable through surgery. Additionally, patients who are in good overall health and have a life expectancy of more than 10 years are also good candidates for prostatectomy.

It is important for patients to discuss the potential risks and benefits of prostatectomy with their healthcare provider to determine if it is the best treatment option for them. Additionally, patients should also discuss the potential for ED after surgery and the available options for managing it to make an informed decision about their treatment plan.

Timeline

Before prostatectomy:

  1. Patient is diagnosed with prostate cancer and discusses treatment options with their healthcare provider.
  2. Patient decides to undergo radical prostatectomy as a treatment for their cancer.
  3. Patient may undergo pre-operative tests and consultations to prepare for the surgery.

After prostatectomy:

  1. Patient undergoes the surgery to remove the prostate.
  2. Patient may experience side effects such as urinary incontinence and erectile dysfunction immediately after the surgery.
  3. Patient may be prescribed medication or undergo therapy to manage these side effects.
  4. If erectile dysfunction persists, patient may explore options such as nerve-preserving surgery or penile implants to improve their sexual function.
  5. Patient may experience improvement in erectile function with these interventions, leading to increased quality of life and sexual satisfaction.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostatectomy and potential erectile dysfunction after the procedure include:

  1. What are the risks of developing erectile dysfunction after undergoing a radical prostatectomy?
  2. What surgical techniques will be used during the procedure to help preserve erectile function?
  3. How successful are nerve-preserving surgeries in preventing erectile dysfunction post-prostatectomy?
  4. What are the potential side effects and risks associated with penile implants as a treatment for erectile dysfunction?
  5. Are there any alternative treatments or therapies available to help manage erectile dysfunction after prostatectomy?
  6. What is the success rate of penile implants in restoring erectile function in patients who have undergone radical prostatectomy?
  7. How soon after the procedure can I expect to see improvements in my erectile function, if any?
  8. Are there any lifestyle changes or medications that can help improve erectile function after prostatectomy?
  9. How often will I need to follow up with my doctor to monitor and address any issues related to erectile dysfunction post-prostatectomy?
  10. Are there any resources or support groups available for patients experiencing erectile dysfunction after prostatectomy?

Reference

Authors: Castiglione F, Ralph DJ, Muneer A. Journal: Curr Urol Rep. 2017 Sep 30;18(11):90. doi: 10.1007/s11934-017-0735-2. PMID: 28965315