Our Summary

This paper is a comprehensive review of current treatments for erectile dysfunction (ED) following radical prostatectomy (RP), a common surgery for localized prostate cancer. Despite the use of techniques to conserve nerves during RP, many men still experience ED due to nerve damage. Current treatments include certain medications, injections, vacuum erection devices, pelvic muscle training, and additional surgical procedures. However, the effectiveness of these treatments varies greatly, and further complications can occur when androgen deprivation therapy is used after RP. The review also highlights potential new treatments, such as stem cell therapy, gene therapy, growth factors, low-intensity shockwave therapy, immunophilins, and other drug treatments, which have shown promise in improving erectile function in experimental models. Further research is needed to develop these into safe and effective clinical treatments.

FAQs

  1. What are the current treatments for erectile dysfunction after a radical prostatectomy?
  2. Why do some men still experience erectile dysfunction despite nerve-sparing techniques during radical prostatectomy?
  3. What are some potential new treatments for erectile dysfunction after radical prostatectomy that are currently being researched?

Doctor’s Tip

One helpful tip a doctor might tell a patient about prostatectomy is to discuss potential erectile dysfunction (ED) with their healthcare provider before the surgery. It is important to understand the potential risks and discuss possible treatment options, such as medications or therapy, that can help manage ED after the procedure. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can also help improve overall sexual function and recovery after prostatectomy.

Suitable For

Patients who are typically recommended prostatectomy are those with localized prostate cancer that has not spread beyond the prostate gland. Additionally, patients who are considered to have a good life expectancy and are healthy enough to undergo surgery are also candidates for prostatectomy. It is important for patients to discuss their options with their healthcare provider to determine if prostatectomy is the best treatment option for their specific situation.

Timeline

Before prostatectomy:

  • Patient is diagnosed with localized prostate cancer through biopsy and imaging tests
  • Patient and healthcare team discuss treatment options, including prostatectomy
  • Patient undergoes pre-operative testing and preparation for surgery
  • Patient may experience anxiety and fear about the surgery and potential side effects

After prostatectomy:

  • Patient undergoes surgery to remove the prostate gland and surrounding tissue
  • Patient may experience pain, discomfort, and side effects such as urinary incontinence and erectile dysfunction post-operatively
  • Patient begins recovery process, including physical therapy and follow-up appointments with healthcare team
  • Patient may experience changes in sexual function, including ED, due to nerve damage during surgery
  • Patient may explore various treatment options for ED, such as medications, injections, devices, or additional surgeries
  • Patient and healthcare team work together to manage and improve sexual function post-prostatectomy.

What to Ask Your Doctor

  1. What are the potential risks and side effects of prostatectomy surgery?
  2. How likely is it that I will experience erectile dysfunction following the surgery?
  3. What steps will be taken during the surgery to preserve nerve function and minimize the risk of ED?
  4. What are my options for treating ED after prostatectomy?
  5. What is the success rate of each treatment option for ED following prostatectomy?
  6. What are the potential side effects and risks associated with each treatment option?
  7. How soon after surgery can I begin treatment for ED?
  8. Are there any lifestyle changes or exercises that can help improve erectile function?
  9. Are there any experimental or emerging treatments for ED following prostatectomy that I should consider?
  10. How often should I follow up with you or a specialist for monitoring and adjusting my treatment plan for ED?

Reference

Authors: Asker H, Yilmaz-Oral D, Oztekin CV, Gur S. Journal: Prostate. 2022 Sep;82(12):1135-1161. doi: 10.1002/pros.24366. Epub 2022 May 17. PMID: 35579053