Prostate cancer treatment may lead to urinary continence and / or erectile function problems in some patients. Good post-operative care and rehabilitation can help patients to manage these conditions, and greatly improve their quality of life.
Prostate cancer treatments
Prostate treatment is likely to differ from one patient to the next, depending on the severity of the cancer as well as symptoms and the age of the patient. Treatments include active surveillance and regular testing (for lower-grade cancers and possibly for men of more advanced age), brachytherapy (radioactive pellet implantation), radiotherapy, and surgery.
Prostate cancer surgery – known as radical prostatectomy – is performed to remove any cancer in the prostate and the surrounding tissues, and involves complete removal of the prostate, the seminal vesicles, and the associated lymph nodes.
Fortunately, modern surgical techniques involve what is known as nerve sparing – which basically refers to preserving the nerves involved in erectile function. Nerve sparing helps to reduce the risk of erectile problems after surgery, and may also help to make erectile dysfunction treatments more effective.
Post-operative rehabilitation options
For men who undergo surgery and who do experience urinary incontinence and / or erectile function problems there are various treatment options available.
Urinary incontinence post prostatectomy
This may occur as a result of a weakness in the urinary sphincter valve which forms part of the pelvic floor group of muscles. It can be treated by:
Believe it or not, scientists in North Carolina have managed to grow human penises in the lab, and may only be a few years away from testing them by transplanting them onto men.
This could prove to be a very positive breakthrough for men suffering from penile congenital abnormalities, injury from trauma, damage from disease, or for those who have undergone penile surgery or removal.
While it might sound like the stuff of science fiction, transplants of lab-grown rabbit penises have already proved a success, with all of the male rabbits involved in the experiment attempting to mate and with some even successfully reproducing.
There have also been successful transplants of other bio-engineered human organs in recent years, which was no doubt very encouraging for the scientists involved in this research and development.
Why the delay?
Because they are a very complex organ in terms of structure, cell density and the uniqueness of the erectile tissue, growing penises in the lab has been a rather slow process. The scientists involved also need to be sure of safety and effectiveness before performing the first transplant. They are presently putting the lab-grown penises through their paces – so to speak! – to test for the ability to withstand wear and tear and to work as anticipated.
Also, while there has been success with the rabbit experiments, human penises are much larger, and growing them successfully has been a much more involved process.
Why not just transplant from donors?
At the present time, donor penises can be transplanted onto patients but the risk of rejection warrants drug treatment – complete with the potential for unpleasant side effects. Direct penile transplants like this can also have a psychological effect on patients, because of the rather intimate nature of the organ itself.
Other current treatments for men with penile damage include penis reconstruction using tissue taken from the forearm or thigh, along with prosthetic implants for producing erections.
How does this differ from donor transplants?
Growing penises in a laboratory is done using cells from the intended recipient. It involves taking a donor penis and washing it in a detergent of enzymes to remove donor cells, leaving the collagen ‘scaffolding’ or basic structure remaining. Cells from the live patient which have been grown in cultures are then seeded onto the penile structure to rebuild the organ. It is hoped that this method will overcome the problem of donor organ rejection.
What is the next step?
Approval from the US FDA will need to be sought before any transplants can commence. The lead scientist involved in this work, Professor Anthony Atala, expects this to occur within five years, but anticipates that the initial stages will likely involve growing smaller lengths for treating damaged penises and performing only the partial replacement of organs.
Either way, the future for urology procedures for men suffering from severe penile injury, disease or erectile dysfunction may just be very positive indeed as a result of all the work done by Dr Atala and his team.
When erectile dysfunction is a problem the good news is that there are a number of treatment options that may help a man reclaim his sex life. In this post, we discuss penile prosthetic surgery and how it compares to other treatments for erectile dysfunction.
What is erectile dysfunction?
Erectile dysfunction is the inability to attain and / or sustain an erection long enough to engage in sexual intercourse. Causes include conditions that affect the blood vessels such as cardiovascular disease, diabetes, and high blood pressure, as well as prostate surgery, trauma, injury, kidney or liver failure. Sometimes the cause may be psychological but it is more likely to be physical or have a physical component.
If the condition is temporary or mild non-surgical treatments may be the best option. However, if it is ongoing, an implant could be an option for getting back into action!
How prosthetic implants work
Prosthetic implants are made from biocompatible silica and they have an antibiotic coating to reduce the risk of infection. There are a few different types of implant:
Urinary incontinence is an issue that some sufferers may feel embarrassed about, but might be relieved to hear is more common than they realise. It is also usually very treatable – with treatments ranging from exercises, to various surgery options or medication, depending on the nature of the condition and its cause.
Urinary incontinence refers to involuntary leakage of urine, and is a condition that may affect around 15% of men and 37% of women at some stage of their lives. In a healthy bladder, urine passes from the kidneys to the bladder via the two ureters, and then is passed out of the body through the urethra. In a normal situation, the person is able to tighten the urinary sphincter muscle that surrounds the urethra – therefore having some control over the flow of urine out of the body. When this muscle is weakened, incontinence may happen. In some cases, incontinence can occur when the pelvic floor muscles have become weakened.
There are a number of different types of urinary incontinence, including what is known as stress incontinence.
Contrary to what you might think, the term stress incontinence does not refer to emotional stress (although it may well cause emotional stress for some people!). It is a condition where urine leaks out when the sufferer sneezes, coughs, laughs, lifts something, plays sport or does exercise. These activities create an increase in pressure in the abdomen, which then pushes down on the bladder causing the leakage.
It is more common in women and is often caused by pregnancy and childbirth, due to the weakening of the pelvic floor muscles that support the urethra. The condition can also occur in menopausal women due to a drop in the hormone oestrogen (which helps to maintain the thickness of the lining in the urethra), and in men after prostate surgery.
Treating stress incontinence
Treatment of stress incontinence may not necessarily involve surgery. Post-childbirth women may benefit greatly from pelvic floor strengthening exercises, enabling them to manage the condition. If the condition occurs due to a urinary tract infection, it can often be successfully treated with antibiotics.
For weakness in the sphincter muscle, there are a number of surgical treatment options:
Kidney stones occur when salts in the urine form into solid crystals or ‘stones’. These stones can block the normal urine flow, and can be accompanied by severe pain. Kidney stones can also cause infection, and even kidney damage or failure in severe cases. There are several types of kidney stones, with the most common being what are known as calcium stones.
Symptoms, causes and diagnosis
Symptoms may include severe gripping pain in the back, blood in the urine, passing small stones in the urine, and a fever if infection is present. It’s also important to note that some people with kidney stones do not experience any symptoms at all.
Causes of kidney stones include high levels of calcium and other substances in the urine, as well as certain medications and medical conditions.
Diagnosis may be done by ultrasound, CT scan or x-ray. Stones that are passed in the urine can also be examined by a physician or kidney stone specialist to determine what category they fit into.
Kidney stone treatments
Kidney stone treatments vary, and will depend on the size and type of stone, and what problems it is causing for the patient.
In many cases, no treatment is necessary, as the patient will pass the stones in the urine. Pain relief might be required, and if pain is particularly severe, hospitalisation and strong medication might be necessary.
Kidney stone removal by open surgery is rarely used in Australia, usually being reserved for severe cases such as those where large obstructive stones are present, and / or there is a risk of complications such as organ damage.
Since the prostate is one of the organs mostly involved in urinary and reproductive health issues among men, promoting awareness of prostate diseases is a significant step for prevention. Some prostate conditions, although benign and non-cancerous, may be potential risk factors of prostate cancer. At Katelaris Urology, we aim to help raise men’s knowledge and awareness about prostatic diseases for better prostate health and improved overall wellness.
Let’s look into the two most common non-cancerous prostate problems.
Inflammation of the prostate may be bacterial or non-bacterial in nature, and occurs mostly in young and middle-aged men. Bacterial prostatitis can be due to leakage of infectious microbes into the gland, from the urethra and rectum. Chronic prostatitis, also referred to as chronic pelvic pain syndrome, is not caused by bacterial infection and usually has no known specific cause. Common risk factors of prostatitis include: recent urinary tract infection, anal intercourse, usage of a urinary catheter, urinary tract abnormalities, and local trauma in the pelvic region.
Signs and symptoms
An affected person may experience pain and difficulty upon urination; discomfort and pain in the groin, testicles, rectum, pelvis or lower back; fever; body malaise; urinary urgency; painful orgasms; erectile dysfunction; and haematuria (blood in the urine).
Diagnosis and treatment
A digital rectal examination is performed to assess a tender and swollen prostate. In this procedure, a physician inserts a lubricated, gloved finger into the rectum and gently palpates the gland to check the degree of pain and inflammation. Testing of blood, urine, semen and prostatic fluid specimens and imaging procedures such as bladder ultrasound and cystoscopy may also be performed to further confirm diagnosis.
Antibiotics are prescribed to kill bacteria if infection is present. Analgesics and anti-inflammatory medications are used to address the pain and discomfort from accompanying symptoms. Alpha-adrenergic blocking agents (medicines that relax the bladder and prostate muscle fibres) may also be used to lessen urinary symptoms and improve bladder emptying and urine flow.
Benign Prostatic Hyperplasia (BPH)
A common condition among older men, primarily those over 40 years old, Benign Prostatic Hyperplasia (BPH) is a non-cancerous growth of the prostate gland. It is highly treatable and non-life-threatening, but may cause major discomforts if left untreated. Nearly all men experience this as part of the ageing process. It remains unclear what actually causes BPH, but researchers link it to the hormonal and cellular changes as men age. Since the prostate surrounds the urethra, enlargement of the gland may compress the urinary tube, disrupting normal urine flow.
Signs and symptoms
BPH is accompanied by lower urinary tract symptoms (LUTS) classified into two. Voiding or obstructive lower urinary tract symptoms are caused by the narrowing of the urethra from the enlargement. A patient experiences urinary retention, incontinence, a weak and dribbling stream of urine, and difficulty and pain upon urination.
When the urethra narrows, the bladder may also thicken. Storage or irritative lower urinary tract symptoms are due to the thickening of the bladder wall, resulting to a smaller bladder with lesser storage capacity. Urinary urgency, frequency and nocturia (frequent urination at night) can be expected.
Other symptoms include haematuria and pain in the perineal region. Some men who have prostate enlargement experience only a few symptoms or none at all.
Diagnosis and Treatment
After taking a detailed medical history, a digital rectal exam may be performed. A urine flow test or urinary incontinence assessment may also be done to evaluate how urination is affected. A prostate-specific antigen (PSA) blood test is usually included to determine the possible presence of cancerous cells. If cancer is suspected, a biopsy, cystoscopy and transrectal ultrasound may be done.
If the enlargement is benign and symptoms are mild, pharmaceutical or surgical treatment may not be required, but certain lifestyle changes must be observed, such as reducing caffeine and alcohol intake, limiting fluid intake up to 2L per day, staying active, and maintaining a healthy weight. An annual exam is required for monitoring.
For moderate to severe symptoms, alpha-adrenergic blocking agents are used to improve urine flow, along with drugs that may reduce the size of the enlarged gland. Surgery may be prescribed if severe urinary complications occur, such as kidney and bladder damage.
Here at Katelaris Urology, our experienced and pre-eminent urologist, Dr. Katelaris will help you manage prostate problems with the use of the latest and most innovative technologies for urological medical-surgical care, including robotic prostatectomy. Call us now and book a consultation appointment.
We also offer surgical reproductive health procedures such as male vasectomy and reversal and prosthetic surgery for erectile dysfunction.