Surgeons attempt to maintain post-operative erectile function by preserving the cavernosal nerves during radical prostatectomy. Unfortunately, claims of potency preservation are often unrealistically presented and erectile dysfunction remains a significant ongoing morbidity relating to prostate cancer surgery.
Similarly, 50% of pre-treatment potent men have significant erectile dysfunction two years after radiotherapeutic intervention. This erectile dysfunction is due to corporal fibrosis of the erectile tissue.
There are many treatments available for erectile dysfunction following treatment, and sexual rehabilitation is considered an essential part of your treatment for prostate cancer.
Penile injection therapy.
It is very important that penile injection therapy be commenced four to six weeks following radical prostatectomy surgery to prevent permanent atrophy of the erectile mechanism.
Combinations of drugs that act on the blood vessels to increase blood flow to the erectile tissue are used, most commonly combinations of prostaglandinm, papaverine and phentolamine.
You will be instructed in the technique by our experienced sexual counsellor, Mr David Cain, and given instructions on how to manage the side effects of therapy, including priapism (prolonged erection).
You may also find these medications successful in restoring erectile function. Viagra is the most well-known, but you may also be prescribed Cialis or other similar medications.
These drugs only work when a degree of cavernosal neve function exists. For men who have had successful nerve sparing surgery, it is often the case that the nerves do not function, even partially, for at least three months after surgery. It is therefore appropriate to introduce oral therapy for erectile dysfunction at three months post-operatively.
These drugs are safe, but must not be used in combination with nitrate compounds, such as those used to treat angina.
More information about oral PDE-5 inhibitors which include Viagra and Cialis.
Penile prosthetic surgery
For men who do not respond or do not wish to use medication or injection therapy, penile prosthetic surgery is a permanent solution to erectile dysfunction. This involves the implantation of an inflatable prosthesis attached to a scrotal pump. Manipulation of the pump transfers fluid into the prosthesis, allowing a virtually instant erection.