Restoring Sexual Function After Prostate Surgery

April 27, 2021

5 mins

Prostate cancer affects nearly 1 in 7 men. Fortunately, it’s a very treatable condition, especially when it’s caught early. One of the most common treatments for prostate cancer or having an enlarged prostate is to undergo prostate surgery, also known as a prostatectomy. This surgery comes with a very high success rate, boasting a 10 year survival of nearly 90%, but just like any other surgery it will come with potential risks and side effects. 

According to the Prostate Cancer Foundation, one of the most common side effects of a prostatectomy is erectile dysfunction. Luckily, there are plenty of ways to fight back against erectile dysfunction and restore sexual function while recovering from prostate surgery. 

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Reasons to Have Prostate Surgery 

One of the most common reasons for having prostate surgery, or a prostatectomy, is to treat prostate cancer. 

According to the American Cancer Society, prostate cancer is the second most common form of cancer in American men, right behind skin cancer. Nearly 174,000 new cases are reported in the United States every year. If the cancer has not yet spread outside of the prostate gland, then surgery will be a great treatment option. Another reason to have prostate surgery is to treat an enlarged prostate. 

As the prostate grows, it may block the flow of urine which can create bladder, urinary tract, and kidney related problems. Removing a part of the prostate can help to solve or prevent these issues. 

What Happens During Prostate Surgery? 

Before having a prostatectomy, a surgeon will either use general anesthesia causing the patient to lose consciousness or they will use a spinal anesthesia which numbs the lower half of the patient’s body while they remain conscious. 

There are two main types of prostate surgery. The more traditional open prostatectomy is when the surgeon will make a large incision in the skin in order to remove the prostate. 

The more modern method, and more common these days, is to use minimally invasive laparoscopic surgery. This version will result in the surgeon performing the procedure through four small incisions using a tiny camera and small tools. 

Many surgeons now will also use robotic assistance in order to perform this type of surgery. When a radical prostatectomy is performed, the prostate gland is removed entirely. The prostate gland is a donut shaped gland that surrounds the urethra and is located just below the bladder. The urethra is what carries the urine and semon out from the body through the penis. There are some risks associated with this surgery. There are two small bundles of nerves on either side of the prostate that are vulnerable to injury during this operation. Some surgery may require the removal of some nerves if there is a chance that the cancer has invaded them. If both sets of nerves are removed, it may not be possible to achieve  an erection without the assistance of medical devices.

Recovering From Prostate Surgery 

During the surgery, the doctor will insert a catheter into the patient’s penis. This thin, flexible tube will help to drain urine until the patient is healed enough to urinate on their own. The catheter will typically remain for about one or two weeks after the surgery. 

The patient can usually leave the hospital within a day or two, but the incision site will likely feel sore for a few days after. The patient will most likely not be able to drive for at least a week, but should be able to return to normal activities within a few weeks. 

During the recovery, the patient may experience several side effects including:

• Urinary tract infection

• Swelling

• Temporary loss of bladder control

• Infertility

• Ejaculatory dysfunction

• Erectile dysfunction

After the surgery, it’s possible to experience erectile dysfunction for a few weeks, a year, or even longer in some cases. This is because the surgery might potentially injure one of the nerves, muscles, or blood vessels that are involved with getting and maintaining erections. There are other factors that could influence the severity of the erectile dysfunction during recovery as well and so it can be difficult to predict how any specific person may recover from the surgery. 

If there are any injuries to nerve tissues sustained during a radical prostatectomy then the recovery process will take longer. Additionally, if the patient is already experiencing erectile dysfunction before the surgery, then it won’t be resolved afterward. There have been many improvements in prostate surgery techniques that have resulted in much better outcomes for the men undergoing them. 

The Prostate Cancer Foundation has reported that about half of all men undergoing nerve sparing surgery will regain their pre-surgery function within the first year of the surgery. 

However, there are other additional factors that could negatively impact the patient’s sexual health, such as:

• Age

• Cardiovascular disease

• Diabetes

• Smoking 

• Obesity

• Excessive alcohol use

• Sedentary lifestyle

Restoring Sexual Function 

For the most part erectile dysfunction, and other issues related to sexual well being, will be resolved naturally within two years of the nerve sparing surgery. However, there may be complications or other factors that create issues for the patient. There are several different options for treating these potential complications.

PDE5 Inhibitors 

There are plenty of prescription oral medications available to help treat erectile dysfunction. Drugs like sildenafil (Viagra®), vardenafil (Levitra), and tadalafil (Cialis®) all work to improve blood flow to the penis and help to achieve and maintain erections. 

These medications will reduce the breakdown of cyclic guanosine monophosphate (cGMP), a cellular signaling molecule, which will stimulate the outflow of calcium ions from the inside of the cell. The result of this movement is that the smooth muscles of the penis will become relaxed, allowing blood to arrive faster and creating an erection. These drugs can be used either nightly (Cialis®) or as needed (Viagra® or Levitra). 

The success rate is typically around 75% of men after nerve sparing prostate surgery but are somewhat less effective after conventional prostate surgery. These medications should be avoided by anyone with heart related conditions. 

Penile Injections

This treatment has options for the method of delivery but they both work the same. Either by injection using small needles into the corpora cavernosa of the penis, or as small suppositories that are inserted into the penile urethra. Whichever delivery method is chosen, the way that it works is that alprostadil is a drug that will deliver PGE1, which causes the levels of signaling peptide cyclic adenosine monophosphate (cAMP), to increase and result in similar effects as to that of PDE5 inhibitors. 

Vacuum Erection Devices 

These cylindrical devices create negative pressure around the penis, which will cause arterial and venous blood to be pulled into the corpus cavernosum, therefore creating an erection which is maintained by placing a band around the base of the penis. 

Unlike the use of some of the other options, this treatment does not require arousal to work. However, the band used to maintain the erection should be removed within 30 or so minutes of application otherwise the penile blood may become hypoxic.

Penile Prosthetic Implants 

First introduced in the 1870s, the penile prosthesis is a small invisible implant that includes a balloon located within the penis and along the penile shaft that can be inflated by a tiny pump located in the scrotum. The reports have indicated that in experienced hands this is a highly effective treatment with excellent satisfaction scores for patients and their partners even after 10 years of use, barring mechanical failure. 

Low Intensity Shock Wave Therapy 

This therapy is based on the core principle of inducing local microtrauma so that the body will respond by stimulating the growth of tiny blood vessels in the penis. These shock waves can cause upregulation of vascular growth factors and nitric oxide creation, as well as enhance the function of the smooth muscle cells of the penis. 

Cavernous Nerve Grafting 

Using microsurgical end-to-side grafting of the sural nerve of the leg to the femoral nerve and the cavernous bodies has produced solid results. The sural nerve is micro surgically attached to join the femoral nerve to tissue with the corpora cavernosa of the penis. This method of grafting is aimed at the restoration of the nerve supply to the erectile muscular tissue and helpt to enable erections. A study showed that 71% of men had a satisfactory erectile function at 12 months after undergoing this procedure. 

How Rex MD Can Help

There are many options at restoring sexual function during the recovery of prostate surgery. The most common will be the use of oral medications that help relax penis muscles and increase blood flow, but in the event that these are ineffective or not an option, there are other choices available. 

For the most part, restoring sexual function is most easily achieved with the help of prescription medication such as Viagra®, Levitra, or Cialis®. In more extreme cases, there may be further surgery required, penile injections, or prosthetics. Ultimately, it will all come down to the specific person and their circumstances, risk factors for erectile dysfunction, lifestyle, and results of the prostate surgery itself.