Prostatectomy is an operation to remove the entire prostate gland or part of it (less often), which in most cases is performed for prostate cancer. When performing prostatectomy, sparing robotic or laparoscopic methods are used, much less often – retropubic access through an incision in the lower abdomen. All of them have comparable functional and oncological results.
The most common and at the same time most troubling complications for men after radical prostatectomy are urinary incontinence and erectile dysfunction. Both of these conditions are associated with the fact that the removal of the prostate affects not only the gland itself, but also many surrounding tissues. The operation can cause injury to the muscles and nerve fibers responsible for urinary retention. Modern methods of prostatectomy imply the preservation of these structures intact, but the anatomical proximity of the area of operation and the sphincter of the bladder explains the situation when, even with its preservation, the function of urinary retention may be temporarily impaired. However, in most cases (up to 98% of operated patients) with the help of simple exercises, complete control over urination is restored within six months.
Situation with erectile dysfunction after surgery to remove the prostate is much more complicated. If a man leads an active sex life and is interested in maintaining sexual function after surgery, it is necessary to discuss this with the surgeon in advance. During the operation, the surgeon can preserve one or both of the neurovascular bundles closely adjacent to the prostate gland. As part of these bundles, the nerves are responsible for the occurrence of an erection, that is. Given that the neurovascular bundles pass in close proximity to the prostate, their preservation is possible only if this doesn’t compromise the results of the operation (depending on the prevalence and nature of the tumor lesion). It is important to note that a high preoperative level of sexual activity is a positive predictor of maintaining a spontaneous adequate erection after surgery. However, this is possible only if the above-mentioned neurovascular bundle is preserved. If a man doesn’t have an active sex life before the operation or the neurovascular bundle cannot be preserved for some reason, the chance of maintaining a spontaneous erection is very small.
Even the preservation of the neurovascular bundle doesn’t guarantee the restoration of potency after surgery, but still it significantly increases the likelihood of such a prognosis. At best, sexual function returns in 4-12 months. First, there are spontaneous, then motivated erections. Taking certain medications to restore potency helps to restore an erection more quickly. For this purpose, Viagra, a drug from the group of PDE-5 inhibitors, which is recommended for ED after radical prostatectomy, is advised to be taken not on demand, but on a regular basis, for example, daily or twice a week. You may decide to buy a cheap generic Viagra instead of an expensive branded drug, since the course of treatment is long, up to a year, and there is no difference between branded and generic Viagra.
Caroline Moore receives charitable research funding from Movember, Prostate Cancer UK, the National Institute for Health Research, the Medical Research Council, Cancer Research UK and the JP Moulton Foundation. She does proctoring work in focal therapy for SonaCare. She has a clinical research study funded by SpectraCure.
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