Sexual Function After Radical Prostatectomy

Your cancerous prostate was surgically removed using the state-of-the-art laparoscopic robotic nerve-sparing technique by a highly skilled and experienced urologist. With the cancer concerns gone and the PSA undetectable you breathe a major sigh of relief. Now a new concern has emerged: erectile dysfunction. Things down below were working well or reasonably well before the operation and you and your partner would like to resume normal sexual relations as soon as conceivable. Right now, however, erectile function seems to be in a state of shock.

It is vital to understand that “nerve-sparing” prostatectomy does not mean “immediate nerve-functioning” as it can take a considerable amount of time for nerve and erection recovery, even when the surgery is performed by the most skilled robotic urological surgeon. Erectile function will typically gradually improve over time, sometimes taking 2 years or even longer until optimal function returns.

BEST PREDICTORS OF ERECTILE FUNCTION FOLLOWING PROSTATECTOMY

·      Age (younger = better recovery)

·      Pre-treatment function (better functional beforehand = better recovery)

·      Extent of preservation of the nerve bundles (both nerves spared better than one nerve spared better than no nerves spared)

·      Body mass index (healthier BMI = better recovery)

·      Medical co-morbidities (fewer medical issues = better recovery)

·      Surgeon skill and experience (more skilled and experienced = better recovery).

NERVE DORMANCY

After prostatectomy, there is a period of time in which the nerves to the erectile chambers remain in a state of dormancy. Failure of nerve conduction results in the inability to obtain or maintain an erection and therefore the loss of the capacity for penetrative sexual intercourse. In this dormant state, there is diminished release of nitric oxide–the key chemical responsible for relaxation of erectile smooth muscle and the capacity for erections.

USE IT OR LOSE IT PRINCIPLE

It is vital to obtain erections in order to maintain erections. Erections not only provide the capacity for penetrative sexual intercourse, but also keep erectile smooth muscle and erectile tissues richly oxygenated, elastic and functioning, preventing disuse atrophy.

A consequence of prolonged penile flaccidity that can occur after prostatectomy is scarring and damage of the erectile tissues. This can lead to permanent erectile dysfunction on the basis of venous leakage (veno-occlusive disease) in which the penile blood trapping mechanism fails to work properly, further impeding rigidity and durability of erections. Herein lies the importance of efforts directed at the expeditious resumption of erectile function to prevent the occurrence of this vicious cycle and optimize long-term erectile function.

Next week’s entry–penile rehabilitation, a.k.a. “penile rehab”–will explore all of the techniques that can hasten sexual (and urinary) recovery following prostatectomy.