Better patient counseling needed on post-RP erectile function – – UrologyTimes

Acting on anecdotal evidence, Dr. Nelson and his co-authors, Peter Scardino, MD, and John P. Mulhall, MD, assessed the erectile function of 250 men average age, 59±8 years pre- and post-radical prostatectomy. Of the men with baseline erectile function scores ≥24 mild to no dysfunction, about one-third 32% regained function; however, well over half 60% required medication to do so. Only 13% of men reporting mild to no dysfunction prior to prostatectomy reported returning to full baseline function at 24 months without medication.

via Better patient counseling needed on post-RP erectile function – – UrologyTimes.

This study from Memorial Sloan Kettering points out that it is important to explain to patients that the ability to achieve an erection  is less after surgery.   Many factors account for a patients ability to recover erectile function including, age, preoperative function, sexual activity, the type of nerve sparing that can be performed (based on the amount of cancer), skill of the surgeon, type of surgery (open vs. robotic), and other factors.

I try to give an estimate of the probability of the ability to get erections after surgery with and without PDE5 medicines (viagra, levitra, cialis) for each patient.

Sexual life after prostate removal

This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.

prostate diagram

click to expand the image

Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away.

The prostate makes the liquid in the ejaculate. This is necessary for the sperm to work and therefore to have children. Other than having children, the prostate is of little use later in life and only causes problems with urination (BPH) and is a leading cause of cancer.

nerves surrounding the prostate

click to expand the image

The “nerves” that go to the penis course very close to the prostate. They are only a few millimeters from the prostate and can be affected by surgery or radiation. These nerves are solely responsible for erections, or the ability of the penis to get hard.

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ED and the Veil of Aphrodite

Dr. Menon gave a presentation at the Pacific Rim Robotics Conference on nerve preservation and the anatomical concept that he has named the veil of Aphrodite. After first reviewing the history of impotence after radical prostatectomy he described the latest modification of his techniques, which he claims further improves the preservation of potency. Originally, of course, radicals were associated with nearly 100% impotence until Dr. Walsh introduced the concept of “nerve sparing”. While Walsh has at times claimed very high rates of preservation, many others felt that preservation in perhaps 50-60% of patients having a nerve sparing represented excellent results. In the introductory remarks to his talk Dr. Menon cited several papers that quoted rates of “normal” erections of only 4-33% after nerve sparing. There is clearly room for improvement.

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