As you’ve no doubt seen on our website, one of my strongest passions is helping men regain their continence and erectile function after prostatectomy. I feel strongly about this, not only because there are men who suffer in silence for years or even decades, but also because the solutions to some of these issues are simple, clear, and surprisingly doable. Ultimately, any given prostatectomy patient may have a slower or faster recovery of these functions than a peer. But ultimately, every patient should be able to enjoy normal urination and erectile function, even if that means with the help of a penile prosthesis.
Let’s recap why many patients lose their ability to hold urine, known as incontinence, and are unable to achieve or maintain the erection they want.
While the prostate itself does not have direct control over urinary and erectile function, the nerves and vascular structures around the prostate certainly do. On the continence front, prostatectomy requires the removal of one of the two sphincters or valves that regulate the flow of urine. We cannot know in advance whether the remaining valve will be strong enough to support proper discharge function. For some it is, and continence is quickly restored after surgery. For a minority, they are not, and they may need more time (and possibly possible surgical help) to stay dry.
Regarding erectile dysfunction, it was once thought that the main cause of erectile dysfunction after prostatectomy was irritation or damage to the nerves surrounding the prostate that also help control erections. This led to what we call a nerve-sparing prostatectomy. Although you think that this is the only issue, this is not true. We found that it is the damage done to the blood vessels in the area – unfortunately, an unavoidable circumstance – that may be the real culprit in post-prostatectomy ED. Not only can ED be affected by the mechanical stresses caused by resection of the prostate but also by radiation, if necessary, which can lead to delayed ED, sometimes several months after the procedures.
Now that we know what causes these problems, we can discuss patient expectations after their procedure.
In terms of continence, more than 90% of patients will regain normal urinary function within one year after surgery. Improvement can be slow and deliberate or spontaneous, depending on the patient. In some patients it may take up to two years. It is also important to emphasize that progress will likely be slow and patients should not be discouraged. If you’re making progress during the first few months after surgery, meaning you can spend more of the day and night dry, you’re on the right track.
Erectile dysfunction, on the other hand, can be much more difficult and more men find that they cannot achieve or maintain an erection. In this case, there may be several potential concerns. Any vascular damage caused by radiation, therapy or surgery can slowly improve. If patients were already experiencing erectile dysfunction, most commonly due to age-related vascular concerns and lack of blood flow, improvement may be slow or nonexistent. Even after regaining some function, patients may find that they are not the same as before surgery, which requires a multifaceted approach. Part of my commitment to men after their prostatectomy is that we can work with Greg, a fellow pharmacist, and Lise, our sexologist, to develop a plan that addresses desires and potential relationship issues, as well as the limitations you may experience after surgery through medication such as Viagra/Sildenafil or Cialis/Tadalafil.
If these interventions are not enough to return patients to their daily sex lives, we can work with them to develop a plan for a penile prosthesis or implant that returns them to normal sexual function in a discreet and, frankly, quite elegant way.
Conclusion
Most importantly, we want men who suffer from ED or urinary incontinence, whether caused by a prostatectomy or not, to understand that there are solutions, and those solutions are safe and highly effective. The most critical next step is to ask me, a urologist near you, or a men’s health specialist in your area about your options for correcting these debilitating issues. If you are in the Charlotte, North Carolina area, we encourage you to call our office and schedule an appointment. I would be excited to discuss options with you and determine the best way forward.
