One of the well known risk factors to radical prostatectomy is erectile dysfunction. The nerves responsible for erectile function, the neurovascular bundles, lie in close proximity to the edges of the prostate gland. Even if a nerve sparing prostatectomy is performed, the nerves can get “stunned” during the dissection.
Luckily, nerves can heal and regenerate, albeit slowly. Urologists have gone through great efforts to perfect this stage of the operation so men can have quicker return of erectile function after surgery.
There are currently a few things a man can do to improve erectile function following surgery. Many people are familiar with the medicines Viagra (Sildenafil), Levitra (Vardenafil) and Cialis (Tadalfil). These are in a class of drugs known as phosphodiesterase-5 (PDE-5) inhibitors which stimulate blood flow to the penis.
As blood flows to the penis, it is stored in two cylindrical chambers called the corpora cavernosa. An erection is formed when these chambers fill with blood. There are numerous articles describing the development of scarring, called fibrosis, of the corpora cavernosa if erections are not achieved over a period of time.
The inability to achieve an erection after a radical prostatectomy puts a man at risk to develop scarring (fibrosis) of the corpora cavernosa due to lack of sexual activity. Scar development is permanent and irreversible.
Men in my practice are started on Cialis 10 mg to take Monday, Wednesday and Friday. This “penile rehabilitation” is initiated one month after their robotic prostatectomy. Men have to watch for side effects which include headaches, sinus congestion and an upset stomach. The dose is increased to 20 mg if the man does not have an adequate response.
Overall, men do very well with this regimen. Fibrosis is prevented by stimulating blood flow to the corpora cavernosa. Results from multiple studies show that pharmacologic penile rehabilitation improves erectile function after radical prostatectomy. Other methods of “penile rehabilitation” include vacuum assisted devices and injection therapy.
You can read more about erectile dysfunction and the various treatment options at our partner site ErectileDysfunctionConnection.com.
Published On: April 26, 2007