Surgery

Nerve-sparing procedures are proving to be helpful in reducing impotence as well as incontinence. Other techniques may improve sexual function after the procedure. For example, some doctors are investigating methods for sparing the vessels that carry seminal fluid in the prostate. In one preliminary study, when this approach combined with nerve sparing techniques it was more effective at preserving erectile function than the nerve sparing approach alone.

Sildenafil (Viagra) may help restore potency on average in about a third of patients, but some men may do better than others. In one study, for example, 80% of younger men who were potent before surgery and had bilateral nerve sparing procedures responded to the drug. (Only 40% responded with only unilateral procedure.) Sildenafil is unlikely to be effective for men who had unilateral or no nerve sparing procedures. In those who respond, sildenafil may provide a benefit for years. Sildenafil may take 9 months or longer to become effective. Men who take it may benefit from alprostadil injections started right after surgery to preserve elasticity and help prevent scarring.

Early treatments with alprostadil injections may helpful in restoring erectile function in any case. This treatment maintains blood flow in the penis, and some research suggests that impotence after prostate surgery may be due in part to injury to these blood vessels. In one study, men administered injections every other night for 6 months. They then started taking sildenafil (Viagra) 3 months after surgery. At 6 months, 82% of these men achieved penetration compared to only 52% of men who took Viagra only. The vacuum pump may serve a similar purpose as the injections.

[For more details on this condition, see In-Depth Report #15: Erectile dysfunction.]

Even when erectile function is preserved, men may experience other sexual problems: