Erectile Dysfunction and Urinary Tract Symptoms
In the preceding entries I have focused on the erectile dysfunction that typically follows the surgical treatment of prostate cancer. All treatments for prostate cancer are accompanied by their own spectrum of side effects. The major side effects include incontinence and ED. My goal with any prostate cancer patient is to first cure the cancer. Whether my patient opts for radiation therapy, cryosurgery or robotic surgery, all interventions will, in some way, alter their lifestyle. Surgical technology has given us the ability to better preserve the nerves responsible for erectile function, but it is likely that their erections will not be as strong as before the operation. However, injury to adjacent organs (bladder and rectum) can also occur with various types of radiation therapy, side effects not seen with surgery. When I discuss the various treatment options for prostate cancer with a given patient, all side effects are discussed, and an individual assessment is made based on patient preference and what they feel is an acceptable side effect profile.
Recent research has shown a close relationship between urinary function and erectile function. What does this mean? This suggests that difficulties with voiding (passing urine) will adversely affect a patient's erections. Typical complaints of urinary dysfunction include having to get up multiple times during the night to urinate, having to strain to pass urine, having to wait before the stream will begin, and slowing of the urinary stream. If any of these symptoms are present, several tests will be performed by your urologist including a urinalysis (test to see if your urine is infected), a uroflow (a test to determine how fast your stream flows) and a post void residual (fancy term for checking to see how much urine is left in your bladder after you urinate).
As they age, men are offten unable to sense a lot of these symptoms. Abnormalities can exist without the patient's knowledge. For others, the symptoms are readily apparent and bothersome. It is common for enlargement of the prostate to block the flow of urine out of the bladder. The prostate is the "gate-keeper" of the bladder. As it grows, it can grow into the lumen, through which we pass our urine. If this occurs, sometimes we may not empty the bladder to completion. This extra urine will cause symptoms like urinary frequency (sensing that you have to urinate every hour or so) and nocturia (having to get up at night to urinate).
Research has shown that if we can make a patient's urinary symptoms improve, let's say by improving the patient's ability to fully empty their bladder, then their erections may improve as well. Improving the bladder's ability to empty often relies on the addition of a medication to shrink or relax the prostate. Sometimes I may treat the patient's urinary symptoms before adding any medication for erection. This utilizes a "less is best" philosophy. With others, however, based on how bad the erectile function is, I may start both medicines together.