After robotic prostate surgery that is performed for cancer, the patient will have a foley catheter (a small drain that is placed in the penis to allow the newly sewn connection between the bladder and the tube a male urinates through (the urethra) to heal. The urethra is disrupted by removing the prostate, and the two ends must be sewn back together. Usually, after seven to ten days following the operation, the catheter is removed. On this visit in the office, the patient will begin erectile function rehabilitation. As discussed, this will occur with one of the three medications on the market (LevitraTM, ViagraTM or CialisTM). There have been many methods described on how to do this. Some will give the medicine to be taken on a daily or every three day basis (depending on which medication). The patient is counseled that they may not achieve an erection, but that the medicines are used to rejuvenate the nerves, or as I commonly tell the patients, “make the nerves remember what they were supposed to do.” They are to take it like a vitamin (meaning on a daily basis, but not to expect the erection outcome). The medicines will theoretically cause an increase in blood flow to the cavernosal tissue (part of the penis that gives erection). Other physicians will have the patient take the medicine at bedtime. During the night, if a man has normal erectile health, the penis will cycle through erect stages (get hard) without the person’s knowledge. Night-time dosing takes advantage of this phenomenon by enhancing that state of blood flow.
Another trick is to combine the use of the penile vacuum tumescent pump with these medicines. For example, a man will be instructed to take ViagraTM on a daily basis and also to use the penile pump from one to four times a day. I have described the pump in other blog entries. The pump forces blood to enter the penis. Normally a constriction band (a small rubber band) is placed at the base of the penis after the pump is used to keep the blood in the penis. During pump “therapy,” however, this is not used, and the erection is allowed to become soft. Several studies have been performed showing the benefit of these treatments in causing erections to come back more quickly following surgery.
Other medications for ED have also been used for penile erection “rehabilitation” including MuseTM, the urethral suppository, and the medicines (such as CaverjectTM), that are injected into the penis.