Sexual rehabilitation after prostate surgery

Prostatectomy is a procedure that involves removing a man’s prostate gland. A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. Radical prostatectomy (RP) in any form (open, laparoscopic, or robotic) is the most frequently performed procedure for patients with localized prostate cancer and who have a life expectancy greater than 10 years.

Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The prevalence of erectile dysfunction as a complication following pelvic surgery, especially radical prostatectomy, ranges from 25 to 100 percent. Sexual dysfunction that develops after prostate surgery can have a negative impact on both sexual and overall quality of life.

Advances in the knowledge of pelvic anatomy and pathological mechanisms have led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing radical prostatectomy.

Penile rehabilitation is defined as the use of any drug or device at or after RP to maximize erectile function recovery. Pharmacological therapy is effective for some men after having their prostate removed to improve erectile function. Sildenafil (Viagra) is the drug that has been studied most extensively men having had their prostate removed. Response rates to sildenafil after surgery range from 10 to 76 percent in improving sexual response.

For men who do not respond well to erectile medication, penis injections known as intracorporeal injections (ICIs) with erectile medications are effective treatments for ED. Success, defined by the ability to engage in sexual intercourse with a hard erection, is often achieved in as many as 94.6 percent of patients who have had a prostate removal procedure.

Vacuum therapy (VT) utilizes negative pressure to increase the blood inflow to the penis and improve erections. Vacuum constriction device are sometimes used with the aid of an external constricting ring which is placed at the base of penis to prevent blood outflow, maintaining the erection for sexual intercourse.

Maintaining sexual satisfaction and overall quality of life after prostate surgery is an important consideration for all men and their partners. Although sexual dysfunction may not be a first concern as surgery for prostate cancer is considered, it is probably the single most common long-term problem encountered after open or robotic surgery. Our sexual rehabilitation approach is based on research for both prostate cancer surgery and sexual medicine.

We are excited to have the opportunity to help with this vitally important challenge, and we are dedicated to helping you retain your sexual function after your prostate surgery.