Recovery of erectile/sexual function after surgical treatment for prostate cancer

A new review article in the journal Sexual Medicine Reviews has addressed current knowledge on the topic of penile rehabilitation after surgery for localized prostate cancer.

The abstract of this new article by Osmonov et al. (who specialize in male andrology and erectile/sexual function at institutions at Kiel and Rendsburg in Germany) is currently available on line but once it is available in print it is an article that support group leaders and others may want to get a copy of for their files.

Osmonov et al. provide a careful and thorough review of the reasons why erectile and sexual function are usually so significantly affected after surgery — even among younger men who are given bilateral nerve-sparing procedures by highly skilled and experienced specialists. They also discuss the available data related to the use of drug therapies in the rehabilitation of penile function post-surgery.

The authors are clear that we still have no one “best” way to ensure recovery of good erectile function, but they are also clear that they believe certain  forms of management can be helpful in assuring recovery of erectile function as soon as possible in those men for whom recovery of good erectile function will be possible. In doing this, they emphasize the following:

  • The potential recovery of good erectile function is highest in men who have high-quality, bilateral nerve-sparing procedures carried out by skilled and experience surgeons.
  • While the probability of recovery of good erectile function will be lower, it is also possible in men who have unilateral nerve-sparing (again carried out by skilled and experienced surgeons).
  • Early initiation of rehabilitative treatment is key, and Osmonov et al. state that, in their experience, it should be initiated immediately following removal of the post-surgical catheter.
  • There is no one “right” way to ensure recovery of good erectile function, but they state that they have had a high success level using procedures that are based on daily treatment with low-dose PDE-5 inhibitor therapy (e.g., with sildenafil/Viagra, tadalafil/Cialis, etc.) given each evening so as to help to stimulate spontaneous, nocturnal erections.
  • The occurrence of spontaneous, nocturnal erection appears to be a key factor in the early recovery of erectile function.

The authors also emphasize that:

… the main principle is always the same: the increase of local oxygenation can achieve maximum rehabilitation of [erectile function] after [nerve-sparing radical prostatectomy]. Full erectile rehabilitation takes up to 24 months after surgery. However, the fact that it can take a long time until the first erection occurs should not lead the doctors to wait passively. Rehabilitation  should should begin with supportive medication as soon as possible.

They refer to this strategy for penile rehabilitation as “the Kiel concept.”

Clearly this type of therapy is much less likely to be effective among patients who have not had at least unilateral nerve-sparing. For such patients other strategies may be required — up to and potentially including penile implants. We should also be clear that the quality of post-surgical erectile function is also likely to be highly dependent on the quality of pre-surgical erectile function.

Editorial note: The “New” Prostate Cancer InfoLink thanks Dr. Daniar Osmonov for providing us with a copy of the full text of this article that is currently in press in Sexual Medicine Reviews.

5 Responses

  1. My religion doesn’t permit rehabilitation.

  2. Dear Bob:

    That’s a matter you’ll need to take up with your God and his earthly representatives. We can’t help you with that one!

  3. Others have found that an on-demand (rather than daily low dose) PDE-5 inhibitor is best after surgery. Those drugs (e.g., Cialis) have the effect of encouraging urine flow, which is the opposite of what one needs when trying to recover continence too.

  4. Six years since my husband and I have had anything resembling sex. I tried to be proactive, but his doctor didn’t believe in penile rehab … insisted it wasn’t proven … and didn’t seem to appreciate my concern. Our insurance didn’t cover the very expensive Viagra. The whole thing didn’t mean enough to my husband to fight for — wouldn’t push his doctors, wouldn’t go to counseling, gave up on alternative sex. (I’ll confess, so did I, it really never seemed different than masturbating.) … I’ve had a severe depression ever since. How is this a marriage? How is this a life?

  5. @Allen. Ummmm. The mechanism by which Cialis improves urine flow is relaxing the prostate. Not a problem post-surgery. And “encouraging urine flow” is not inconsistent with regaining continence, viz. OAB (which can be a specific problem post-catheterization).

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