Prostate Surgery 6. Q: What is available for Erection Rehabilitation After a RRP? A: Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. The relatively new strategy of rehabilitation in clinical management after an RRP comes from the idea that early-induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity. Some experts in erectile dysfunction now believe that taking agents such as Viagra, Levitra, or Cialis will hasten the return of erections. Alternatively, vacuum erection devices, MUSE suppositories, or injections of blood vessel dilating drugs into the side of the penis can produce good erections in some patients. The basis for this belief is that, normally, men have erections every day; therefore, the normal situation for the penis is to receive an infusion of well-oxygenated blood every day. This infusion helps to keep the intricate anatomical structures in the penis healthy. All patients with postoperative erectile dysfunction had significant blood flow changes after surgery, partly explaining the ED rates after nerve-sparing surgery. https://www.cornellurology.com/clinical-conditions/erectile-dysfunction/prostatectomy-anderection-problems/ The causes of ED after this form of surgery include nerve injury, artery injury or deterioration in erection tissue structure and function after surgery. In 1997, Dr. Montorsi from Milan, Italy completed the first study looking at early postoperative preventive drug therapy for this problem. Immediate therapy after surgery, using penis injections, administered within the first two months of surgery resulted in a 67% incidence of return of a man’s own erections compared to 20% in men who had no treatment after surgery. The concept is that these erections induced after surgery can protect the erection tissue itself and promote the return of a man’s own erections. There is a strong body of opinion that suggests that men with poor erections after radical prostatectomy should be treated with medications to induce erections early after surgery. It is unknown at this time if the administration of sildenafil that fails to cause a rigid erection after radical prostatectomy can increase the chances of a man’s own erections returning. When patients with prostate cancer present to the Sexual Medicine Program at The New York Presbyterian Hospital prior to undergoing radical prostatectomy surgery, they are counseled regarding all postoperative sexual dysfunctions including ejaculatory and orgasmic problems. During surgery, the urologic oncologists at this institution use techniques to minimize nerve trauma if possible. All patients are encouraged to seek postoperative evaluation and treatment for erection problems within the first 2 months of the procedure. When ED exists, the best approach is believed to be the commencement of early drug therapy in the form of oral agents (currently Viagra®), transurethral alprostadil (MUSE®) or penile injection therapy. When these treatments have failed or the patient is not a candidate for these three options then the use of vacuum erection device therapy or penile implant surgery may be of benefit to some patients. It is important that patients are followed up with on a regular basis to make sure that a successful drug therapy has been identified. The patients are encouraged to obtain 2-3 erections per week and this therapy is continued for 18 months postoperatively before a full idea is possible regarding return of the patient’s own erections. http://www.hisprostatecancer.com/penile-rehabilitation.html …These studies suggest that early use of oral ED medications, penile injections, urethral pellets, and a vacuum erection device for penile rehabilitation may all help improve sexual function in men following radical prostatectomy. Even if your man takes an ED medication and sees no result, some in the medical community believe there may still be benefits in continuing to use an ED drug for penile rehabilitation. OUTER-COURSE VS. INTER-COURSE http://www.vancouversun.com/health/Prostate+removal+surgery+Very+same+before/3 600403/story.html
