Erectile dysfunction remains the most common side effect after prostatectomy. How erectile dysfunction can be solved? What are the available treatments?
A range of solutions exist to overcome erection problems consecutive to prostate ablation. These treatments are gradual; in all cases, the motivation of the couple and psychological support are essential for treatment success.
The level of patient’s erectile dysfunction depends on prostate cancer stage and tumor extension.
If the tumor is localized within the prostatic capsule (intra-capsular), the surgeon may succeed – according to local anatomical conditions- to save part of the nerves responsible for erection process and thereby maintain erectile function in 40% to 85% cases, final success rate will be function of the quality of neurovascular bundles preservation.
When the tumor expanded to a locally advanced stage, the neurovascular bundles must be sacrificed to meet primary objective of curing cancer.
However, post-prostatectomy, many treatments exist to rehabilitate patient sex life within 2 years following the intervention.
It is essential to assess accurately patient sexuality before surgery to set realistic goals.
Possible treatments of erectile dysfunction
Treatments should be implemented gradually, from least to most invasive.
Medicaments are recommended for moderate disorders, or in combination with intra-cavernous injections or vacuum constriction devices.
They improve the frequency and quality of erections, as well as oxygenation of erectile tissues of the corpora cavernosa (also called “cave-like bodies”). Medicaments act by stimulating blood flow throughout the penis inducing erections that can last more than an hour.
Erection facilitators are mainly from pharmacological type-5 PDE inhibitor group, with the SILDENAFIL being the leading molecule.
The use of these treatments is simple since they are orally ingested.
A wide range of molecules and dosages allow to adjust treatments with couple’s sexual habits and patient’s wishes, medication can be scheduled at regular time slots, or tuned upon sexual intercourse timetable.
When medication fails to induce an erection strong enough to allow full sexual intercourse, use of intra-cavernous injections or vacuum constriction devices will be advised.
2. Intra-cavernous injections
Intra-cavernous injection therapy consists of injecting small amount of chemical right into the corpora cavernosa of the penis.
Practiced laterally on the penis right into the corpora cavernosa, with a very fine and short needle, the intra-cavernous injection rapidly induces penile rigidity for full sexual intercourse.
The chemical injected are vasoactive substances from the “prostaglandins” group.
Injection itself is almost unfelt thanks to fine and short needles used.
A patient education beforehand as well as a close monitoring by an healthcare specialist are essential to ensure the intra-cavernous injections are properly carried out and avoid possible incidents related to improper manipulation or inadequate dosage.
These treatments are in most cases reimbursed by health insurance (subject to variation upon patient’s country).
3. Vacuum constriction devices
A vacuum constriction device (VCD) is an external pump represented by a hollow cylinder of transparent plastic opened at one of its ends, wherein the penis is introduced. The other end of the cylinder is connected to a pump.
The vacuum, by creating a blood flow within the corpora cavernosa, triggers the erection.
The erection induced by this system is maintained thanks to an elastic ring placed at the penis base (the ring plays a compression role).
This solution requires some preparation but its efficiency is above 90% and it avoids the use of medication.
Moreover, its tolerance, lack of side effects and quality/price ratio turn it into an excellent solution.
4. Penile implants
The penile implant is another treatment option for men with erectile dysfunction. Such implant is surgically implanted in the penis.
Several types of implants are available, the most sophisticated one consists of a pair of inflatable cylinders (implanted in the corpora cavernosa) connected to a container filled with liquid.
This container is positioned before the bladder and linked to a pump placed next to the testicles while the patient interacts with the pump to start or stop an erection.
These cylinders act in place of the corpora cavernosa erectile tissue, therefore this solution should be considered only when those erectile tissues are permanently altered, in case of other treatments failure.
Patient psychological counseling
Sexual desire might be affected by the physical and psychological consequences of the disease and its treatments, especially by the fear of losing some sexual capacities which could turn into a vicious cycle.
The partner and the couple are psychologically affected and, in most cases, consulting a sexologist is recommended. The latter, acting as a team with the urologist, implements methods aiming to mitigate to the maximum the ejaculation and erection problems, while taking into account the partner sexual concerns.
Some bibliographic elements:
List of available solutions (French)
The intra-cavernous injections (French)
The vacuum constriction device (French)
The penile implant (French)
Solutions Comparison (French)