Prostate surgery and erectile dysfunction

One of the most feared consequences for patients in relation to prostate surgery is the impact on the erection. To understand this possible consequence, we must differentiate the two most common pathologies of the prostate: benign hyperplasia and cancer.

Dr. Shailendra Goel, Best urologist in Ghaziabad, Noida explains that both entities are totally different since hyperplasia is a benign process associated with aging. This non-malignant growth of the inner part of the prostate causes an obstruction to the exit of the urine with all the known consequences: difficulty to initiate urination, thin stream or rising several times at night to urinate. On the other hand, prostate cancer is a disease that does not produce symptoms, it usually sits on the external or peripheral part of the gland and is a tumour process, so it needs a specific treatment according to the result of the prostate biopsy.

An anatomical data relevant to understanding the impact of prostate surgery on erection is the location of the erector nerves; both nerves pass to both sides of the prostate on their way to the penis; these nerves "embrace" the prostate and pass intimately attached to this organ laterally, says sexologist in Noida.

A point that generates confusion in patients is to distinguish between the types of surgery performed according to the process is benign or malignant: in the surgery of benign prostatic hyperplasia the entire prostate is not removed but only the enlarged part responsible for the obstruction of the exit of the urine while in prostate cancer surgery, the entire prostate is removed completely. To understand it better and if we imagine the prostate as an orange, in the intervention of the hyperplasia the orange is extracted leaving the shell so that the erector nerves remain in place while in the intervention of prostate cancer all the organ is eliminated so that the probability of causing damage to the erector nerves is much higher.

In benign surgery of the prostate, injury to the erector nerves is much less likely (around 5%), which can occur by perforation of the prostatic capsule or due to the transmission of heat or electricity from the instruments used. sexologist in Ghaziabad says that the factors responsible for erectile dysfunction (age, cardiovascular and hormonal risk factors) are also causing benign growth of the prostate, so many patients suffer both situations concomitantly.

The surgery for prostate cancer or radical prostatectomy removes the entire prostate completely. It is always tried that the clinical conditions of the patient allow it, to preserve the erector nerves by means of a fine dissection but in many occasions, it is complicated, difficult or it is not possible to do. In recent years, first laparoscopic surgery and later with the emergence of robotic surgery that allows a 3D vision and greater precision have tried to alleviate this side effect to maintain an erection but not always obtain these results. Despite these advances and depending on the surgical technique, there may be between 60-80% postoperative erectile dysfunction, says urologist in Ghaziabad, Noida.

A key point after surgery for prostate cancer is to start a program of rehabilitation of the corpora cavernosa that can last several months to avoid erectile dysfunction and loss of characteristic penis length. This improvement program consists of the use of a vacuum pump several times a day that allows an inflow of blood to the corpora cavernosa of the penis combined with the stretching of the penis. These exercises are usually supplemented with a daily pharmacological treatment of an erection enhancer.

From 12-18 months after radical prostate treatment in Noida, if an erection improvement has not been observed, a treatment can be evaluated by intracavernous prostaglandin injections that produce an erection without sexual stimulation.

In cases of failure of all previous treatments, the only option is the placement of a penile prosthesis with excellent results. This prosthesis consists of 2 cylinders that are introduced into the corpora cavernosa and by placing a device inside the scrotum (between the testicles), the patient can provoke an erection at their discretion. You will get enough stiffness for penetration. The satisfaction index is very high since it allows offering a guaranteed response to sexual relations.