Does Prostate Surgery Cause Erectile Dysfunction?

January 11, 2019

Prostate Cancer

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Radical prostatectomy, which involves removing the entire prostate and some of the surrounding tissue, and erectile dysfunction as a complication is a common occurrence. The entire prostate is removed because on average, a man will have five or more tumors in his prostate, and their exact locations cannot be identified accurately before surgery. Rather than risk leaving any cancerous tissue behind, surgeons remove the entire gland. Men considering this procedure should ask their doctor about radical prostatectomy and erectile dysfunction so they know what to expect.

A radical prostatectomy can be performed using any one of four different techniques: retropubic, perineal, laparoscopic, and robot-assisted laparoscopic prostatectomy. You need to discuss the risks and benefits of each type of surgery with your oncologist and surgeon so you can decide which procedure is best for you. Of all the possible side effects, the combination of prostate cancer surgery and erectile dysfunction is one of the most common and distressing.

How Are Radical Prostatectomy and Erectile Dysfunction Related?

Despite advances in nerve-sparing techniques used during prostatectomy, erectile dysfunction is still a major consequence of this surgical procedure. Most men suffer erectile dysfunction to some degree after prostate surgery because of the trauma to the soft erectile tissue and the nerves, increased muscle atrophy of the cavernosal smooth muscle, and fibrosis (excessive tissue formation).

After prostatectomy the penile muscles go to sleep and atrophy. This leads to a lack of nighttime erections, which are necessary to maintain erectile tissue. For some men erectile dysfunction is temporary, but for others it can be permanent. The severity of erectile dysfunction depends on the type of surgery, the stage of cancer, and skill of the surgeon.

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In addition to the penile muscles, the erection nerves also are at risk during a prostatectomy. Even if a surgeon is highly skilled at nerve-sparing prostatectomy, erection nerves go to sleep when they are handled, and they can remain dormant for one to two years. The good news is that dormant nerves can revive, and so erectile dysfunction can resolve over time.

How Long Until You Regain Erectile Function after Prostatectomy?

The answer to this question is, it depends on the man. According to a study published in the Journal of the American Medical Association, for example, 18 months after their radical prostatectomy, nearly 60 percent of men reported an inability to get an erection. That percentage dropped to 41.9 percent after 24 months.

For men who undergo a nerve-sparing technique, recovery from erectile dysfunction may occur within 12 months of surgery. Recovery of erectile function after a non-nerve-sparing procedure is less likely. One study, for example, found that one year after prostatectomy, 66 percent of men experienced erectile dysfunction after having a nerve-sparing procedure versus 75 percent who did not have nerve-sparing surgery.

The good news is that more men may regain erectile function if they participate in a penile rehabilitation program within a few months of prostatectomy. The success of such a program will depend in great part on your pre-prostatectomy erectile function and the type of prostatectomy you have. If you are considering prostatectomy, you should discuss this program and the potential for erectile difficulties with your physicians even before undergoing prostate cancer surgery.

References for Radical Prostatectomy and Erectile Dysfunction:

Capogrosso P et al. Postprostatectomy erectile dysfunction: a review. World Journal of Men’s Health 2016 Aug; 34(2): 73-88

Stanford JL et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000 Jan 19; 283(3): 354-60

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