How to recover erections after prostate cancer surgery?

This article was translated from the original Portuguese. Português

Erectile dysfunction is a side effect greatly feared by most men who will undergo prostate cancer treatment.

In recent years, technological advances in the surgical technique itself have helped improve outcomes. One example is robotic surgery.

The risk of developing erectile dysfunction depends on several factors, such as age over 65, obesity, smoking, vascular disease and men whose disease was already discovered at an advanced stage.

Therefore, younger men without health problems have the best chances of maintaining erections after treatment.

In addition, the surgical team's experience and the availability of technology such as robotic surgery make it more likely that the nerves carrying the signals for erection can be identified and preserved.

The erectile nerves are delicate structures that leave the spinal column and run just a few millimeters from the lateral surface of the prostate.

These fine structures converge toward the area known as the prostatic apex, which happens to be where the urinary sphincter is located — the muscle responsible for controlling urination.

This is a very delicate anatomical area, where the surgeon must remove the prostate together with the cancer while preserving vital structures such as the nerves responsible for erection and the urinary sphincter.

This is because the prostate acts as a connector between the tubing that carries urine and the tubing that carries semen.

These two systems converge in the middle of the prostate, allowing them to drain directly into the penile urethra.

That is why the prostate is a vital organ for both the male reproductive system and the male urinary system.

Another very important strategy that can speed up erection recovery after prostate removal is the use of medications with a vasodilating effect on the corpora cavernosa, such as tadalafil and sildenafil.

These drugs are started approximately one week after surgery, when the urinary catheter is removed.

Another point that needs to be made clear is that erections do not return immediately after the catheter is removed. Recovery time varies from man to man, but it is estimated that full recovery can take up to 18 months.

To speed up this process even further, we can combine pelvic floor physiotherapy with penile rehabilitation with the vasodilating medications.

This strategy can benefit the vast majority of men, and it also speeds up the recovery of continence and potency at the same time.

In cases where these strategies do not work, it is still possible to achieve an erection with medications injected into the base of the penis or, in rarer situations, with the implantation of a penile prosthesis.

Your urologist has all the tools needed to assess and individualize treatment in each case.

Remember to share all relevant information and symptoms with your medical team to support a fast recovery.

By: Dr. Bruno Benigno

CRM SP 126265

Urologist

Dr. Bruno Benigno
Urologist and uro-oncologic surgeon (CRM-SP 126.265 · RQE 60022). More than 1,500 robotic surgeries. Member of the AUA, EAU and SBU. Meet Dr. Bruno · In the Media

This content is educational and does not replace a medical consultation. Each case must be assessed individually, based on AUA, EAU and NCCN guidelines.