Penile Prosthesis Implantation after Radical Prostatectomy for Prostate Cancer
Erectile Dysfunction after Treatment for Prostate Cancer
Erectile dysfunction (ED) is one of the most common side effects of treatment for prostate cancer. Erectile dysfunction or impotence refers to difficulty with obtaining or maintaining an erection of the penis that is hard enough for sex.
ED is particularly common after radical prostatectomy in men who have some difficulty with erections preoperatively and in men over age 50. If other treatment options such as oral medications that include Viagra, Cialis, Stendra, or Levitra do not work, vacuum erection (VED) therapy, as well as intraurethral alprostadil (MUSE), can be effective. Penile injection therapy can also work for many men and can be considered as part of penile rehabilitation therapy after radical prostatectomy.
Penile Prosthesis after Radical Prostatectomy
A penile implant offers an effective treatment option for erectile dysfunction for men who experience ED as a side effect of treatment for prostate cancer. Men who have undergone robotic prostatectomy or open radical prostatectomy, radiation therapy or cryoablation for prostate cancer are candidates for the penile implant.
Penile implantation restores the function of the penis and allows men to resume sexual activity without the need for medications.
Erectile Dysfunction after Treatment for Prostate Cancer
Erectile dysfunction is very common after surgical treatment for prostate cancer with robotic radical prostatectomy or traditional radical prostatectomy. While nerve-sparing radical prostatectomy decreases the severity of erectile dysfunction and improves the chances of recovery, few men older than 50 experienced complete recovery of erectile function to the levels it was prior to surgery.
Most men with very good erections prior to surgery will require the use of oral PDE-5 inhibitor medications such as sildenafil (Viagra), tadalafil (Cialis) or Levitra.
Men with persistent erection problems after radical prostatectomy are advised to undergo a penile Doppler ultrasound to evaluate for veno-occlusive insufficiency (venous leak). Men with severe veno-occlusive insufficiency are unlikely to recover erectile function and may be best served by penile injection therapy, vacuum erection therapy or penile implant.
Penile Rehabilitation after Radical Prostatectomy.
Men who undergo treatment for prostate cancer with radical prostatectomy, whether it is performed robotically, laparoscopically, openly or transperineally, tend to experience erectile dysfunction and penile length loss after surgery.
At New York Urology Specialists, we recommend early initiation of treatment to maximize the chances of erectile function recovery and to prevent length loss after radical prostatectomy.
Penile Implant after Radical Prostatectomy.
Men with moderate to severe erectile dysfunction prior to radical prostatectomy are unlikely to recover erectile function to the point that they can penetrate without the use of medications, penile injections, or penile implant.
For men with severe erectile dysfunction 3 to 6 months after radical prostatectomy despite the use of PDE-5 inhibitors, we usually perform a penile Doppler ultrasound. If a man is not responsive to penile injections with Trimix, usually due to severe veno-occlusive insufficiency, it may be reasonable to proceed with penile implant surgery. Men with partial recovery of erections may want to wait before deciding how to proceed.
Penile Implant Options After Radical Prostatectomy
Men with erection problems after radical prostatectomy may be treated with penile implant surgery which is an effective option for treatment for erectile dysfunction.
There are 3 types of penile prosthesis available for treatment for erectile dysfunction after radical prostatectomy: malleable penile prosthesis, three-piece inflatable penile prosthesis, and 2-piece inflatable penile prosthesis.
A malleable penile implant is the simplest to use as it does not need to be inflated and deflated and provides good satisfaction. Inflatable penile prostheses are a little bit more sophisticated and have higher erection rigidity satisfaction rates.
Usually after radical prostatectomy, if a three-piece penile implant he is chosen, the reservoir is placed in the belly, and sometimes it may be palpable or protrude under the skin in what we call “ectopic position”. The three-piece inflatable penile implant offers better rigidity potential than a 2-piece inflatable penile implant. However, the 2-piece inflatable penile implant also offers adequate rigidity for sexual activity.
The 2-piece inflatable penile implant has the advantage of not having a reservoir and avoids the need for abdominal surgery. It is particularly useful in thinner men and in men who are concerned about the cosmetic appearance of their abdomen.
The Bottom Line
Prior surgery for prostate cancer does not affect the success of a penile implant in treating erectile dysfunction.
Penile implant surgery can reliably treat men with erectile dysfunction regardless of the cause. Men with ED after treatment for prostate cancer are good candidates for the penile implant.
How Soon After Prostate Surgery (Radical Prostatectomy / Robotic Prostatectomy) Can Penile Implant be Performed?
A penile prosthesis can be implanted soon after radical prostatectomy once the patient recovers from prostate surgery. Usually for men who had good erections before surgery, waiting 6-12 months is optimal to see if the natural erections return.
Men with severe ED prior to surgery or severe ED 3 months after prostatectomy may choose to have penile prosthesis surgery earlier as a recovery of adequate erections without the use of oral or injectable medications is unlikely. Penile rehabilitation therapy is advisable as soon as the patient recovers from prostate surgery.
Scheduling Appointments for ED Treatment at New York Urology Specialists
We have excellent reviews from patients and their partners.
Dr. Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation and other sexual concerns. He has successfully treated hundreds of men with sexual problems including ED and poor libido.
by Robert Clarke on Aug 04, 2019
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ED is Treatable in Nearly Every Man
At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction. We understand the challenges that ED creates for our patients, their relationships and their self-esteem. We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.
Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED. We offer medical and surgical treatment for erectile dysfunction.
We Treat Some of the Most Complex ED Problems Including:
- Erectile dysfunction in men with prostate cancer after radical prostatectomy
- Impotence in men with diabetes.
- Erectile dysfunction in men with Peyronie’s disease
- Erectile dysfunction in men for whom Viagra and Cialis do not work.
- Erection problems in men with low testosterone.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in evaluation and treatment of sexual and erection problems in men using modern effective and proven treatment methods. We offer inflatable penile implant, shockwave therapy for ED and treatment for Peyronie’s disease.
He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.