Top Specialists in NYC For Treatment of Erectile Dysfunction after Prostate Cancer Treatment with Robotic Radical Prostatectomy

by Alex Shteynshlyuger MD

If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5211.

Dr. Alex Shteynshlyuger is a specialist in treating erection problems after prostate cancer treatment using the latest scientific and medical breakthroughs.

Effective Treatment of ED after Prostate Removal Surgery

At New York Urology Specialists, we use the most advanced methods of ED treatment to help men recover erections after prostate cancer treatment with surgical removal of the prostate.

Our approach to the treatment of post-prostatectomy ED is very effective for men of all ages.  We offer treatment for impotence for men who are planning to undergo surgery for prostate cancer, men who recently had surgery as well as men who have been living with ED for many years after prostate surgery.  

Erectile Dysfunction is a Frequent Side Effect of Surgical Treatment for Prostate Cancer with Radical Prostatectomy.

Is Erectile Dysfunction Associated with Prostate Surgery?

ED after ProstatectomyTo some degree, ED is associated with every prostate cancer surgery. With rare exceptions, one cannot expect to have as good erections after surgery as before surgery.

Patient age and erection quality prior to surgery are the most important factors in predicting erection quality after surgery. Men younger than 45 have the best chance of maintaining their erections after surgery.  Of course, few men under 45 undergo prostate cancer surgery.

Most men who undergo treatment for prostate cancer are over age 50 and many have erection difficulties prior to surgery (erections are not as hard as they used to be, increased difficulty maintaining and getting erections).  Many men use medications such as Viagra, Cialis, Levitra, and Stendra prior to surgery for prostate cancer.  Erections after surgery are rarely as good as before even with medications such as Viagra and Cialis.

Is Erectile Dysfunction after Prostatectomy Permanent?

Many men recover at least some of erectile function after surgery but many require medications to achieve erections. Younger men are more likely to recover sexual function.

It is important to understand that most men will require treatment for erectile dysfunction after radical prostatectomy or radiation therapy for prostate cancer even with nerve-sparing radical prostatectomy.   When surgeons quote that they have a high success rate with maintaining erections, it is important to understand that success is often defined as ‘ability to obtain erections with medications such as Viagra and Cialis”.

Nerve-sparing radical prostatectomy helps to decrease the risks of erection problems but does not entirely prevent them.

Causes of  ED after Prostate Removal Surgery for Prostate Cancer

During a radical prostatectomy, the nerves of the penis (cavernous nerves) are often damaged or sometimes removed with cancer. Nerve-sparing radical prostatectomy seeks to preserve as much of the nerves as possible.  Most prostate cancer surgeries performed nowadays as ‘nerve-sparing’ surgeries.  In my practice, I perform nerve-sparing procedures for around 90% of my patients.

However, in patients with high-risk, aggressive prostate cancer (Gleason 7-10, high PSA, palpable or hard prostate), it is important to remove all cancer tissue and sometimes that requires removal of cavernous nerves running in nerve bundles around the prostate gland.

Duration of Erectile Dysfunction after Nerve-Sparing Surgery:

  • Erectile dysfunction usually persists for at least 3-12 months even after a nerve-sparing prostatectomy, whether open or robotic/laparoscopic.
  • The patient may start to experience spontaneous erections during this period.
  • It is important to start the treatment for erectile dysfunction as soon as possible.  There is no reason to delay treatment as delay can affect patient relationships and self-esteem

Penile Rehabilitation Therapy after Radical Prostatectomy in New York City

The penile rehabilitation program has been shown to accelerate recovery of sexual function in men. In general, medications such as Cialis or Viagra or penile injections are used shortly after surgery to recover sexual function.  Penile injections with medications such as prostaglandin and Trimix as well as vacuum erection devices have been used as well.

Risk of Erection Problems after Robotic Prostatectomy Depends on:

  • age – the older the patient the more likely he is to experience erectile dysfunction after surgery. This is likely related to an underlying increased risk of vascular disease that occurs as people age.  Vascular disease may be subtle enough not to manifest itself in other ways.
  • diabetesmen with diabetes are at higher risk for erectile dysfunction. The stress of surgery to remove the prostate may tip the balance over and lead to the earlier manifestation of the underlying problems that predispose to ED.
  • hypertension – erectile dysfunction is a known problem in men with high blood pressure.  High blood pressure affects small blood vessels that carry blood to the penis.  All men with high blood pressure are at risk of developing erection problems. Prostate cancer treatment tends to accentuate the problem by affecting the nerves in addition to already affected blood vessels.
  • Coronary Artery Disease (CAD) – heart disease affects blood vessels to the penis the same way the heart vessels are affected.
  • the baseline quality of erections (can a patient obtain erections easily? maintain erections? are erections hard enough?)
  • the use of PDE-5 inhibitors (sildenafil, vardenafil, etc prior to surgery)
  • type of surgical procedure

What Treatments are Available for Treatment of Erection Difficulties after Prostate Surgery for Prostate Cancer (Radical Prostatectomy or RALP)?

For many men, treatment of erectile dysfunction should start prior to radical prostatectomy if they experience signs and symptoms of ED.

In general, two types of treatment options are available.

  1. Non-surgical treatments
  2. Surgical treatment

Non Invasive Non-Surgical Treatments of Post Prostatectomy ED:

These are pharmacologically based treatments and medication-free options. The following drugs may be useful: Cialis (tadalafil), Viagra, Levitra and Stendra.

Shockwave therapy for ED, a new, medication-free option may be a good option for some men with post-prostatectomy ED. 

Penile Injection Therapy:

Intracavernous injection of prostaglandin E1, or Trimix injections are very useful for men after radical prostatectomy. We teach our patients to self-inject medications right before intercourse. The injection is nearly painless, just a little needle-prick.  The success rate is up to 80%.  Penile injections improved sexual function after prostatectomy by improving erections hardness, improving satisfaction with the relationship, and boosting sexual confidence

Nerve Graft

Sural nerve grafting has been tried in the past with inconsistent results.  It is not generally used at the present time.

Surgical Treatment: Effective Treatment of ED with Penile Implant

A penile implant is a good treatment option for men who do not respond to medications such as Levitra, Cialis, and Viagra. Men tend to be very satisfied with erection quality after penile implant.


Learn More About:

What You Need to Know:

Scheduling Appointments for ED Treatment at New York Urology Specialists

If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5211.

We have excellent reviews from patients and their partners. 

ED is Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At 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:

Schedule an Appointment with Dr. Shteynshlyuger:

Call/text today: 1-646-663-5211 or make an appointment online

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.

If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.

This post is also available in: Russian Arabic Chinese (Simplified) Japanese Spanish

Leave a Reply