Erectile Dysfunction, Penile Rehabilitation, and Sex After Robotic Prostatectomy Surgery

Advancements in robotic prostatectomy surgery have greatly reduced the risk of impotence in men following the procedure. With my nerve-sparing SMART Surgery Technique 85% of my patients regain sexual function within one year. The question for many men though is, “What about the other 15%?” While I do everything in my power to save the delicate nerves around the prostate that control sexual function, there are times when the location and size of the tumor do not allow for a bilateral nerve sparing (sparing of the nerves on both sides of the prostate). In instances where nerves on one side of the prostate are removed the return of sexual function is more difficult. For men who have the nerves from both sides removed a return of natural sexual function is rare.

To combat these problems a nerve graft, commonly taken from the leg, can be used in a nerve reconstruction process. These nerves are used to help regenerate the penile nerves, in an effort to restore a man’s ability to maintain an erection.

For some men, a little extra help is needed. This can be done several ways. The least invasive methods are medications such as Viagra, Levitra, or Cialis. Viagra and Levitra are short acting medications that stay in the body for about four hours. They are used to help a man get and maintain an erection. Cialis is a longer acting medication that stays in the blood for a couple of days, and performs the same function. Men who have experienced some nerve damage during the prostatectomy procedure may benefit from these medications, and help them to restore their sexual function to what it was prior to surgery.

For men who have had extensive nerve damage and are not able to naturally gain an erection there are still options available. Due to the nature of my surgical techniques full loss is a rare occurrence for my patients. However, if the need is there, a man can have a surgical implant called a “penile prosthesis” or “penile implant” that can bring a return to their sexual activity. A penile prosthesis is a device that is surgically implanted into the body. It consists of two tubes that are fitted inside the erectile bodies of the penis. A reservoir of liquid is implanted into the abdomen, and a pump device is implanted into the scrotum. Upon activating the pump the tubes inside the penis are filled with liquid, making the penis erect.

For men who have entirely lost their sexual function due to prostate cancer, this can be a very desirable solution. While the procedure itself sounds “harsh” or “unnatural” the results are very much there. It’s nearly impossible to tell that a man has had a penile prosthetic implanted. There are no visible signs, and it does not in any way inhibit ones daily activities. Implants have very high satisfaction rates among men as well as their partners, and this is an avenue that should be considered if potency is lost.

For 85% of men, a regain of sexual function will be a reality. I feel it’s important for the other 15% of men to know that, despite not regaining their potency, it does not mean that they have come to the end of a fulfilling sex life. There are still very successful options to try.

More information about post-operative erectile dysfunction treatments and sex after prostate surgery can be found at these links:

Sex After Robotic Prostatectomy
Dr. Samadi Discusses Erectile Dysfunction on Good Day New York


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