Most men find it difficult to have an erection after undergoing prostate surgery. But why does this happen, and how long does erectile dysfunction last after prostate surgery? This article provides an overview of the prostate, explores the types of prostatectomies, and answers the commonly asked questions about prostate surgery and erectile dysfunction.
The Purpose of the Prostate
The prostate is a walnut-shaped gland wrapped around your urethra, the tube where urine passes through. It sits right below the bladder and is positioned in front of the rectum. its main function is to provide additional fluids to your semen which contains nourishment for your sperms. It also helps during ejaculation by contracting and rapidly releasing semen. A little-known fact about the prostate is that it converts testosterone into dihydrotestosterone (DHT), a more potent androgen which helps with repairing the prostate and penis as needed.
Diseases of the Prostate
Certain conditions can affect the prostate, which may require prostate surgery. These diseases can also impact erectile capacity. Prostate conditions that men should be aware of include:
- Prostatitis – Prostatitis is the inflammation of the prostate. Usually, this occurs because there is an infection either due to bacteria or a virus (as in the case of sexually transmitted diseases). However, sometimes, the cause of the inflammation is unknown which would classify a man with having asymptomatic inflammatory prostatitis which requires no treatment. If pain is present, the diagnosis becomes chronic pelvic pain syndrome.
- Benign Prostatic Hyperplasia – Benign prostatic hyperplasia (BPH) occurs when the prostate becomes enlarged. This usually gets diagnosed because of difficulty with peeing. In other cases, this gets detected during a routine digital rectal exam where your doctor inserts a finger in your rectum to examine the area. Note that BPH is not a risk factor for getting prostate cancer, but it can lead to urinary and kidney issues.
- Prostate Cancer – Prostate cancer happens when there is abnormal cellular growth called a tumour which begins to harm the prostate. If the tumour is only within the prostate (meaning it hasn’t spread to nearby tissues and organs), prostate surgery is often the best form of treatment. Prostate cancer is often slow growing, which means early detection gives high survivability rates. In rare cases though, it can be aggressive which may require additional treatments on top of surgery.
Types of Prostate Surgery
There are different kinds of prostate surgery, also called prostatectomy, depending on the type of prostate disorder you have. Here’s a quick overview of the several types of prostate surgery:
- Simple Prostatectomy – Simple prostatectomy is what is used if your condition is BPH. Surgeons only need to remove a portion of the enlarged prostate, usually the part that is nearby the bladder as it is what is impeding your urine flow. Sometimes, simple prostatectomy is also done for prostatitis but only when other medical options have been exhausted, and the inflammation is severe (as in the case of chronic bacterial prostatitis that doesn’t respond to antibiotics).
- Radical Prostatectomy – Radical prostatectomy is the removal of the prostate gland. When prostate cancer has been confirmed, doctors may recommend having the entire prostate removed to reduce the risk of metastasis (cancer spread). Metastatic cancer can be extremely dangerous as certain organs may not respond to current conventional cancer treatments.
There are currently three types of radical prostatectomy:
- Open prostatectomy – Traditionally, surgeons make one large incision in the area between your belly button and pubic bone, then retrieve your prostate. Not many hospitals do this anymore as this is the most invasive option and has the longest recovery time.
- Laparoscopic prostatectomy – Instead of one giant cut, surgeons would instead make several small incisions. They would insert a laparoscope in one of the incisions which will allow them to view the area and decide how to best cut the prostate. They will cut parts of the prostate from the other incisions. Major hospitals have robotic-assisted laparoscopic prostatectomy, which decreases the risk of human error. There’s also the single-port prostatectomy where surgeons operate with just a single incision (but it’s still new and may only be available in the top hospitals in your country).
Prostate Surgery and Erectile Dysfunction
Erectile dysfunction is one of the side effects of prostatectomy and almost every man experiences. Surgeons may opt for nerve-sparing radical prostatectomy to reduce the risk. However, erectile capacity still largely depends on the severity of the trauma caused by the operation and how the body reacts to it.
What Causes Erectile Dysfunction after Prostate Surgery?
A lot of men ask, “why does prostate surgery cause erectile dysfunction?” Some are also confused because the penis is untouched during surgery. Even if the surgeon isn’t making incisions on your penis, there are nerves on either side of the prostate that transmit signals during the erectile process. If the cancerous tissue is near them, they may be removed during the surgery. Even if the nerves remain intact, they may still get damaged.
Since surgery causes physical trauma, nerves may end up stretched beyond their limits (nerve traction). They may also be impacted by pressure due to swelling or inflammation in the area (nerve compression). Apart from the nerves, the blood vessels that direct circulation to the penis may also suffer. Blood clots are also a side effect of surgery. If there’s a blockage, erections won’t form. But more than that, the lack of blood flow may lead to Peyronie’s disease (scarring of the penis) or penile necrosis (tissue death). If you experience any of these, please seek medical attention ASAP.
How Long Does Erectile Dysfunction Last After Prostate Surgery?
While patients recover 4-10 weeks after the prostate surgery, erectile function can take longer to return to normal. Some may witness an improvement as early as 3 months. For others, it can take 6 months. But if the damage to the area is serious or the patient is older than 50 years old, it can take up to 2 years. If erectile issues last beyond 2 years, the risk of permanent erectile dysfunction increases. Urgent medical intervention from experts during recovery heightens the chances of preserving erectile capacity.
How to Improve Erectile Dysfunction after Prostate Surgery
If erectile dysfunction is almost inevitable after a prostatectomy, you might be wondering, “how do you regain erectile dysfunction after prostate surgery?” The good news is that there is a myriad of treatment options available for erectile recovery depending on your specific circumstances and preferences:
- Oral medications – Oral medications are the first in line for treatment for erectile dysfunction due to prostate surgery. However, they’re not effective for serious cases. Oral medications are used to deliver more blood flow to the penis and men are recommended to maintain erection thrice a week.
- Penile injections – If oral medications are not working, penile injections will be prescribed. The medicine will be injected directly into the shaft. It’s different from PDE-5 inhibitors but it also encourages additional circulation towards the penis. However, a lot of men are not comfortable with the idea of injecting on their penis.
- Vacuum Pumps – Vacuum pumps are a less invasive form of erectile support. It’s a cylinder that is placed on the penis. It comes with a suction which is used to pull more blood into the penis and start an erection. A vacuum pump is great for erectile care but may not be enough for sustaining erections when there’s severe damage.
- Urethral Pellets – Urethral pellets are an alternative to penile injections. A man places the pellets on their urethra which is the opening in the penis where pee and semen comes out of. The pellets melt in the urethra and the medication is absorbed by the body. Some men report feeling a stinging sensation and this may not be as effective as penile injections.
- Penile Implants – Penile implants are usually given to men who are struggling with extreme erectile dysfunction. The implants can be either semi-rigid or inflatable. Most men use an inflatable implant because of how it allows the penis to be flaccid when not in use. It’s recommended for men to heal first and wait up to 6 weeks before having sex.
- Shockwave Therapy – Shockwave therapy is a newer form of erectile dysfunction treatment. Experts will use a low-dose shockwave to create microtrauma in the penis so that it will trigger what is called as angiogenesis. Angiogenesis is a natural biological process where the body creates new blood vessels.
- Kegels – After a man fully heals from prostatectomy, he is recommended to start doing kegels, also called kegel exercises, to re-strengthen the muscles and tissues in the pelvic area. Kegels also allow for increased blood flow in the area, which helps with recovery.
Conclusion
How long does erectile dysfunction last after prostate surgery? It depends on the extent of the damage to the erectile network of nerves and blood vessels. It can take up to 2 years for erectile function to return to normal. However, recovery is also dependent on what a man does to preserve his sexual health and whether he has experienced erectile dysfunction even before the prostate surgery.
Erectile dysfunction is often caused by multiple factors. If you’re struggling to regain erectile capacity after prostate surgery, please speak with our ED experts. They’ll help uncover the root causes of your erectile difficulties and improve the chances of recovery with our comprehensive approach to managing erectile dysfunction. Book an appointment to begin your erectile rehabilitation journey today!
