Sexual Rehabilitation Post Radical Prostatectomy

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Sexual rehabilitation post radical prostatectomy is a very, very important aspect of the overall management of patients following prostate cancer surgery. 

We really emphasise this to patients. 

My protocol at the moment, and this is always changing according to literature, but currently what we generally do is when the catheter comes out day six we usually start the patient on an oral phosphodiesterase inhibitor and that could either be Cialis, Viagra or Levitra. 

You can either take half a full tablet every second day or a daily tablet of Cialis 5mg every day. 

Studies have shown that when patients are placed on this they get a better outcome and return of nerve function at 12 to 18 months than if they do not take this oral medication.

The downside is that there is significant cost involved. 

Obviously if patients are on nitrates, particular heart medications they should not take this medication and if ever they get any chest pain or chest tightness they need to contact their doctor. 

There’s no evidence that there’s any increased cardiovascular or heart risk with these medications.

They are relatively safe to use but it’s important to follow the instructions when taking them. 

The second aspect is to discuss with patients the option of a vacuum pump device or penile injection therapy. 

Both these are unusually initiated at the six week mark to allow healing to occur. 

So a vacuum pump device is relatively easy to use and utilise. 

We put a sheath over the penis, the patient pumps this up and creates a negative pressure, it sucks blood into the penis and then you slip a band, a firm band at the base of the penis and this allows the patient to have an erection sufficient for intercourse. 

The advantage is that it’s very simple to use, it’s easy to learn, it’s reproducible, there’s a relatively low cost. 

The disadvantage is that obviously it’s a planned event, it’s not spontaneous like the natural erection. 

It does lead to a slight hinge effect because the erection is from the skin forward and the penile tissue actually goes into the body. 

So you do have slight hinge effect but it’s very effective to use. 

The other option is penile injection therapy usually with prostaglandin or in some occasions with an agent called Trimix, three agents mixed together. 

This sounds a bit daunting to start off with but it’s very easy to do and once learnt it’s a bit like diabetics giving themselves insulin shots. 

It involves drawing a certain medication in a little syringe, you then inject that syringe into the side of the penis, this compound works within five or 10 minutes. 

The erection occurs through the whole penile tissue so it occurs on the external part and internal, so it is more natural. 

It lasts 20 minutes to half an hour depending on the dose that you use and usually we advise that it can be used two to three times a week at most. 

It’s important to vary the site of the injection so that you don’t get scarring occurring which can occur as a side effect of this treatment. 

The other side effect of concern is what we call priapism which is a prolonged erection. 

If this occurs it is a medical emergency, it needs to be treated straight away with medications that you obtain from the accident and emergency department although it is very rare if you’ve been prescribed properly and start off with a low dose. 

They’re the treatment options, patients usually have an oral agent and they either have the vacuum pump or the injection therapy. 

Sometimes patients use all three and it’s important with the vacuum pump and the injection therapy to remember that these treatment options are used not only for sexual activity but to keep the penis healthy. 

It’s very, very important. 

It can sometimes take one to three years for the nerves to regenerate.

So these treatments, the rehabilitation allows the patient to have good sexual function during the recovery period and maximises the chance of natural recovery.