Erectile Dysfunction After Cystectomy Operation Must Read
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Erectile dysfunction after cystectomy has become a common affair. Researchers have focused on analyzing the prevalence of ED after cystectomy and looking for a way to limit the chances of sexual dysfunction.
However, they have revealed that there are some factors such as psychological issues, health-related risks for ED, partner response, age, change in lifestyle, body image, and sexual priorities, which are also responsible for erectile dysfunction.
At present, sexual dysfunction including ED is the most important complication of cystectomy. Although scientists and health experts are trying to make changes in the surgical approach that may bring some outcomes.
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Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or cauterizing the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
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What Is A Prostatectomy
A prostatectomy is a surgical procedure in which part or all of your prostate gland is surgically removed from your body. Its usually carried out to treat advanced benign prostatic hyperplasia or prostate cancer.
Your prostate is a small gland thats located between your penis and your rectum. Its roughly the same size as a ping-pong ball and plays a key role in your reproductive health by creating the semen that mixes with your sperm before you ejaculate.
Prostatectomy surgery is generally described as simple or radical. In a simple prostatectomy, the inner part of the prostate gland is removed through an incision thats made in your lower abdomen. This type of procedure is usually performed to treat prostate enlargement.
In a radical prostatectomy, your entire prostate gland and some of the surrounding tissue may be removed. This type of procedure is usually performed to treat prostate cancer.
Erectile Dysfunction After Bladder Cancer Treatment
- Bladder cancer, the fourth most common cancer among men, develops when cells that make up the urinary bladder start to grow and eventually develop into tumors.
- A radical cystectomy is a common treatment option for bladder cancer patients when the cancerous tumors become muscle invasive, or spread into deeper layers of the bladder wall. This procedures involves the removal of the bladder along with nearby lymph nodes, other organs in the pelvis and potentially other nearby organs as well.
- A radical cystectomy can cause erectile dysfunction because the prostate is often one of the surrounding organs usually removed during the procedure, and the nerves that allow men to have erections run right past the prostate. Sometimes, the nerves can be spared, but other times they might need to be removed altogether if the cancer is nearby.
- Even if a radical cystectomy causes erectile dysfunction, there are options to treat it including vacuum devices, the use of intracavernosal injections and medications.
When bladder cancer, the fourth most common cancer among men, has grown into deeper layers of the bladder wall, a radical cystectomy might be the best treatment option. You should expect potential side effects including the possibility of erectile dysfunction.
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Restoring Sexual Function After Prostate Surgery
Prostate cancer affects nearly 1 in 7 men. Fortunately, its a very treatable condition, especially when its caught early. One of the most common treatments for prostate cancer or having an enlarged prostate is to undergo prostate surgery, also known as a prostatectomy. This surgery comes with a very high success rate, boasting a 10 year survival of nearly 90%, but just like any other surgery it will come with potential risks and side effects.
According to the Prostate Cancer Foundation, one of the most common side effects of a prostatectomy is erectile dysfunction. Luckily, there are plenty of ways to fight back against erectile dysfunction and restore sexual function while recovering from prostate surgery.
Search Strategy And Inclusion Criteria
Studies were identified by conducting searches for Medline , the Cochrane Central Register of Controlled Trials and Ovid Gateway between May and July 2019 using a list of defined search terms . To be included in the analysis, the studies must have met the following criteria: study on the impact of bladder cancer treatment on sexual health/dysfunction and reported outcomes specifically for sexual health/dysfunction .
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Q: Does Prostate Removal Surgery Cause Erectile Dysfunction
A:Yes. Erectile dysfunction can and often does occur after a radical prostatectomy the complete removal of the prostate gland. Thats because the operation can sometimes injure tiny nerves, muscles and blood vessels involved in getting an erection.
If you develop ED after undergoing surgery, the problem isnt necessarily permanent. Many men regain full sexual function over time, usually within a year, though for some it can take a few years.
If problems continue, medicines and devices can help. Your doctor may also prescribe medicines and devices during recovery to help bring back erection.
You are more likely to develop ED following surgery for prostate cancer if:
- You are 60 or older
- You had some evidence of erectile dysfunction before surgery
- You are in poor health
Its important to also point out that there are different types of treatments for prostate cancer and many men who are diagnosed dont need to be treated right away. If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. Watchful waiting involves monitoring changes in your symptoms and tumors.
Each treatment option for prostate cancer has different benefits and risks. Talk to your doctor about what option is best for you.
For more information about Mount Sinai South Nassaus Center for Prostate Health, .
Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
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Biofeedback For Pelvic Floor Stimulation
Biofeedback aims at providing consciousness about activity, and hence maximizing the muscle contractions in the pelvic floor region while avoiding other muscle groups contractions. In order to do so, we translate the intensity of muscle contractions into visual signals that are provided back to the subject performing the contractions. The biofeedback itself consists of a subject receiving this visual information about his own contractions, and then using such visuals to control the next contractions. It is a well-known fact that the use of visual biofeedback can improve a persons ability to perform muscle activity, by visualizing the effects of his or her efforts and hence responding in a guided way in the following stages .
This is the reason why many urologists request physiotherapy urological sessions for perineal strengthening in prostate cancer patients before surgery. In fact, this process of bringing consciousness about pelvic muscles contractions improves strengthening of the specific desired muscles and helps reduce the UI and ED incidences . We have also observed that, even when UI and ED occur, patients who took part in biofeedback perineal strengthening protocols experience more ease in solving these problems later. In this paper, we wish to evaluate the first of these aspects.
When Erection Issues Become A Concern
Necessarily, you shouldnt be worried too much about erection problems as having issues with erections doesnt mean you have erectile dysfunction. According to studies, trouble in getting or maintaining an erection is normal for up to 20% of sexual encounters. However, if the percentage goes up to 50%, that means you should consult with a doctor.
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How Does Sexual Dysfunction Impact Men And Women
Bladder cancer and its treatments can cause a range of physical and emotional changes that can affect a patients sexuality.2,3 Both male and female patients with bladder cancer may experience a decrease in their level of sexual desire. This can be caused by physical effects of cancer or its treatment, but it can also be caused by emotional changes, including:
- Lower energy levels
- Mood changes, such as stress, depression, and anxiety
- Feelings of sadness, fear, and frustration
- Feeling insecure or self-conscious about the physical effects of surgical treatments
- Worries about fertility
Men with bladder cancer may experience sexual effects caused by the physical effects of treatment. These symptoms are more common among men who are older, as well as among men who were already experiencing sexual issues before they were diagnosed and treated for bladder cancer. Some men may experience pain during sex and/or have problems achieving or maintaining an erection . They may also experience issues related to ejaculation, such as:
- Premature ejaculation
- Urination during ejaculation
- Dry ejaculation that does not produce semen
Women with bladder cancer can also experience sexual effects due to the physical effects of bladder cancer and its treatments. These include pain during sex, for example, due to vaginal dryness or to other effects of treatment.
Treatments For Erectile Dysfunction
You may affect by erectile dysfunction for various reasons. It may occur due to overage , side effects of medicine, imbalance of hormones, cardiovascular diseases, diabetes, or any other physical problem and physiological problems. The doctor will treat you as per the diagnosis report for erectile dysfunction.
But anyone feels that he is suffering from erectile dysfunction after a Cystectomy operation then he must consult with his doctor. As earlier, we have said that the vas deferens will be cut down and the prostate and seminal vesicles will be removed during Cystectomy operation. It is the important reason for erectile dysfunction after the operation.
In this case, he may suggest medication like PDE5 inhibitor. In some cases, he may suggest injection in your penis or penile implants operation. But it has some disadvantages and is risky.
Still, if you feel more insecure with your sexual ability after a Cystectomy operation you can take some herbal medicine like Vigrx Plus, Prosolution. These medicines are a blend of various herbal and considered side effect free if the patient is above 22 years.
But it is always better to consult with the doctor who did your operation.
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Prostatectomy And Sexual Issues
As a man, your prostate gland plays several important roles in your bodys sexual and urinary function.
During sex, your prostate gland is responsible for releasing seminal fluid, or semen, into your urethra. As you reach orgasm and ejaculate, the muscle tissue of your prostate forces semen and sperm out from your penis.
The nerves that surround your prostate also play an important role in allowing blood to flow to the erectile tissue of your penis when youre sexually aroused.
Because prostate surgery involves removing the prostate gland, its normal to lose some parts of your normal sexual function after the surgery.
For example, radical prostatectomy involves cutting the connection between your urethra and your testicles. This means that sperm is no longer able to flow down your urethra and out the tip of your penis during sex.
As a result of this, men who undergo radical prostatectomy surgery can still reach orgasm, but arent able to ejaculate.
Several different approaches are used to remove your prostate gland during surgery. Some of these approaches particularly those used to treat prostate cancer may result in damage to the nerves that surround your prostate gland, testicles and penis.
Nerve damage caused by prostatectomy surgery may affect your erectile health. If your nerves need to be cut during the procedure , you may find it difficult or impossible to get and/or maintain an erection after surgery.
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Patient And Partners Sexual Satisfaction And Mental Wellbeing
Seven studies evaluated patient sexual satisfaction and mental wellbeing . None of those included both patient and partner satisfaction and mental wellbeing. One study included sexual satisfaction for both patients and partners, but did not report on mental wellbeing . Regarding mental wellbeing, perception of body image , worry about daily life , feeling of anxiety and depression were the most commonly reported outcomes. Six of those studies included patients with MIBC and one NMIBC. Six studies included patients in the age range of 5065years and two included patients 6680years old. Overall, radical cystectomy was found to be associated with negative feelings regarding patients body image and consequently a negative effect in sexual satisfaction. Patients who underwent a bladder sparing technique had a better perception of their body and a better sexual satisfaction. There is no consistency in the measurements used for sexual satisfaction and/or mental wellbeing: interviews and semi-structured interviews, sexual function index questionnaire, QoL questionnaire and a functional assessment of cancer therapy questionnaire.
Table 3 Patient and partner sexual satisfaction and mental wellbeing
Sexual Dysfunction After Prostate Surgery Is More Common Than Previously Reported Says Hutchinson Center Study
Media briefing: A media briefing will be held at 1 p.m. PST Tuesday, Jan. 18 at the Centers Metropolitan Park East Campus, 1730 Minor Ave., between Olive and Howell streets. A Media Relations representative will greet you in the lobby and escort you to the briefing room. Free parking is available in an underground garage entrance off Minor Ave. A map of the site is available upon request.
B-roll available: A related video news release, including sound bites and b-roll of Dr. Janet Stanford and a Seattle-area prostate-cancer survivor, will be available via satellite feed twice on Tuesday, Jan. 18: first between 6 and 6:30 a.m. PST and again between 11 and 11:30 a.m. PST .
SEATTLE Sexual dysfunction among men who undergo prostatectomy appears more prevalent than previously reported, according to a multi-center study led by an investigator from the Fred Hutchinson Cancer Research Center in Seattle.
The results will appear in the Jan. 19 issue of the Journal of the American Medical Association.
Funded by the National Cancer Institute, the Prostate Cancer Outcomes Study is the first comprehensive, population-based assessment of sexual function and urinary continence among men treated with radical prostatectomy for early stage, localized prostate cancer. It is also the first study to examine the sexual and urinary side effects of such surgery in minority populations.
Age and education also had an impact on the frequency of impotence.
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Low Intensity Shock Wave Therapy
This therapy is based on the core principle of inducing local microtrauma so that the body will respond by stimulating the growth of tiny blood vessels in the penis. These shock waves can cause upregulation of vascular growth factors and nitric oxide creation, as well as enhance the function of the smooth muscle cells of the penis.
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