Prostate Patients Potency

Prostate Patients Potency

It is important to remember that regaining erectile function takes time after radical prostatectomy. Most studies in the literature use endpoints of 18-36 months after surgery.

Nerve tissue can be easily damaged during prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate.

It is believed that early postoperative medical therapy, such as intracavernosal injections, can aid an earlier return to potency.

Long-term potency data for robotic prostatectomy is limited for the time being due to how new the procedure is. Very few surgeons world-wide have been using the da Vinci Robot for more than two years.

As such, the two year endpoint traditionally used for open prostatectomy is not available. Here is the standard data on open prostatectomy potency (very little is published about potency in the first 6-12 months after prostatectomy):

 

Percentage of Men Obtaining Full Erections 24 months after Open Prostatectomy

(From Campbell's Urology)

Nerves Spared < 60 yrs 60.1 - 65 yrs 65+ yrs
Both (Bilateral) 70% 49% 43%
One (Unilateral) 60% 40% 35%
None (Non) 26% 15% 13%

 

As one can see, the chance of regaining potency diminishes with age and with the number of nerves damaged. Even though it is usually technically possible to spare the nerves, sometimes the nerves themselves are cancerous and must be removed since the primary goal of the surgeon is to remove the cancer.

If the cancer has not reached the nerves controlling erection, the da Vinci Robot has the visual capabilities and the precision necessary to spare these nerves in most cases, thus it is possible that using the robot may add to the chances of being potent after surgery. However, there is no way to guarantee this due to variability in patient anatomy and condition.

It is important to realize that some men never regain the ability to maintain an erection after prostatectomy.

It is still unclear how using the da Vinci robot for prostatectomy will affect potency effects. While, as mentioned above, it would appear that using the robot may increase chances of potency, this has not been proven and should not be assumed.

It is known that using the robot reduces blood loss, and length of hospital stay.

We are maintaining a database of clinical outcomes for our patients for two purposes: firstly, so that we are aware of any patient who is not recovering as we would hope. We can then arrange for any additional assistance they may need. This is especially important for patients who live at a distance. We also use this information to track the outcomes of the patient group as a whole so that we can identify any areas where we can improve.

To date we have 12-month data on continence and potency. Of patients younger than 65 years at the time of their surgery, who were potent pre-operatively, 40% are potent 12 months following their surgery, with some of these men using tablets to assist with this. Return of erectile function can occur up to two years or even longer from surgery so we are confident that more of the patients who are not potent at one year will regain their erections. Over the past two years the surgical technique has been further refined and there is no diathermy used near the nerves. It is thought that the heat from the diathermy is a major factor in nerve function. So we are hopeful that our potency figures will be even better in the future.

Of the patients who reported that they were completely continent pre-operatively, at 3 months 80% were not using any pads, or were using one security pad per day. This figure is 94% at 12 months.

The robot certainly has its benefits. Research into how all this may translate into earlier return or increased percentage of potency is still ongoing.

 

 

When can I return to sexual activity?

Let the surgery heal for three to four weeks before attempting anything. It is recommended you wait at least one month before you resume sexual activity.

Stimulation of the nerves is thought to be a first step on the journey back to potency. Remember that you can still experience the pleasures of orgasm and other sensual stimulations without full erections.

The average time to recovery for erections adequate for intercourse (in those who do recover) is 12-24 months, but in some men it is even longer.

 

I don't have erections after surgery, am I impotent for life?

Think of your erections as a well conditioned athlete, who has been injured. This injury is going to take time to heal. You should try to remain patient, and remember that this will be an ongoing battle for many months and even years.

Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.

If you see any fullness in your erections in the months after surgery, this is a positive sign that some of the nerves are working or re-growing.

You are taking the first steps down the potency recovery path. Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.