Penile Rehabilitation and Impotence

Penile rehabilitation is an option for most men who undergo prostate surgery to remove their entire prostate gland in order to prevent the further spread of cancerous cells. While there are many different treatments available after receiving the prognosis of prostate cancer including radiation therapy, partial surgery, and even deferring the treatment until a later time, most healthy young men opt for the full procedure right away. 

What is a Prostatectomy? 

A prostatectomy is a generally safe procedure that can be performed through open surgery, less invasive laparoscopic surgery, or performed with a robotic arm with the guidance of a surgeon.

Depending on how serious the cancer has spread, most skilled surgeons can perform a non-invasive procedure that spares the patient long recovery time. However, there are unavoidable side effects that could cause some malfunctions in the penis.

What are the Side Effects?

The most common complication is erectile dysfunction. During the surgery, the nerves and blood vessels on either side of the prostate used for erecting the penis may be damaged or disturbed to the point where erections are physically hard to achieve.

Although most surgeons can perform non-invasive surgery to spare the nerves as long as the cancerous tumors have not grown too large, men will experience a case of erectile dysfunction regardless of how successful the operation was to remove the prostate. Before seeking treatment, most doctors recommend looking at causes within a man’s diet or lifestyle that could be the culprit as most severe cases of male impotence after prostate surgery end after about a year.

Common causes of erectile dysfunction not related to prostate surgery include smoking, obesity, alcohol consumption, high blood pressure, high cholesterol, and diabetes. If the erectile dysfunction persists despite some lifestyle or diet changes, the second option would be to use erection gaining medication like Viagra or Cialis due to their moderate side effects.

The third option is penile rehabilitation that attempts to restore normal blood flow and oxygen to the deprived regions in the body damaged by surgery.

What is Penile Rehabilitation?

Theoretically, penile rehabilitation involves repairing the nerves in the penis so they can properly send signals to the penis’ blood vessels to relax. The relaxed blood vessels then allow blood to rush in and swell the penis to form an erection.

Providing oxygen to the penis via the new circulation of blood is also part of penile rehabilitation based on the belief that more oxygen-rich tissue repairs any damage done to the area faster than any other treatment. 

Since prostate surgery sometimes causes direct damage to the nerves or scars the soft tissue in the penis to prevent oxygen from reaching as many blood vessels as before, penile rehabilitation attempts to reconcile this imbalance either through oral pills or erectile dysfunction chemical treatment.

Alprostadil is commonly used for penile rehabilitation. It widens the blood vessels and allows more blood to flow to the penis. However, this comes at the drawback of having to inject the chemical directly into the corpora cavernosa of the penis using a tiny needle each time or by using a urethral device to deposit a pellet into the penis. 

Erectile dysfunction pills are the preferred method for most men after prostate surgery because they’re cheaper and less invasive to the penis. However, the chemicals used to turn a man’s penis flaccid again are not apparent in sildenafil, vardenafil, or tadalafil leading to the possibility of an unwanted erection after intercourse. 

Other theoretical forms of penile rehabilitation include:

• Increased sexual activity with a partner to stimulate the nerves in the penis;

• An inflatable tube inserted into the penis after surgery to mimic the effects of an erect penis and restore confidence; and

• Penile exercises to stimulate the penis back into normal behavior.

Am I a Candidate? 

A 2009 study of urologists concluded with 86% recommending penile rehabilitation after prostate surgery. Most recommend a male impotence pill to gradually improve the penis’ ability to grow an erection without causing damage to the nerves and blood vessels. 

Since male impotence pills relax the soft tissue in the penis and increase blood blow, they’re seen as the most effective medication for the two most important things missing from men with male impotence: blood flow and oxygen. 

Considering the popularity of penile rehabilitation as a standard after prostate surgery, most doctors would recommend it as part of life during recovery.