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Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
Question Title: Sexual functions after bladder removedForum: The Urology Forum
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I am due to have my bladder removed to have a stoma or a neobladder (yet to be decided), and my Urologist has informed that they is a chance of inability to achive erections afterwards. Also that the prostrate would be removed so advised to donate to sperm bank (no chrildren but desire to have later) Background: I'm 40, male, fit, had no previous medical problems, non (never)smoker and not aware of exposure to any toxins (& sexually active !). Discovered by blood in the urine, and had a bladder tumor removed 2 weeks ago. This had been diagnosed as a "muscle invasive tumor". I am having a CT scan later this week. I have spoken to my Urologist who said the bladder has to be removed since the tumor has reached the muscle, and will later discuss the 2 options above. My questions are - What are the chances to not being able to achieve an erection - If this is the case does it mean I loose the sensation/feeling/orgasim on the Penis. - Does either of the above 2 options make any difference to sexual function afterwards (he said the nerves are cut or moved during surgery) Thank in advance. Peter
____DeDear Peter, A nerve sparing modification of the cystoprostatectomy that may preserve erectile function has been recently developed. It is even possible to preserve potency when a urethrectomy is required. With nerve sparing cystectomy the bladder pedicals, which are structures in the pelvis which house the nerves,arteries and veins, are divided next to the seminal vessicles and ureter. This maximizes the chances of preserving the nerves responsible for erections. Also some of the lymph nodes that are generally removed in an aggressive resection, are often left alone if they appear grossly normal. This alone bring to the discussion table, are we getting adequate cancer control. Early results of the nerve sparing procedure are compatible with standard cystoprostatectomy but further studies and follow-up need to be done. It should make no difference in your erections if a neobladder vs a diverting stoma is performed. I think this decision will be between you and your urologist and how comfortable he feels with the procedure I have discussed above. The first goal of the surgery is to eradicate the cancer. If this means removing some suspicious tissue in the area of the neurovascular bundles, than I would hope you want your urologist to excise this area, even if your erections might be compromised. Anyways, about 60% of the patients undergoing the nerve sparing procedure are able to have spontaneous erections, that means in the best hands, 40% don’t. To directly answer your questions, the chance of you being able to have spontaneous erections is probably less than 50%, your sensation and ability to climax should not be affected however this depends on how aggressive your cancer is and where it has grown. Today we have new medications and devices to help you achieve an erection if you are unable to spontaneously. If after surgery you need help, an in-depth discussion can take place. In the mean time it sounds like you are in good hands and I wish you good luck. You will know much more about your prognosis once the bladder is out and analyzed. This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568). Sincerely,
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