post robotic prostatectomy challenges

[omoarannie]

My husband had robotic prostatectomy in jan 2008 for prostate cancer and it was deemed successful as he had no need for rado or chemo therapy afterwards. However, six months later, he still seems to have incontinence as our mattress smells of urine . More troubling is the inability to resume sexual function as he cant seem to achieve an erection with me even with the help of medication. Please can you give suggestions on how I can help? I have allowed him his space in the management of himself up till now as he is sensitve and proud. I am feeling very confused right now as I believed all the assurances on this procedure of complete control by 6 months .

[Ash Tewari, MD, M.Ch.]

Urinary incontinence and sexual dysfunction are the two most bothersome effects following successful treatment of cancer following radical prostatectomy.  Some patients do not recover full urinary continence for upwards of a year to a year and a half depending on numerous factors. I would encourage you to discuss this issue with your doctor where you can discuss things like pelvic floor exercises and medications that can improve certain aspects that may contribute to his leakage.  

Sexual function after radical prostatectomy can similarly take time to return after surgery.  The same surgeon, in similar patients can frequently have widely different outcomes with regard to potency.  The reasons for impotence following radical prostatectomy are multifactorial and are postulated to be related to variations in individual anatomy, previous erectile function, and comorbid disease to name a few.  It is not uncommon for men to experience a period of “neuropraxia” immediately following their operation.  Neuropraxia is a result of manipulation of the nerves during surgery that supply the penis. Neruopraxia can be thought of in a similar way to the numbness one feels after sitting on crossed legs for an extended period of time.  During Neuropraxia sensation from the penis is not transmitted to and from the penis and many men are not able to get even partial erections even with the use of PDE5 inhibitors.  They are, however, frequently able to climax with sufficient stimulation.  The duration of neuropraxia is not well defined and does not improve in a consistent time period in every man.  Many men do not regain their ability to have erections for a year to two years.  

There is increasing amount of support for the use of erectile medications after radical prostatectomy which may be beneficial in improving the time to erectile function.  These “penile rehabilitation” protocols are not standardized among institutions as there is no proven best regiment.  These medications can help stimulate the penis and are believed to hasten the recovery of erections.  

Some things your husband should consider are medications that he can use, such as injection therapy or intra urethral therapy which are very effective in causing a man to have an erection.  Talk to your husband and his urologist who can help guide him to the treatment most appropriate to his situation.

Best,
Ash

[omoarannie]

I thank you very much for your answer.- it has relieved me . He is already using cialis and getting partial success. And also has been told to start pelvic exercises by his doctor.but because the incontinence is still persisting , it got me worried. But now that i know it can take up to a year or more with the exercises, am relieved. We will continue to work at it.Thankyou once more.