How Can I Regain Erectile Function After Prostatectomy?

Reviewed on 2/22/2022

Illustration of an enlarged prostate
Medications that can help restore erectile function include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Other therapies may be used for erectile dysfunction, including the Muse urethral suppository, a vacuum pump, or the Caverject injection.

A prostatectomy is a surgical procedure for the partial or complete removal of the prostate, which is a small gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum in males.

The prostate supplies part of the seminal fluid (semen), which mixes with sperm from the testes, which helps sperm to travel and survive for reproduction. 

  • A simple prostatectomy is used to treat severe urinary symptoms and enlarged benign prostate glands in men, and only the obstructing part of the prostate that's blocking the flow of urine is removed. 
  • A radical prostatectomy, in which the entire prostate gland is removed, is used to treat localized prostate cancer

Recovery After Prostate Surgery

Following a radical prostatectomy, patients can typically expect to be in the hospital for one night for monitoring. About seven to 10 days after surgery, the catheter is removed and the doctor will usually have pathology results around this time and can discuss if further treatment is needed. 

  • Side effects during recovery are usually temporary and may include urinary incontinence and erectile dysfunction (impotence).
  • Patients are advised to avoid strenuous activity or heavy lifting for at least one month after surgery, and most patients need to take off work for three to four weeks. 

After one month following the surgery, patients may resume sexual activity which can help stimulate the nerves and help with recovery.

  • Patients may not get full erections but they can still orgasm and have other sensations. In men who are able to recover, it takes on average six to 12 months (though it can take longer for some men) to regain the ability to have erections that are adequate for intercourse.
  • However, 25-55% of men will not regain the ability to have erections following prostatectomy.
  • It is important to remember that sexual feelings, sexual fulfillment, climax, and the sensation of orgasm can still occur without an erection.
  • Men can perform Kegel exercises to strengthen the group of muscles called the pelvic floor muscles which may help them return to potency. 

Medications may also be used to help restore erectile function, such as: 

Other medical therapies used to help restore erectile function may include: 

  • Muse, a tiny wax suppository used to stimulate an erection, inserted with a small plastic device into the urethra
  • Vacuum pump
  • Caverject, which is injected directly into the penis correctly via a small syringe and needle by the patient or the patient's partner at home

Factors that can affect whether a man will regain erectile function after prostatectomy include: 

  • Previous sexual function before surgery
    • Robotic prostatectomy will at best return a man to his level of sexual function pre-surgery
    • It will not improve upon the function that existed before surgery
  • Age
    • The younger a man is, the better his chances of regaining erectile function
  • The number of nerves that can be spared
    • The highest chance of regaining erections will occur if both nerves can be spared, but even men with no nerve sparing can regain erectile function

What Is Prostate Removal Used For?

Prostate removal (prostatectomy) is usually performed to treat prostate cancer or benign prostatic hyperplasia (BPH).

Less common reasons for prostatectomy include:

  • Frequent bleeding from the prostate 
  • Inability to empty the bladder completely
  • Bladder stones with prostate enlargement 
  • Slow urination 
  • Increased pressure on the ureters and kidneys from urinary retention (hydronephrosis) 

How Do Doctors Perform Prostate Removal?

During prostate removal (radical prostatectomy) the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. A prostatectomy takes about two hours and is performed under general anesthesia.

There are two approaches used for a prostatectomy:

  • Robotic surgery
    • Minimally invasive procedure with faster recovery time 
    • Uses smaller incisions and robotic technology 
  • Open surgery
    • Uses traditional incisions and tools
    • May be used for more complex cases

The surgical process is as follows:

  1. The doctor will make a small incision to gain access to the prostate
  2. The prostate is removed
  3. The bladder is reconnected to the urethra 
  4. A catheter is connected to the bladder to allow urine to drain while the area heals

What Are Risks and Complications of Prostate Removal?

Complications of prostate removal (radical prostatectomy) include: 

  • Urinary incontinence
    • May take up to a year after surgery to resolve 
  • Urinary leakage or dribbling
    • Usually worse right after surgery and improves over time
  • Erectile dysfunction
    • May take up to two years after surgery and may not be complete
  • Sterility
    • A man may be able to have an orgasm, but there will be no ejaculate (a “dry” orgasm)
  • Lymphedema (rare)
    • Fluid accumulation in the soft tissues, resulting in swelling
  • Decrease in penis length
    • Occurs in a small percentage of surgeries

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Reviewed on 2/22/2022
References
Image Source: iStock Images

https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostatectomy-what-to-expect-during-surgery-and-recovery

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/radical-prostatectomy

https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-gland/

https://www.topdoctors.co.uk/medical-articles/radical-prostatectomy-what-is-it