Erectile dysfunction after Prostate surgery
Prostate cancer is one of the most common types of cancer in men. Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. The nerves responsible for the penile erection are called Cavernous Nerves and they are located near the prostate. For this reason, radical prostatectomy carries a high risk of erectile dysfunction (ED) despite the preservation of these Nerves (Nerve sparing Radical prostatectomy).
ED occurs suddenly after nerve sparing radical prostatectomy surgery, owing to the inevitable but temporary (at least 6 months) impairment of the cavernous nerves, called neurapraxia. Commonly hypothesized causes of ED include nerve traction/percussion, thermal damage due to electrocautery use, nerve ischemia due to vascular injury, and local inflammatory effects associated with surgical trauma.
Neuropraxia eventually results in the loss/reduction of both daily and nocturnal erections, and it is associated with a persistent penile hypoxia and penile fibrosis. This vicious cycle, started by neuropraxia, leads to a fibrosis of the penile tissue and in several cases to a permanent ED even in the presence of a return to the normal function of the nerves.
It is scientific proved that less than 30% of the patients recover the pre-surgery erectile function after 3 years.
Current protocol for treating ED after radical prostatectomy
To reduce the rate ED, the concept of Penile rehabilitation therapy was introduced for the first time in 1996. Penile rehabilitation following RP involves the use of any intervention or combination (medications, devices, or actions) with the goal of attempting and restoring Erectile function to pre-surgery levels.
This treatment protocol is based on two key points: the first is that the therapy should be started always after the surgery and secondly that must be administered to all types of patients.
Penile rehabilitation with oral phosphodiesterase type 5 inhibitors like Viagra or Cialis is currently considered the standard of care in patients undergoing RP, especially in patients who received Nerve sparing Radical prostatectomy and, according to recent trials, it should be instituted as soon as possible to prevent penile fibrosis.
Despite of 90% of urologist prescribe penile rehabilitation with oral phosphodiesterase type 5 inhibitors ( Viagra, Cialis etc..), most of the clinical trials showed clearly the inefficacy of this type of treatment in improving the recovery rate of erectile function after nerve sparing prostatectomy!!!
Holistic Andrology Penile Preservation Protocol – Before it is better than after!
There are several scientific analyses showing that among patients treated with nerve sparing radical, those younger than 55 years had a significant higher rate of EF recovery, as compared with older patients. Moreover, low pre-surgery erectile function and comorbidities like diabetes are predictor for ED after prostatectomy.
According to these data, It can be hypostasized that the prostatectomy could led to e reversible or irreversible ED depending on the trophic status of the corpora cavernosa of the patient as if there is a limit to the penile functional reserves and when the fibrosis reaches a cutoff percent it leads to a not recoverable ED.
Interesting, recent studies showed that starting the therapy before the surgery could improve the recovery of erectile function.
Based on these analyses and on the scientific data showing that Shockwave penile therapy and a chronic treatment with PDE5i can ameliorate the quality of penile tissue in condition that could promote Erectile dysfunction (ie. Diabetes, age, metabolic syndrome), we believe that a prophylactic therapy based on the administration of shockwave therapy PDEi5 before and after nerve damage, could improve the penile functional reserve and could permit to penile tissue to better support the neuropraxia damage.
We developed the first Penile Preservation Therapy protocol for Erectile dysfunction after radical prostatectomy that starts before surgery. The therapy is based on a combination of shockwave Erectile dysfunction treatments and the use of Cialis, penile vacuum and Penile injection.
The protocol changes according to the risk of the patient to develop Erectile dysfunction. This means that each patient will receive a personalized protocol!!!
For more information please contact us.
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Shockwave Therapy For ED: the latest treatment strategy for patients suffering from ED.
Improves Sexual Performance
Increases blood flow in the penis
Increases Sensation in the Penis
More Spontaneous Erections
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