Why Can It Take So Long to Regain Erectile Function After Prostatectomy

Man and woman lying together holding hands on the mans chest

In the early days of radical prostatectomy, the anatomy of the prostate remained poorly understood. Erectile dysfunction occurred in all men who underwent a prostatectomy in those times. However, with an improved anatomic description of the prostate several decades ago, we began understanding the erectile nerves that envelop the prostate gland. This led to the advent of a procedure known as a nerve-sparing radical prostatectomy, which is now performed most often robotically. Despite taking great care in sparing the erectile nerves with the incredible 3-D visualization of robotic technology, virtually all men still get erectile dysfunction temporarily. Many fortunately regain erectile function over the period of months to a year. This is not to say that the nerve-sparing feature of the surgery is not essential. Quite the opposite. However, it has become evident that the involvement of other structures during surgery contributes to ED.

How Long Does Erectile Dysfunction Last After Prostatectomy?

Despite the nerve-sparing nature of the surgery, most patients experience ED that lasts beyond the physical recovery time after a prostatectomy. We expect most patients to regain erectile function in one to 12 to 18 months. That is considered the goal; for some, it can take up to two years. Up to 50% of patients may never regain erectile function and will need to consider alternative treatment options.

What Can Be Done?

For patients that require a prostatectomy to address fast-growing or aggressive prostate cancer, the best option is to visit a urologist and men’s health specialist like Dr. Kapadia, who has a specific program for patients with post-prostatectomy impotence. Our program follows a stepwise approach to address the two most common and disruptive concerns a man will face after a prostatectomy – ED and urinary incontinence. The first phase starts soon after cancer treatment and will include daily 5mg Tadalafil, generic Cialis, or Sildenafil, generic Viagra, on demand. If necessary, we may move on to injection therapies and other proven rehabilitative options. For most, this will improve erectile function satisfactorily; however, for some, we may need to continue to the restoration phase of treatment if we do not see results within the first year to 18 months. That said, we don’t give up because everyone’s anatomy is different, and there is no linear improvement in erectile dysfunction. Learn more about Dr. Kapadia’s post-prostatectomy rehabilitation and restoration program.

The Long-term Solution

For those who have not regained satisfactory erectile function after 12-18 months, there is a good chance that the dysfunction will not reverse. At this point, it is time to discuss an inflatable penile prosthesis, also known as a penile implant. Penile implants carry a very high satisfaction rate for couples and represent an elegant solution to a complex problem. The implant is completely customized to a man’s anatomy and provides a natural-appearing erection. Most importantly, the sensation, the ability to climax, and urination are completely unchanged. This means a man can enjoy a full and normal sex life with their partner.

For more information, we encourage you to contact our office to explore erection rehabilitation options after prostatectomy. If you are experiencing erectile dysfunction for any reason, we can discuss the possibility of a penile prosthesis.

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