• Prostatectomy and Impotence

The prostate cancer has a big impact in man's health as well as in his life's quality. Thousands of cases are annually diagnosed and unfortunately many men still die due to this problem. Many treatments are available being often the radical prostatectomy and the most recommended for cases of located cancer. The patients that will be submitted to radical prostatectomy must be always oriented about its risks of erectile dysfunction or urinary incontinency.

The radical prostatectomy is a great risk factor to erectile dysfunction, ejaculation problems and alterations in part of the organism. Some factors may interfere in this part, such as the patient's age, how the erectile dysfunction was before the surgery, the tumor advancement stage and the surgical technique that was used. The rate of the erectile function's maintenance is bigger between men below 65 years. Also factors like diabetes, hypertension, arteriosclerosis, high rates of cholesterol, smoking and cardiac problems end up interfering in erectile dysfunction after surgery. (*17). Patients that already had some sort of erectile dysfunction before the surgery have the tendency to have this compounded framework.

Studies (*14) show that the erectile dysfunction's incidence after the radical prostatectomy may arrive in 60% regardless if the surgeon considers that the operation has failed to achieve the preservation of the vascular and nervous bundles. It is important to remember that the exact localization of this nervous bundles during the surgery is, in some cases, very complex and hard.

Also in cases of surgical treatment of benign prostatic hyperplasia (transurethral or trans vesical resection) there was no difference in the results depending on the type of procedure and that the older the patient it, the greater the chance of ED. (*15) The risk of ED after the transurethral resection of the prostate is extremely low on powerful individuals, but is high in those who already have some previous dysfunction.

The time of return of the erectile functions is very variable and normally the man can't return as fast as he gets back the control of the urination. Some studies show that it can take 18 months after the surgery for the man to come back to have his erectile functions. It's observed that a stimulation the fastest possible of part of the erection and the increase of the blood flow in the penis makes it easier the natural erection's return. Even though still there isn't a definitive protocol of when it must be started the erection's stimulation, there is this consensus that there is no need to wait the natural erection.

The treatment for ED after the prostatectomy follows the same principles of erectile dysfunction for any other cause. The first option of treatment will be with the clinic treatment with the use of medications by oral if there isn't none contraindication for their use. If it's not possible or enough, it should be chosen the second line of treatments that include the self-applications. Only after these attempts, if it's still not obtained the expected results it should be chosen the penile implant. What is observed is that even though the incidence of erectile dysfunction after prostatectomy, many men remain without treatment after this procedure.

The erectile function may come back slowly in a period of 12 to 18 months after the surgery. The start of the treatment as soon as possible may help and improve the chances of the erectile function's recuperation.

In cases where the patient remains with problems of urinary incontinency and erectile dysfunction, there are clinical treatments for both problems, in case it is not obtained success, there's also a surgical treatment for urinary incontinency.

The most important is to treat the cancer and preserve life in the best way possible, and then, if there's any possible sequel, it must be treated with the same tranquility reminding yourself that medicine is very advanced in this area.