Medical Q&As

Impotence - radical prostatectomy?

I am in my late forties and two years ago, was diagnosed with prostate cancer. As a result, I underwent a radical prostatectomy. From a medical standpoint, this has been a complete success and I required no further treatment. Unfortunately, as a result of the surgery, I am now impotent. I have discussed this with my Consultant and with my GP and have been given details on the various treatments available. I have tried Viagra and Uprima, but to no avail. I also purchased Muse, but have not actually come to terms with using it. I believe my problem is directly related to the side affects of the surgery and is not psychological. For situations like this, is there a specific treatment available? Is further surgery, to repair the damaged blood vessels possible?

Radical prostatectomy involves the complete removal of the prostate gland. During this procedure the cavernous nerves, which control erectile function may also be removed. Depending on the location of the tumour within the prostate one or both of the cavernous nerves may be removed along with the gland. It is sometimes possible to perform “nerve sparing” surgery but that is not technically feasible in every case. You ask about further surgery to repair damaged blood vessels but as my previous comments indicate the problem is not really with blood vessels but rather it is with the nerves. New surgical techniques are being developed, such as nerve transplantation, to overcome the effects of the removal of the cavernous nerves but that surgery is at the experimental stage and is not generally available. I note your comments about MUSE (alprostadil) but would urge that you give it consideration. This is a very innovative product that increases penile blood flow thereby resulting in an erection. It is a pre-filled, single use, plastic applicator that contains a micro-suppository. The applicator is inserted into the urethra and the micro-suppository is deposited within the urethra. The medication is then absorbed through the lining of the urethra and transported into the surrounding erectile tissue in the penis. You might find it useful to read a previous Ask the Doctor question that also deals with the question of impotence following prostatectomy. You can access that question and answer at: http://www.irishhealth.com/askdoc03.html?f_backurl=askdoc02.html&f_qid=4905