Q. Is there a better chance to get erectile function back after robotic prostatectomy? Is there an advantage with robotic prostatectomy over an open prostatectomy in terms of getting erectile function back?
A. Yes. Compared to open surgery to remove the prostate, there is an advantage to robotic surgery. With robotic surgery, the doctor can see the nerves more clearly. That means there is a better chance to keep those nerves safe from lasting harm. For a man who had good sexual function before surgery, it will still take a few months to a few years to return to sexual activity. There is no guarantee that you will have recovery of sexual function like you had before surgery. However, you will have a better opportunity for recovery by following Dr. Patel's treatment plan.
Q. What does the doctor have to do to "save" the nerves?
A. The main goal is to remove all of the cancer if possible. If the doctor is able to save the nerves, he has to peel, stretch and move the nerves away from around the prostate gland. So during the surgery the nerves are disturbed and do have some traumA. It takes time for nerves to heal and work again after they go through the trauma of surgery.
Q. How long will it be until I can have normal sexual activity after a robotic prostatectomy?
A. Better recovery of sexual function is expected after this method of surgery when the patient continues to follow the treatment plan. A person's age and past sexual function are the other key factors that affect recovery. With the robotic method, it generally takes a few months to a few years for a man to regain ability similar to before surgery. A few men will be able to have an erection 1 month after surgery. The norm is longer.
Q. If a man is taking blood pressure medication or is overweight, can that affect his ability to have an erection after a robotic prostatectomy?
A. Yes. Some blood pressure medications and some other medicines can have that effect. A man who is physically active and close to his normal body weight has a better chance of regaining a level of function like before surgery.
Q. If a person has trouble getting an erection before surgery, will it still be an issue afterward?
A. Yes it can be. If a man is having an issue before surgery then he is more at risk of not being able to get an erection after surgery. That is why it is very important to follow your ED treatment plan.
Q. What do you mean when you say follow Dr. Patel's protocol?
A. Some patients who have robotic prostatectomy at OSUMC are placed on a special treatment plan for ED. Dr. Patel designed a treatment plan (protocol) for ED for his patients. If you are on this protocol it means that you will take oral medicine and use a vacuum erection device (VED). This rehabilitation begins 4 - 5 weeks after the catheter is removed.
The medicines that are used are cheap cialis, viagra or Levitra. These are taken 2 - 3 times a week at bedtime to improve blood flow. The blood flow is to help the traumatized nerves and tissues to recover. The medicines continue until the man regains his usual level of sexual function.
The VED is used each day. For best results VED is done in two sessions each day. This helps the penis to keep its usual size and ability to have an erection during the healing process. The VED sessions continue until the man regains his usual level of sexual function. On this protocol the person continues to return for follow-up appointments and evaluation. If the person is not able to get erections on his own, then the treatment plan may be changed. Other therapies may be added to the treatment such as MUSE or injection therapy.
Q. What is injection therapy and what does it do?
A. This is the process of injecting a mixture of medicines into the side of the penis. This is done to produce an erection satisfactory for sexual activity. The man does the injection himself just before he wants an erection. Two clinic appointments are needed to start this therapy.
Q. Is this process of injection therapy painful?
A. Is it NOT painful, but you feel something. In fact, most men state that it was not as bad as they thought it would be, and that it was beneficial for them.
Q. What is MUSE and what does it do?
A. MUSE is a medicated pellet. It is placed in the urinary opening with a disposable applicator. A man would use this before he wants an erection for sexual activity.
Q. How many appointments do I need to follow-up for this ED protocol?
A. That depends on the person's needs and motivation to regain a level of sexual function like before surgery. Usually there are follow up visits every 3 or 6 months for the first year. Communication via phone or e-mail is available for questions between visits or for a person who live out-of-state.
Q. Can someone else come along to appointments?
A. We encourage a man to bring his spouse or partner to appointments.
Q. Having ED is embarrassing to me. How does The James deal with that issue?
A. That is a good question. Each person is treated with respect, in confidence and professionally. Each person's individual situation is important. Our goal is to help him through this process to feel comfortable again.
