Sexual Function After Surgery

In order to have an accurate discussion on sexual function after surgery one must look at many factors:

Age of the patient.
Sexual Health of Patient prior to surgery.
Surgeon experience/expertise.
Rehab process.
Extent of cancer
location of cancer

When looking at statistics, one must separate results in older men from those in younger men and results from 10-15 years ago vis-a-vis results gathered in the last 5 years.

I think that the overall statistic saying that 50% of men who undergo surgery is probably roughly correct. However, this includes the many men in their 60s-70s who would have had diminishing results already because of their age, men who had surgeries more than a decade ago when the technique was far form refined, and men who were/are unfortunate enough to be what amounts to training for inexperienced surgeons. So I think it is probably very misleading to tell a young guy 40-55 who is sexually healthy heading into surgery, and who has selected an experienced surgeon in a good center that he will have a 50% chance of losing his ability to have an erection. The overall statistic is misleading for many men. Just as it would be misleading to tell a 68 year old with pre existing ED issues that he will not have any post surgical issues with regards to ED.



"Sexual Function After Surgery

Many men worry about whether surgery for BPH will affect their ability to enjoy sex. Some sources state that sexual function is rarely affected, while others claim that it can cause problems in up to 30 percent of cases. However, most doctors say that even though it takes awhile for sexual function to return fully, with time, most men are able to enjoy sex again.

Complete recovery of sexual function may take up to 1 year, lagging behind a person's general recovery. The exact length of time depends on how long after symptoms appeared that BPH surgery was done and on the type of surgery. Following is a summary of how surgery is likely to affect the following aspects of sexual function.
Erections

Most doctors agree that if you were able to maintain an erection shortly before surgery, you will probably be able to have erections afterward. Surgery rarely causes a loss of erectile function. However, surgery cannot usually restore function that was lost before the operation."

kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/#sexual


"Columbia Urology's researchers found that up to 93% of men with normal erections before surgery were having sexual intercourse by one year after the operation."

columbiaurology.org/specialties/roboticsurgery/robotic-prostatectomy.html


"Outcomes from robotic series are at least as good, if not better than those reported for open prostatectomy. Our data has shown that among preoperatively potent men aged less than 65 who underwent a nerve-sparing procedure, 89.7% were able to have satisfactory erections at 24 months.

Patel reported 78% of men were potent at 12 months following RARP (Table 1)."

www.urology.uci.edu/prostate/Potency_info.html


"Of patients with no pre-existing erectile dysfunction who underwent Dr. Menon's nerve-sparing robotic radical prostatectomy, over 90 percent eventually had return of erectile function."

www.drmanimenon.com/preserving-erectile-function/


"# 96% of patients regain continence*
# 85% of patients regain sexual function*"

www.roboticoncology.com/



"A notable study in 2005 showed that a year after surgery, 97 percent of patients were able to achieve an erection adequate for intercourse. But last month, researchers from George Washington University and New York University reviewed interim data from their own study showing that fewer than half of the men who had surgery felt their sex lives had returned to normal within a year.

So which of the studies is right? Surprisingly, they both are. "

"If a patient has good sexual function without erection-enhancing drugs before surgery, Dr. Tewari tells him that he has about an 85 percent chance of regaining an erection firm enough for intercourse, although he may need erection drugs and it may take up to 18 months for his function to return. "

"Men who are older or who used erection drugs before surgery have a more difficult recovery. "

www.nytimes.com/2008/01/15/health/15well.html

The thing about getting cancer in general at 40 had me questioning my future regardless of possible SE.

I was far more worried about positive margins than I was about the possible two SE.

It does help having a good relationship with spouse post op. My first 1-3 months involved a lot of experimenting and honestly looking back that was fun in itself. After almost 20 years of marriage it was like that freshman year in college where we shared a dorm room (hers) and "experimented" on a nightly basis.

I was lucky I guess but I also saw dramatic improvement in mechanics and need (or lack of need) of pills within months. They say improvement occurs the first 24 monnths. I can say that the improvement was consistent until I was exactly where I was pre surgery.

4.5 months out means you have a lot of recovery still in you probably. Hope you're trying on a consistent basis and taking the meds needed for blood flow.

You're right though, in the end statistics mean little, we are not statistics.

Davidg,

Hubby was dx in Dec at age 45. He had robotic surgery in February, and 1 nerve was spared. We were very much aware of the possible SE's prior to surgery, but like you, we were most concerned with positive margins more than anything else...AND that is coming from a very healthty, happy, "active" love life prior to cancer.

He is doing well. He no longer wears pads, and the ED is a work in progress. We are working closely with his very supportive doctors and as a team here at home to get things going. :) We already see very promising results, and are taking it day by day! I love him now more than ever, and have a compassion for him far beyond what I had before, and I had a lot.

Thanks for the positive post. Being just 6+ plus weeks out from RALP, it is nice to know that isn't long in the big scheme of this journey. I have every bit of faith that it can and WILL get even better!

There are so many variables with all of the side effects it almost makes these studies worthless IMHO. My own URO even says you cannot trust a doctor's personal statistics. Patient variables really skew things. For example, if you only use two pads per day the uro counts you as continent when you work at a desk job. If that same guy was working construction he could go thru 6 pads per day at work but on his day off he may use only two pads per day. So is the guy working at a desk continent? What about the same guy working construction?

I wonder how many guys actually get back exactly to where they were before treatment? Very few IMHO on both ED and continence. Many of us will get back to a level that is acceptable because we are a very adaptive creature. Those men unfortunate enough to get PC in their 40 and early fifties probably have the best chance of getting back to where they were. Those of use in our late fifties and early sixties surely have a tougher time. I have no idea what the odds of men in their 70s would be like. What I do know is my condition isn't where I want to be with either SE being 11 weeks post op. With the type of work I do, I don't know when I will be rocking and rolling like I use to. With that said, the incontinence has improved a lot in the last three weeks to the point having sex can be done in bed instead of the shower. Also, I will get my first rocket fuel injection on April 9th. May the fun begin.

The only thing I would like to add to this wise statement is dead men cannot have sex:
"Clearly, some guys can safely postpone treatment of their prostate cancer, but doggonit it's still cancer, and the available treatments, unfortunately, often exact a price. Our lives are changed. At the extreme end of the spectrum from these guys with "indolent cancer" are our 30,000 brothers who will lose their lives to the disease this year. Now there's an SE that we might like to pretend doesn't exist. "

I said to my wife the day of my diagnosis that, "My prostate will rue the day it was placed in my body. I intend on using it til exhaustion before they cut it out of me."

Big words from a man with a pregnant wife and little interest in sex because of it. Spent a lot of time on my own and truth be told I thoroughly enjoyed myself.

I've had little real time to even think about sex with the wife days from giving birth to our third, but I'm confident enough that with a Viagra for the time being, I'll be fine. My limited research into this has proven very promising.

However, like all the other guys in this thread so far, I'd really like to get my willy back and functioning as it did prior to this whole debacle without the use of meds.

The one thing not really mentioned so far is the pressure we put on ourselves to "perform" or "get it up." The worse that stress is the more willy runs away in my experience. Relaxing and letting things happen is a key.

But for guys that will always need injections or pills to be timed out accordingly, I really don't know what to say. I can't imagine what permanent ED would be like. I hope sex would be the same except for whatever you need to do to get it there...

golfnooch: we went through this about the same time. I am saddened to hear about your lack of success with erectile functionality. I'd also have to encourage you to forgive and not resent your wife. Some women, the ones who post here are a really good example, are wired to be in tune with the risks associated with the surgery. Mine was really not such a creature. She linked the surgery in her mind to some laprascopic surgeries she had in the past and focused on the relative ease of recovery rather than the thin veil of tissues we rely on so much for continence and erections. I, on the other hand, had read books about how dead men don't have sex and watched videos of the actual surgery. It's intricate stuff to be certain and I'm amazed any men get though this with outstanding results. Golfnooch: have you tried the injections? I have a friend who was in your boat and has had very great success (and staying power I still envy).

Sorry for the side rant, but I do believe some surgeons are better than others. Some data skewing is going to happen as all UI and ED is self measured and reported. But I remain convinced that a surgeon's lack of data on patient outcomes is unacceptable. If they do not track it, stay away. If they track it but do not release the data to patients, I find it just as unacceptable. It makes me wonder just how common UI and ED issues really are among this population. If you have a successful trifecta outcome, then you are on the good side of the statistics. If not, your surgeon found the protection of the statistics. The saddest part is the fact that most men who undergo this surgery will accept the statistics in advance, assuming they are the statistics for their particular surgeon and not just borrowed statistics from Sloan Kettering, Hopkins, Ford, Samadi or other.

My surgeon knew his own numbers. He shared how his numbers improved with significant modifications of his technique over time. I think this is incredibly rare. I'm guessing 1-2% of surgeons are fluent with their own numbers AND willing to share.

As for me, I think my wife is tired of me chasing her around again. With meds 95%. (as if dry could ever be the same). I'm close to 90% in the mornings without meds but lose steam throughout the day. Orgasms just as good if not better and a bit longer.

Viagra is a great drug. I switched to Cialis recently just to see what it would do differently. I seem ready to go more often and sexual thoughts translate easier into movement down there. But I am considering stopping due to headaches (debating if they are bad enough to stop for)...

davidg--- yeah, don't get me wrong, my wife and I have been very lucky and the fact that news of this potentially last one came literally a day or two after my diagnosis makes us even more thankful for this little one. I only mentioned it as an aside and certainly didn't mean to throw it in the face of anyone. I was just pointing out that there hasn't been much opportunity to practice after surgery at getting my sex life back in order with a pregnant wife who is uncomfortable and has little interest in me right now.

Also, I'm sorry to hear about your wanting of more kids. I'm an adopted kid so I know all about the heartache that goes with not being able. My parents tried for years and years unsuccessfully. I guess your and my case is a little different from that, tho. I had just mentioned to my wife that I wouldn't be able to actually "deliver" any more little ones. Kinda pi$$ed me off to be honest.

I don't know how common it is, but my uro asked me point blank if I was done with kids at our first appointment. I said we weren't sure so he sent me off to a friend of his over at the fertility clinic to make a few donations just in case. The issues with guys our age are often far different than guys in their 60's and beyond about fertility, at least. I don't think it's too common for a uro to suggest that. Mine is a couple years older than me. I'm 42. I look at the banked sperm and a fourth kid if my wife and I decide on it as a nice stiff middle finger to PCa.

I was really lucky to randomly get the uro I did. Young guy, in tune with younger issues... he was/is terrific as a guide thru this disease. Prepared me for thinking about a lot I wouldn't have on my own. And this site too.

David and Dude,

We too had a young uro and young surgeon.  I'd say his uro was MAYBE 40, and surgeon was in early 40's but looked really young.  His uro was so very considerate of us, and all our needs/concerns.  He said hubby was the youngest PC patient he ever had.  We felt like they both connected with us because they were able to put themselves in hubby's shoes.  I still haven't had time to write a thank you letter to them.  We both feel so very taken care of, and cared for.  His uro replied to every email with, "it's so nice to hear from you".  They both were so responsive to us.  We both feel very fortunate to have had such a positive experience.

As far as kids, I am 41 and we both knew we were more than happy with our two, ages 9 and 11.  I hadn't had the urge to have another, and thankfully do not now.  I feel relieved that  has been taken out of the equation, and think it will make our "love" life even better! 

Statistics give some clue as to what the odds are, but tell you nothing bout your individual case other than that you may have ended up in the majority or the minority. Somebody gets the short end of the stick or the statistics would be 100%, not 95% or 90%...

Myself, as best I could ferret out ahead of time through the fog of bad studies, worse studies, and generally terrible-quality data was that I (at my age) was looking at better than 9 out of 10 on incontinence in a year (still dribbling at 5 months, but never all that badly - still irritating, though) and 7 out of 10 on ED (looks good so far, but still not what it was - early days yet.)

I also was looking at perhaps 15-17 years if I left it alone and then I'd (almost certainly, based on applicable data) be in deep, dire stage IV crap at age 62-64. So, I rolled the dice.