What Should I Do Now

When Can I return to Sexual Activity?

Let the surgery heal for three to four weeks before attempting anything.  After one month after the robotic prostatectomy, it is recommended that you resume sexual activity.  Stimulation of the nerves is thought to be a first step on the journey back to potency.  Remember that you can still experience the pleasures of orgasm and other sensual stimulations without full erections.  The average time to recovery for erections adequate for intercourse (in those who do recover) is 6-12 months, but in some men it is even longer.  You should also be performing kegel exercises regularly to help your return to potency.

I Don’t Have Erections After Surgery, Am I Impotent for Life?

Think of your erections as a well conditioned athlete, who has been injured.  This injury is going to take time to heal.  You should try to remain patient, and remember that this will be an ongoing battle for many months and even years.  Rehabilitation of potency is much like a sports injury.  Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.

If you see any fullness in your erections in the months after your robotic prostatectomy surgery, this is a positive sign that some of the nerves are working or re-growing.  You are taking the first steps down the potency recovery path.  Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.

Medical Therapy For Erectile Function

 Medical therapy requires a prescription from a doctor.  Therapies include medications (Viagra, Cialis, Levitra), treatments (Muse), devices (Vacuum Pump) and small injections (Caverject.)  All of these therapies have their respective costs and benefits.


Viagra

 Sildenafil (Viagra) has limited, not 100%, success in prostatectomy patients.  Nonetheless, existing literature on its use after radical robotic prostatectomy suggests it may significantly aid potency.  Certain heart medications and Viagra are potentially fatal.  Viagra can also produce headaches, skin flushing, and other side effects. Always obtain permission from your physician before starting Viagra.

Viagra works best if taken 1/2 hour before sexual activity.  It should also be taken on an empty stomach, and remember that alcohol suppresses its effectiveness.

If you take Viagra, and nothing happens, you may try it again.  Viagra can be taken at anytime during the potency process, and will work better as the nerves heal.  Thus it is possible, that it may begin to work later, even after not working noticeably initially. Viagra (R) is a product of Pfizer Inc., please visit their site for more information.

Cialis

 Tadalafil (Cialis) conceivably works similar to Viagra as a “potency tickler” to encourage a faster return to erections.  Just as with Viagra, potentially lethal combinations with certain other medications exist, so consult your physician before beginning Cialis.  As advertized, Cialis can begin to work within 30 minutes, but notably, can work for up to 36 hours.  Because it is longer lasting, it has been speculated that this may make it more effective as a “potency tickler.”  However, this has not yet been proven. Cialis is made by Lilly, you can learn more by visiting their site.


Levitra

Vardenafil (Levitra) has been studied for use after radical robotic prostatectomy, similar to Viagra, and is believed to aid the return to potency due to the positive results of such studies.  As with both Cialis and Viagra, serious side effects with certain medications are possible, so consult your physician before use.


 

Muse

A tiny wax suppository is used to stimulate the erection, and is inserted with a small plastic device into the urethra.  As many as 70% of men who fail to achieve erection with Viagra will be responsive to Muse therapy.  There is, however, a potential irritating burning pain during the first several erections, and it costs more per use than the above oral medications.  Muse videos demonstrating the process are free and can be sent to you upon request.  Muse is made by Vivus, visit their site for more information, or contact Dr. Ahlering’s assistant Lydia.


Vacuum Pump

The vacuum pump is a non-invasive method to obtain erections. This method has been around for quite some time now.  The efficacy of the pump, however, is somewhat low.


Caverject

Caverject, made by Pharmacia Corporation, effectively produces erections in approximately  80% of men, and may work in men for whom Viagra did not work. One slightly unpleasant drawback is that Caverject must be directly injected into the penis correctly via a small syringe and needle by the patient, or the patient’s partner, at home.  However, studies have shown men using Caverject after radical robotic prostatectomy have an earlier return to potency.

What You Never Lose: The Good News about Sexual Function

While regaining erectile functiom is not possible for all men, it is important to remember that erection is just one part of a satisfying sex life.  The other parts remain intact despite prostate cancer surgery.  Sexual feelings, sexual fulfillment, climax and the sensation of orgasm are still available without erection.

What Do We Know About Potency After a Robitic Prostatectomy

 The return of potency is dependent on several factors:

  • Previous sexual function before surgery.  Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery.  It will not improve upon what you already had before surgery.
  • Age.  The younger you are, the better your chances.  Men under 65 have a better chance of regaining potency, or erectile function than those over 65.
  • How many nerves are spared.  As discussed previously, ideally both nerves can be spared and this will give you the highest chance of regain erections.  However, even men with no nerve sparing can regain erectile function.

Ejaculation (the release of fluid during orgasm) will no longer occur in any patient.  This is because the seminal vesicles (which store fluid for ejaculation,) and the vas deferens (the tubes that carry sperm to the prostate), are removed and cut during the surgery.  This means that you will no longer be able to father children (at least by any standard means.)