Several studies have shown that even with bilateral nerve-sparing surgery, it may take up to 18 to 24 months before a patient recovers reasonable erections. However, major gains are usually made between 6 to 18 months. There are several potential explanations for this time delay: transient nerve injury, postoperative psychological issues and a history of infrequent and non-rigid erections, which affect the flow of oxygen to and the subsequent health of penile tissues.
The delay in the return of potency can be improved by several approaches:
- by employing a careful surgical technique, one is able to minimize potential trauma to the nerves.
- by providing a comprehensive preoperative counseling program for the patient and his partner, one is able to address postoperative concerns and minimize the psychological impacts of surgery.
- by providing early, pharmacologic erections with the drugs listed below, one can avoid long-term penile tissue damage, thus expediting the return of spontaneous erectile function.
We recommend that, within the first 2 weeks after catheter removal, all patients who have undergone an RP should begin self stimulation to enhance eventual recovery of potency. Oral agents (Viagra®, Levitra® or Cialis®) are prescribed to enhance the flow of oxygen to penile tissue. The most common side effects are headache (20 percent), flushing (8 percent), visual disturbance (6 percent) and nasal congestion (6 percent). We ask patients to attempt to have at least 2 to 3 erections per week in the months after surgery in order to maximize post-operative recovery.
The successful recovery of erectile function is highly dependent on the patient and his partner’s education about treatment-related sexual problems. Open sexual communication between partners is essential. Other issues, such as loss of sexual desire, difficulty reaching orgasm, ejaculatory problems or sexual pain also should be addressed. Finally, reproductive health, fertility issues and sperm banking counseling are an integral part of our sexual health rehabilitation program.