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SEX AFTER ROBOTIC PROSTATECTOMY
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 | | DAVID B. SAMADI, M.D.
Chief, Division of Robotics and
Minimal Invasive Surgery
Mount Sinai School of Medicine |
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I am fortunate enough to work with internationally known expert in the field of Sexual function after Robotic Laparoscopic Radical Prostatectomy, Natan Bar-Chama, MD. His expertise is part of the all-rounded approach for the treatment of prostate cancer with the advanced technology of robotic radical prostatectomy.
The program includes individualized evaluation of sexual function prior to radical prostatectomy and specific methods to recover sexual function thereafter.
“The harshest onset of erectile dysfunction (ED) comes with facing the reality of prostate cancer. One day you are healthy (or so you think) and the next day, after a standard yearly physical and a blood test, the prostatic specific antigen (PSA), you find out you have cancer. Your first reaction and that of your sexual partner will be to get through it, save your life, fight the cancer and get rid of it, nothing else matters. But something else does matter, especially to you—your sexual wellbeing, your ability to have an erection. Although you cannot ignore the prostate cancer, any of the various treatments for it can rob you of your sexual ability. And once the cancer threat is passed, and you know you’ll survive and you get your normal life and routine back, sexual performance will suddenly be very important again. Facing ED as a result of prostate cancer treatment can be devastating, but let me reassure you that there is successful rehabilitation of your sexual function after treatment of prostate cancer.
Robotic radical prostatectomy and sexual function
Robotic radical prostatectomy is the most commonly recommended treatment to men who have localized prostate cancer and reasonable life expectancy. Robotic assisted prostatectomy is the procedure in which the prostate and a small rim of tissue around the gland are completely removed with the intent to insure that all cancerous cells have been removed.
I will make every attempt to spare the nerves that surround the prostate in order to insure your recovery of sexual function. This procedure is called bilateral nerve sparing technique since the nerves on both sides of the prostate are spared. Men who undergo this procedure have a reasonable chance of regaining complete erectile function in 12 to 24 months. If the cancer, however, is bulging to one side, the surgeon must cut the nerve on that side of the gland to remove it. This procedure is called unilateral nerve sparing technique since the nerves on one side of the prostate are spared. If the cancer is bulging on both sides of the gland, the surgeon must cut the nerves on both sides of the prostate. There are instances where all the nerves surrounding the prostate must be cut to remove the gland called bilateral nerve resection. In this instance the patient will rarely regain erectile function. However, for those patients who require loss of the penile nerves on one or both sides, there is a nerve reconstruction procedure. It involves a nerve graft. During robotic prostatectomy, a piece of a nerve in the leg called the sural nerve is harvested and transplanted to the pelvis after removal of the prostate. This nerve graft will function as a conduit for regeneration of the penile nerves. This procedure is has been performed by Dr. Samadi and his peers at Mount Sinai Medical School.
After nerve sparing radical prostatectomy, whether or not you regain erectile function also is determined by your age: the younger you are, the better your chance of regaining complete function. On the other hand, if you experienced partial ED before surgery, you have a lower chance of regaining sexual function after surgery.
Resuming Sex after Prostate Surgery
If you encounter ED in the early months after surgery, there is still a possibility that normal function will resume in about 12 to 24 months. And even if you face ED during or beyond that amount of time, there are many treatments available to you. With the use of these treatments, the large majority of men with ED after radical prostatectomy can resume satisfactory sex life.
Oral Medications
As you start feeling better after surgery, begin being intimate again with your partner to reestablish the physical and emotional closeness you had prior to surgery. Celebrate together the fact that you’ve been victorious over cancer! Anticipate that you will soon regain the ability to have an erection. You might want to start by trying the simplest method of treatment, the oral medications such as Viagra, Cialis and Levitra.
Penile injection therapy
If oral medications are not effective, don’t put off having sex. It is important to continue to be sexually active, or in other words to “exercise” the penis after the prostate surgery. This is thought to give you the best chance of return function. Some researchers believe that erections enhance tissue oxygenation and suppress fibrosis (scarring). Until the nerves regenerate or recover sufficiently to respond to oral medications, penile injection therapy is the most effective and reliable way of restoring erectile function. In a recent study it was shown that it is very valuable to use injection therapy to aid erections soon after surgery to increase the chances of the return of normal function.
Penile implants
In some cases, no erectile function will return after radical prostatectomy. In such cases, you may want to explore the option of a penile implant in order to have a permanent solution to your ED. A penile implant is an excellent option that is associated with a very high rate of patient and partner satisfaction. Dr. Bar-Chama is highly qualified in penile implant surgery with a vast long-term experience.
Other treatment options
If the oral medication, penile injection therapy or penile implants are not satisfactory or indicated, other treatment options might be appropriate. Individual evaluation of each patient will help in understanding the various options and recommendations.
Orgasm and ejaculation
After prostate surgery, you will be able to achieve orgasm; however, you will have no ejaculation since the prostate is no longer available to produce the fluid.
Read more about Is There Sex After Prostate Surgery? |
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"By submitting this information, I write not only to compliment you and your wonderful staff, but also to advise patients with prostate cancer, from my region, the Caribbean, of the benefits of robotic prostatectomy". 
