Penile Rehabilitation

Dear Dr. G,

I am emailing out of desperation and I really hope you can help me. I am a fifty-nine- year old man who unfortunately had been diagnosed having prostate cancer in the beginning of the year.

In view of my age, the specialist I visited persuaded me to go under the robotic operation in order to eliminate the cancer.

Before the operation, the surgeon counseled me for the potential complications of urinary incontinence and erection problems.

Since the cancer was stage one, the doctor was confident of cure. He was also optimistic about protecting my sexual function with some nerve sparing technique.

I am grateful the operation went really well and I made a good recovery after six weeks, and I am fully back to work.

Although I am optimistic about the prospect of long-term cure, I am rather disappointed with the fact that I am completely impotent.

I am very depressed as my wife is 12 years younger than me and our active sex

life used to be an important part of our intimacy.

The doctor told me it is still early and the erection should return. He recommended something called penile rehabilitation.

I am so sorry to put Dr. G on the spot, but can you tell me what exactly is penile rehabilitation and how is it done?
Why is the “nerve sparing operation” not work for me?

Lastly, can you clarify whether this is the end of the road for my sex life?

Yours truly,

Depressed.

The public awareness of Prostate cancer and the Prostate Specific Antigen (PSA) utilization for the screening has become more prevalent in the last two decades.

Media coverage of prominent figures affected by prostate cancer, such as the Singapore Prime Minister, has also encouraged men to present younger with early disease that is suitable for radical intervention.

Recent advancement of Robotic surgery has also allowed surgeons to maximize cancer eradication with minimal complications.

The improvement of medical technology and surgical techniques in recent years has evolved to give clinicians advantage to identify and protect the neurovascular bundle that is responsible to the erectile and sexual functions of men.

Despite the introduction of such “nerve sparing” radical prostatectomy, the rate of erectile dysfunction can still be at best 14% and in some series as high as 100% in men after the operation.

The negative impact of the sexual dysfunction after the prostate operation cannot be underestimate, as the complication is proven to affect the relationship, quality of life, self confident and overall well-being of affected men.

Of course, the post-operative erectile function recovery is quite variable.

The factors that may play a role influencing the return of sexual function may include the age, baseline sexual ability before the operation and preoperative state of health.

Clearly, men who had problems such as diabetes, smoking, hypertension and dyslipidemia would expect poorer outcome of sexual performance after the operation.

Although the terminology of “rehabilitating” penis from “wrongdoing” is somewhat misleading, the notion of penile rehabilitation is essentially to prevent irreversible structural and functional damage.

This is achieved by forcefully enhancing the circulation and hence oxygenation of the tissues to facilitate the recovery from the surgical insults.

It is generally agreed the first four weeks following the operation is non-beneficial to rehabilitate the penis.

It is also well recognised the window of responsiveness range from one to 24 months.

Apart from the recovery of the erectile rigidity, some studies have even demonstrated benefits of sensory recovery and penile length; that had been compromised after the cancer operations.

The regime that is utilized to rehabilitate the penis is very variable. This can range from daily doses of medications such as the blue pills, to daily uses of penile vacuum pumps and the injections of medications.

Besides, data is also emerging on the uses of shock waves aiming to generate new vasculature of the penis to restore the functions.

Although many trials have demonstrated success, the exact dosage, interval of rehabilitation and the long-term benefit of penile rehabilitation is generally unknown.

The detection of prostate cancer at early stages often ensures higher chances of oncological outcome with radical surgery, especially in younger men with aggressive disease.

Undoubtedly, the trauma of surgery itself often leaves men with adversity such as erectile dysfunction and incontinence.

Although the concept of penile rehabilitation may be at its early stages of research, this at least is a potential hope for men to regain their manhood after a hard time dealing with the surgery.

When Dr. G is put on the spot to advice for rehab or not after the op, his advice is simply: “Kick start the little brother and start using it as soon as possible. After all, like everything else, you don’t use it; you lose it!”

On that note, I wish Depressed a “hard” road to rehabilitation!