Erectile Dysfunction and Sexual Dysfunction After Robotic-Assisted Radical Prostatectomy (RARP): What You Need to Know

Why Erectile Dysfunction Occurs After Robotic Prostatectomy

Robotic-Assisted Radical Prostatectomy (RARP) is a highly effective surgical procedure for treating localized prostate cancer. However, like any major surgery, it carries potential side effects. Among these, sexual dysfunction, including erectile dysfunction (ED), orgasmic dysfunction (OD), and urinary incontinence (UI), can significantly impact a patient’s quality of life. This article aims to explain these conditions in patient-friendly language, providing insights into their causes, prevalence, and management options.

Sexual dysfunction after RARP mainly results from nerve damage during surgery. The prostate is surrounded by nerves and blood vessels essential for sexual function. Although surgeons aim to preserve these nerves (nerve-sparing surgery), some degree of nerve disruption is often unavoidable, leading to issues like erectile dysfunction and changes in orgasmic function.

Key Factors Affecting Erectile Dysfunction Post-RARP

ED is one of the most common side effects of RARP, affecting a significant number of men post-surgery. The degree of ED can vary depending on several factors:

• Nerve-Sparing Technique: If the nerves surrounding the prostate can be preserved, the chances of maintaining erectile function improve. However, in cases where cancer is close to these nerves, a more extensive removal may be necessary, increasing the risk of ED.
• Age and Pre-Surgery Erectile Function: Younger men and those with good erectile function before surgery tend to recover better. Older men or those with pre-existing ED might experience more challenges in regaining function.

Managing Erectile Dysfunction After Robotic Prostate Surgery

There are several effective treatments for ED after RARP, including medications, vacuum erection devices, and penile implants. Early and proactive management can make a significant difference in your recovery.

1. Medications: The first line of treatment for ED after RARP often involves medications like phosphodiesterase type 5 inhibitors (PDE5 inhibitors), including Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra). These drugs help increase blood flow to the penis, aiding in achieving an erection.
2. Vacuum Erection Devices (VEDs): These devices create a vacuum around the penis, which draws blood into it, helping achieve an erection. They can be particularly useful for men who are not responding well to medication.
3. Penile Injections: If oral medications are not effective, penile injections such as alprostadil may be an option. These injections directly stimulate an erection by dilating blood vessels in the penis.
4. Penile Implants: For men who do not respond to less invasive treatments, penile implants offer a permanent solution. These devices are surgically implanted into the penis and can be manually inflated to create an erection.
5. Counselling and Therapy: Psychological factors such as anxiety, depression, and stress can also contribute to ED. Counselling and sex therapy can be beneficial, especially for men who find that anxiety or depression is affecting their sexual health.

Orgasmic Dysfunction After Prostate Surgery: Causes and Solutions

Orgasmic dysfunction (OD) refers to changes in the ability to achieve orgasm, including altered sensations, pain during orgasm, or even the complete inability to orgasm (anorgasmia). The PDF outlines several key points:

• Climacturia (Urine Leakage During Orgasm): This condition, where urine leaks during orgasm, can affect between 20% and 93% of men after surgery. It occurs due to changes in the bladder neck and surrounding muscles during the expulsion phase of ejaculation. Strategies like emptying the bladder before sex or using a condom and performing pelvic floor muscle exercises are the first steps. In severe cases, interventions like artificial urinary sphincters or urethral slings may be considered.
• Orgasm-Associated Pain: Pain during orgasm, although less common, can occur in up to 19% of men post-RARP. This pain is usually felt in the penis, perineum, or lower abdomen and is thought to be related to muscle spasms or residual seminal vesicle contraction. Treatment options include medications like alpha-blockers (e.g., tamsulosin) that can reduce muscle tension. Addressing the psychological aspects of pain during orgasm can also be beneficial.
• Altered Orgasmic Sensation: Many men report changes in the sensation of orgasm after RARP, with some experiencing weaker or less pleasurable orgasms. This can be due to both physical and psychological factors, such as the absence of ejaculation (dry orgasm) after surgery. Cognitive-behavioural therapy or sex therapy can help address changes in sexual sensation and the psychological impact of an altered sexual experience.In some cases, medications like cabergoline, a dopamine agonist, have shown promise in improving orgasmic sensation.

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Navigating Sexual Health After Robotic Prostate Surgery

Sexual dysfunction after RARP is common but manageable. Understanding the potential side effects and available treatments can help men and their partners navigate these challenges. If you are experiencing any of these issues, speak up to find the best treatment options for your specific situation.

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