Erection rehabilitation following prostatectomy

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General

  • The erectile rehabilitation program is a voluntary program designed to help speed the recovery of erectile function after a nerve sparing radical prostatectomy, whether performed robotically or by open surgery. It is not a guarantee for erectile function to return but most literature will agree that by encouraging blood flow to the penis as soon as 4-6 weeks following surgery, the length of recovery time for spontaneous erections can be reduced by as much as 40%.
  • Not every patient is appropriate for this program as they may have had poor function before the surgery or we were not able to spare the nerves responsible for erectile function due to prostate cancer control.
  • Many patients report a loss of penile length and girth after a prostatectomy and this program goes long way in preventing this from occurring. We do hope that erections may return as early as 6- months but recovery may continue to occur for up to 2 years. It is important to realize that some men never regain the ability to obtain or maintain an erection after prostate cancer surgery, whether or not a nerve sparing procedure is performed. There are other treatment options available as well that are more invasive but effective and you are encouraged to discuss this with Dr. Weeks. Also, please remember that with orgasm, there will not be ejaculatory fluid anymore as the prostate and seminal vesicles have been removed surgically.
  • Any erectile fullness after surgery is a positive sign that some of the nerves are relearning proper function and encouraging spontaneous blood flow to the area. These signs indicate the beginning of recovery.
  • The components of the erectile rehabilitation program include the use of oral medications, (such as Viagra, Levitra or Cialis) and the Osbon ErecAid vacuum device. If the oral medications are not working after an appropriate time, please discuss the possible benefits of suppository or injection therapy with Dr. weeks at any time.

Oral Medications (PDE5-I)

  • PDE5 Inhibitors (Phosphodiesterade 5 Inhibitors) are designed to support an erection by increasing blood flow to the penis. It will not create an erection on its own and the patient should realize that it will take effort, time and patience for the recovery of erectile function following a prostatectomy. The medication will be prescribed to the interested patient at the time of catheter removal. The preferred use would be at least 3 times a week, on a relatively empty stomach, without alcohol at bedtime. The purpose is to encourage spontaneous nighttime erections, though it will be some time before sexual penetration is possible.
  • Side effects of the medication include headache, visual color changes, nasal congestion, facial flushing, light sensitivity or upset stomach. These medications should NEVER be taken if you are requiring nitroglycerin tablets for cardiac issues within the last 6 months. If these negative side effects occur, please stop the medications immediately and call your physician.
  • Insurance will typically support up to 6 tablets a month though the program will require approximately 15 tablets a month. Dr Weeks and his staff will help all they can with samples when available.

Vacuum Erection Device (VED)

  • The vacuum erection device (VED) is made by Osbon ErecAid. Four to six weeks after the surgery, we recommend using the VED twice a day to passively supply blood to the penile erectile tissue. The goal is to supply fresh blood to aid in healing, and stretch the tissues to prevent scarring or fibrosis from occurring. We encourage the use of the VED with the PDE5I when the medication is scheduled to provide active and passive encouragement of blood flow and maximize the chances of erectile recovery.
  • A specialist will be able meet with you in our office to provide one-on-one instruction, ordering of the product, answer and help with insurance issues and any other assistance along the way. DVD demonstrations and pamphlets are available from Dr. Weeks. The Osbon ErecAid is typically covered by insurance with an appropriate co-pay. It also boasts a 100% money back guarantee for 90 days.

For questions regarding reimbursement or equipment issues, please contact Osbon Customer Service at the number provided at the initial meeting.

Post-Prostatectomy Medication Protocol

Take Viagra 50mg (or one half of a 100mg tablet) every other day (M, W, F or T, Th, Sa) on an empty stomach. The effects will be hampered by alcohol and a fatty meal.

Equivalent dosing of Viagra 50 mg = Levitra 10 mg and Cialis 10 mg.
Equivalent dosing of Viagra 100 mg = Levitra 20 mg and Cialis 20mg.

Do NOT expect erections by starting this medication following your prostatectomy. This medication is designed to support an erection that is already present. However, the purpose of this protocol is to speed up the natural recovery of post-procedural erectile dysfunction. The goal is to encourage oxygenated blood flow to the penis, promote healing, and prevent scarring from unused tissue. There can be recovery of erectile function even up to 2 years following a radical prostatectomy, depending on the preoperative function and the surgery itself.

Side effects possible from these medications include and not limited to facial flushing, headache, chest palpitations, visual changes (blue dots), and priapism (erections lasting longer than 4 hours – go to Emergency Room!), nasal congection and hearing changes.

If these side effects occur, please simply lay down for the evening and the effects will resolve in 4-6 hours after calling the physician to inform them of these symptoms.

*** ABSOLUTELY DO NOT take these medications if you currently need nitrogen based medications for heart disease, have had a recent cardiac procedure (stenting, bypass), or have active chest pain. They may cause dangerous effects to the blood pressure in these situations.

Do not be too discouraged if these medications do not help as there are several other options available if necessary.

This protocol is voluntary and serves the purpose of potential erectile function rehabilitation following a prostatectomy surgery only. This protocol is not designed to be applied to other uses of this medication.