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Case Study: Prostatectomy in 56-year-old man

Peter is a 56 yr. old man who was discovered, on his routine medical, to have an enlarged irregular prostate. His GP ordered blood tests and referred him to a Urologist.

His PSA was elevated.

Biopsies were taken and he was found to have an aggressive cancer.

He was scheduled for a Prostatectomy.

His surgeon used Robotic Surgery, which he had 2 weeks later. His post op recovery was good. His cancer was encapsulated so his risk of spread was minimal. He was discharged 2 days later after his catheter was removed. His incontinence gradually improved and after 2 months he stopped using pads although he did have to go to toilet immediately he felt the need to avoid “accidents”.

He was commenced on Cialis 5mg daily 4 weeks post op. but had not had a firm erection since surgery.

He rated his erectile response at 30% of his normal Pre op. erection. His partner Sally agreed with the estimate. His surgeon had been dismissive of his erectile issues and he had seen his GP again who tried Viagra and Levitra again without success.

His GP eventually referred Peter to us. When we saw Peter he was 14 months post op. and had not achieved a good erection in that time.

We took a full history to exclude other causes and tested his penile function with a low dose injection. He was very nervous but was quickly reassured when his injection was painless. We discussed his options and suggested, if he could afford to, to restart his Cialis daily and to use injection therapy when he and Sally wanted intercourse.

Over the months he noticed an improvement in erections to the point where he could rely on Cialis only for penetrative sex.

He explained that his erections were better but not to the level they were before surgery.

He is now over 2 years post op.

Comments
Peters story is fairly typical. Some Urologists seem to take erectile problems more seriously than others. How much better his function would have been had he been treated more aggressively earlier in his recovery we will never know. We do know that the chance to return to normal erections after surgery depends a lot on the nerve-sparing skills of the surgeon, the area of tumour that is removed and whether it involves the nerves involved with erections. Also Radiotherapy which is sometimes used after surgery, can compound the problem. Research has clearly shown the benefits of getting strong erections soon after surgery by whatever means works well and consistently and is tolerated by the patient.

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