Special risk: loss of limb stiffness (erection)
Another potentially important result after the operation is the loss of spontaneous stiffening member (erection).Is why after the operation member stiffening impaired?
The stiffening member is associated with sexual stimulation through blood vessels and erectile nerves regulated, running along both sides immediately adjacent to the prostate and pull into the penis and into the erectile tissue (Figure 8), the. This neurovascular bundle controls necessary for the stiffening of the penis and erectile tissue increased inflow of blood. The neurovascular bundle can be injured in the radical surgery - or it is deliberately removed for the necessary radical cancer removal on one or both sides.
Basically, however, it is now possible by the refined surgical techniques to preserve the vascular nerve bundle located in or proximate to the prostate capsule, and thus the erection nerves and blood vessels. Unfortunately, tend in the edge region of the prostate capsule or prostate cancers located ingrowth into the neurovascular bundle (Figure 8). Since in these cases is a high risk that the cancer can be removed only incompletely surgically with preservation of the neurovascular bundle, is now usually the neurovascular bundle on the tumor-affected side away. The neurovascular bundle on the other hand can be obtained if it is assumed based on the collected results from the fact that the page in question is tumor-free. In the best case, can be effected in the presence of very small herd prostate cancer and the maintenance of the blood vessels and erectile nerves on both sides. Despite the continuous improvement of surgical techniques and the refinement of surgical techniques, it may not be possible due to the tissue conditions in individual cases, to obtain the erection nerves secure. For preservation of erectile nerves can after surgery until the occurrence of spontaneous erections quite a long period of time elapse.
Even with application of nerve-surgical technique, some patients have after surgery insufficient for sexual intercourse erections longer.
Altered orgasm
The loss of spontaneous erectile function should not be confused with a hearing loss of the penis or the glans penis. It is important to note that the feeling in the penis (sensitivity) and the orgasm feeling remain. Orgasm is after the operation, however, "dry", because large parts of the semen in the prostate and the seminal vesicles, which are removed during the procedure, can be formed. Disruption of the vas deferens and prostate removal is after the procedure infertility. Because some patients complain of an involuntary loss of urine during orgasm, the bladder should be emptied before intercourse.
Treatment options for Impotence
After the physical and emotional recovery from surgery remains to be seen whether spontaneously adjust erections and whether they are sufficient for the exercise of sexual intercourse. The obtaining of an erection nerves during surgery for this is of great importance. To fix a possibly occurring erectile dysfunction (impotence) after surgery several treatment options are available. A drug-oral therapy (taking pills) has now become the standard because of the introduction of effective drugs. When the preparations are so-called phosphodiesterase-5 inhibitors (PDE-5) inhibitors, which lead via a complex mechanism of action to gain an erection.It is important to know that the available drugs can only be effective if the erection nerves and blood vessels (neurovascular bundle) were obtained at surgery. A non-functioning medication-oral therapy (taking pills), so there are more modern therapy methods that can speak restore the member stiffness "on demand".
When Cavernous injection therapy car ("SKAT") are vasodilator drugs that cause an erection, injected by the patient himself in the cavernous (Figure 9).
A mechanical restoring element is constrained to a vacuum erection support system ("vacuum pump") are possible (see Figure 10).
Furthermore, stands as a surgical therapy implantation of a penile prosthesis is available (Figure 11).
All therapeutic methods can be employed at an early stage after the operation. There are scientific indications that, both the regular and the demand-driven post-operative use of a drug-oral therapy (PDE-5) inhibitors, or Schwellkörperautoinjektionstherapie ("SKAT") the recovery of erections be beneficial (recovery of erectile function). Please seek without false modesty or exaggerated restraint - even together with your partner - consult your urologist regarding the various treatment options.
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