Wednesday, September 24, 2014

A Strategic Approach to Erection Recovery after Radical Prostatectomy

Radical prostatectomy has evolved over the past 30 years with improved surgical technique including optimal methods to spare erection-producing autonomic nerves located deeply within the pelvis adjacent to the prostate gland. These surgical advances have improved erectile function recovery rates after surgery. However despite current surgical proficiency for radical prostatectomy, many men still do experience delayed or incomplete recovery of erectile function status postoperatively. Thus, interest continues to better understand the basis for erectile function loss after surgery and develop strategies to promote erectile function recovery after radical prostatectomy.

A. Lateral view of the male pelvis illustrating the course and distribution of the left cavernous nerve fiber, as part of the left neurovascular bundle within intrapelvic fascia coverings. The cavernous nerve travels from the pelvicplexus proximally to the penis distally, in close anatomical relationship to the seminal vesicle, prostate, striated urethral sphincter, bladder, and rectum.  B. Anterosuperior oblique view of the same anatomical structures.  C. Anterosuperior oblique view illustrating preservation of the cavernous nervesafter bilateral nerve-sparing prostatectomy and bladder neck anastomosis to theurethral stump. The cavernous nerve fibers are preserved by division and clip-ping of small prostatic nerves alongside the prostate. When non-nerve-sparingsurgery is required for cancer eradication either unilaterally or bilaterally, wide excision of periprostatic soft tissue includes the cavernous nerves en block withthe removed surgical specimen.

Evidence supports the likely basis of erectile dysfunction associated with radical prostatectomy to relate to traumatic injury of the erection producing cavernous nerves even when they are gently dissected and preserved at the time of surgery. It is certainly clear that the very best surgical technique is needed as the first-line approach of "neuroprotection." The next frontier in this arena involves strategies directed to maximally restoring cavernous nerve function. Various strategies have been studied in this regard including nerve grafting techniques, nerve stimulation techniques, as well as application of "nerve growth factors" that may revitalize the nerve supply to the penis. Ongoing scientific work at the basic science research laboratory level is fundamental to the achievement of progress in this field. New scientific concepts will next be "translated" to the human condition applying rigorously conducted clinical trials.

 

At the Brady Urological Institute, our focus continues in an integrative manner to perform the surgery in the most proficient manner while also offering scientifically grounded options to recover erectile function at the time of surgery and in the early postoperative interval. We employ a number of strategies to improve erectile function for our patients:
  • A thorough preoperative assessment of function and counseling regarding the expectations after surgery.
  • Clinical trials involving experimental therapies to preserve erectile function at the time of surgery.
  • "Penile rehabilitation" that can be performed at the discretion of your surgeon or as part of the post-prostatectomy recovery clinic.
We believe this integrative approach offers men the best opportunity for erectile function recovery after radical prostatectomy.




This blog was written by Arthur L. Burnett, MD, MBA, FACS, Patrick C. Walsh Distinguished Professor of Urology; Director, Basic Science Laboratory in Neurourology; Director, Sexual Medicine Fellowship Program; and Faculty Member, Cellular and Molecular Medicine Graduate Training Program.

 


 


 

3 comments:

  1. I just want to share this personal story about how my husband survived the problem of NO ERECTIONS after prostate surgery.
    My husband undertook prostate surgery 3 years ago and before then i always looked forward to great sex with him and after the surgery he was unable to achieve any erections, we were bothered and we tried so many drugs, injections and pumps and rings but none could give him an erection to even penetrate. I searched for a cure and got to know about Dr. Hillary who is renowned for curing problems of this nature and he did encouraged me not to give up and he recommended his herbal medication which my hubby took for 3 weeks and today his sexual performance is optimum. You too can contact him for similar problems on hillaconn@gmail.com. A man who cannot satisfy his wife's sexual need is not a real man!

    ReplyDelete
  2. Here priestEka we are here to make your dream of pregnancy and other related human diseases over in your life have a happy home. Wespecialise in helping people with their problems such as.
    1 bringing back your lost .
    2 spell to improve your businesses.
    3 spell to bring back your ex-lover( bring back your husband/wife/boyfriend/girlfriend)
    4 spell for business protection from colleague.
    5 spell to prevent witchcraft from your life and that of your family.
    6 spell to prevent you from accident during your business journey.
    7. spell to get employment easily
    We also specialise in providing solutions in any of this spiritual gynaecology diseases affect human existence such as:
    1 fibroid, asthma, ALL STD,
    2 weakness of man organ
    3 infections of all kind (yeast infection)
    4 blockage from the fallopian tube
    5 cyst. From the ovaries
    6 unpleasant smell from the virgina
    7 irregular menstration, menopause
    8 infertility for easy Conception.
    9.skin diseases, Toilet infection and bad body odor…….Etc..
    10.Watering sperm (low sperm count) not able to get woman pregnant.
    Simply contact the spiritualist PriestEka on (dreka14demons@gmail.com) to get his Herbal Medication to cure your disease and put yourself on a motherhood side of life..
    (No more adoption, with PriestEka your problem will solve and you will have your child with ease.
    Contact us at (dreka14demons@gmail.com) your solution home!

    ReplyDelete
  3. I GIVE ALL THANKS TO DR WILLIAMS WITH HIS HERBAL PORTION I WAS COMPLETELY CURED FROM FIBROID
    I can’t believe this. A great testimony that i must share to all fibroid patient in the world. i never believed that their could be any complete cure for fibroid with out going for surgery ,i saw people’s testimony on blog sites and Facebook page of how Dr Williams prepare herbal cure for different king of disease,and with the help of his herb they where able to shrink there fibroid naturally. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually . Right now i want to tell you all that i just give birth to a baby boy last month,and on thin now i have not had any pain, and i have just went for text last week and the doctor confirmed that there is no trace of any fibroid in my system . Glory be to God for leading me to this great Dr Williams I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no herbal cure for fibroid that is Not true ,just contact him and get cure from his email drwilliams098765@gmail.com and you will be free and free forever, Try it and you will not regret it because it truly works. i hope to see your testimony soon.

    ReplyDelete