What Is a Radical Prostatectomy?
Radical prostatectomy (prostate surgery to remove the prostate gland) is most often done to treat localized prostate cancer. Less often, a simple prostatectomy is done to relieve symptoms associated with BPH (benign enlargement of the prostate gland). Radical prostatectomy involves removing the entire prostate as well as some of the surrounding tissue, including nerves and lymph nodes.
One of the side effects of prostate surgery is erectile dysfunction. In fact, several studies cite an 85% occurrence rate, which means about up to 9 out of 10 men who undergo this procedure end up with some degree of impotence. Penile rehabilitation refers to therapies that can help preserve penile tissue and restore erectile function in men who have undergone prostate removal.
A vacuum erection device or penis pump is an effective intervention to improve penis health in men with impaired erectile function after surgery. What are the benefits of using a penis pump before and after prostate surgery? Let’s find out.
Why does prostate surgery cause erectile dysfunction?
In men with prostate cancer that has not spread outside the gland itself, surgery is often the recommended treatment. Radical prostatectomy involves removing the entire gland along with the seminal vesicles and some surrounding tissue. There are several types of prostate surgery, including laparoscopic and robotic-assisted procedures.
In the retropubic approach, the surgeon makes an incision in the lower abdomen, from the navel to the pubic area. The prostate is carefully separated from surrounding nerves and blood vessels before it is removed along with adjoining tissue. In the perineal approach, an incision is made between the anus and the scrotum.
This is a shorter operation and is preferred when lymph nodes do not need to be removed. However, the perineal approach is associated with a higher incidence of post-surgery erectile dysfunction.
Erectile dysfunction is one of the most common side effects of prostate surgery. Nerves in the penis play a critical role in the development of erections. Two bundles of nerves are present on either side of the prostate gland. Although surgeons take great care to avoid cutting these nerves during the procedure, some degree of damage does occur. This is the reason that erection problems are common after prostate removal even with a nerve-sparing approach.
Not everyone suffers from loss of spontaneous erections after prostatectomy. The ability to have an erection after prostate surgery depends on a number of factors, including:
- Erectile function before the operation
- The degree of nerve injury during the procedure
- Type of surgery
- Experience of the surgeon
Older men are more likely to suffer from erectile dysfunction following prostate removal due to age-related effects. A man’s erectile function before surgery also plays a role, and men with good penis health are more likely to retain erectile ability post-procedure. The type of procedure performed is also important.
Surgeons do their best to preserve the nerves during the surgery, but as noted, the perineal approach is associated with a higher rate of ED. Erection problems are equally common following a laparoscopic approach versus an open approach. However, studies show that robotic-assisted prostatectomy has better erectile function recovery rates.
Should I use a penis pump to help improve penile health before prostate surgery?
A penis pump use is like exercise for the penis. Just like exercising the body is good for overall general health, regular use of a penis pump is good preparation for prostate surgery. Erections occur when an immense amount of blood flows into the penis and engorges it. When the penis remains flaccid for long periods of time, penile tissue is deprived of oxygen-rich blood.
This leads to a loss of flexibility and scar tissue formation in the corpora cavernosa (the smooth muscles that relax and allow blood to flow into the penis during erections). The resultant inability of the penis to expand leads to erectile dysfunction Simply put, erectile function is a use-it-or-lose-it deal. Using a penis pump before prostate removal can improve penis health.
Why is it recommended to start using the vacuum device before the prostate surgery?
A penis pump or vacuum erection device (VED) consists of an acrylic cylinder that is placed around the penis. When air is pumped out of the cylinder, the vacuum that is created causes blood to flow into the penis, making it rigid and erect. Using a vacuum erection device before prostate surgery, therefore, improves blood circulation, which in turn helps to maintain a healthy penis.
Healthy tissue recovers faster from surgery. A common side effect of prostate removal is penile shrinkage in terms of both length and circumference. Penis pumps help maintain preoperative penis size and minimize the effect of shrinkage following surgery.
The nerves in the penis that trigger erections may be damaged during the procedure to remove the prostate. The neuropraxia (temporary loss in nerve function) takes time to recover. This means that the ability to have spontaneous erections after surgery often returns slowly. In fact, it can take several months to years to regain sexual function after prostate cancer. During this time, men are unable to experience even nighttime erections.
Rather than waiting for erectile function to return on its own, doctors feel that regaining erectile function after prostate surgery can be helped along by a penile rehabilitation program. Penile rehabilitation is a type of physical therapy for the penis. Following prostate removal, a penis pump helps recover erectile function by regularly exercising the penis.
This keeps the penile tissue healthy and allows the nerves in the penis to regenerate so that eventually satisfactory erections can occur. Studies show that penis pumps are a safe, well-tolerated, and effective method of penile rehabilitation.
A penis pump creates negative pressure and increases blood flow to the penis. Engorgement of the penis with blood is necessary for strong and long-lasting erections. In addition, the blood flowing into the penis carries nutrients that are essential for a healthy penis. By mechanically pumping blood into the penis, a VED helps preserve the tissue and minimize damage while allowing the nerves time to heal.
How long after the surgery may I start using the penis pump for rehabilitation exercises?
Most men are advised to begin using a vacuum constriction device within two months of nerve-sparing radical prostatectomy. A survey of more than 600 urologists from the American Urological Association showed that the overwhelming majority (97%) of physicians start rehab within four months of prostate surgery.
Authors Dalkin BL and Christopher BA published a clinical study in the International Journal of Impotence Research. In an article titled Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Sep-Oct;19(5):501-4. Epub 2007 Jul 26. In this article, they describe when the participants of the study used a penis pump for penile rehabilitation. Daily use of a vacuum erection device was begun the day after catheter removal and continued for 90 days. It is recommended to work with your physician to determine when to start using the penis pump for rehabilitation exercises.
How do the results impact penile tissue?
Fibrotic changes (scarring) lead to shortening and decrease in girth of the penis following surgery. Venous leakage from damaged tissues is also thought to play a role in the development of erectile dysfunction after prostate surgery. Penile rehabilitation with a penis pump helps maintain penile length and girth. It also helps with nerve recovery and overall tissue health for quicker recovery.
The authors of a 2016 clinical study determined that the average loss of penile length (penile shortening) after radical prostatectomy was 1.87 cm and 1.82 cm respectively. They further determined that men who use a vacuum erection device that no significant changes in penile length (penile shortening) were observed in men using a vacuum erection device after surgery.
How long does it take to see results?
Results are not immediate and it can take several months to notice a difference. One study found that 17 percent of men had a return of natural erections after using a VED device for nine months. Doctors typically recommend the use of a penis pump for at least 12-18 months after prostate surgery for penile rehabilitation.