Erectile Rehabilitation Following Prostate Removal

One day after urinary catheter removal – Start oral medication (Cialis, Levitra, Viagra), one pill every other day.

Three to four weeks after urinary catheter removal – Start daily use of vacuum erection device.

Two to three months – If progress is slow, Scott D. Miller, MD will recommend an additional therapy.

***Note:  Any recommended therapies are designed to be used together.  Always discuss a decision to stop or change a therapy with Dr. Scott Miller or his staff unless otherwise instructed to do so.

Erectile dysfunction is a possible side effect following removal of the prostate gland.  Dr. Scott Miller’s expertise using robotic surgery technology minimizes this risk by avoiding injury to the delicate nerves responsible for erectile function [see S.P.E.C.I.A.L. technique].  However, careful following of rehabilitation and care instructions by the patient after the operation is a key component for ultimate success.

A number of factors other than nerve damage can affect the successful return of erectile function.  The small blood channels within the penis can develop scar tissue following prostate removal, thereby preventing full expansion of the penis.  Aggressive rehabilitation can help prevent and even reverse this. Full expansion is necessary for the enlarged penis to become rigid.  Once rigid, blood outflow from the penis dramatically reduces, thereby allowing efficient maintenance of the erection (a so-called “threshold effect”).

Soon after urinary catheter removal, erectile rehabilitation is started by creating as full of an erection as possible, even if by artificial means.  This process for all patients begins with oral medications and a vacuum erection device (VED).  Dr. Scott Miller will then customize the therapy to the individual needs of each patient depending on their progress.

• Oral medications (Cialis, Levitra, Viagra) – Starting the day after urinary catheter removal, Dr. Scott Miller recommends taking one pill every other day.  Even with no obvious response, this treatment can increase oxygen delivery to the penis thereby enhancing healing.
• Vacuum erection device (VED) – A plastic cylinder is placed over the penis and a vacuum is created within the device.  As a result, blood is mechanically pulled into the penis, thereby stretching the tissues.  Dr. Scott Miller recommends starting VED use 3-4 weeks following urinary catheter removal.
• Prostaglandin E (PGE) – For patients who experience little or no improvement during the first 2-3 months following surgery, Dr. Scott Miller recommends use of prostaglandin-containing medications 1-2 times per week.  This prescription drug is a synthetic version of a substance that the penis naturally produces to cause an erection.  Although it must either be placed in the urethra (urinary channel) or injected with a small needle into the side of the penis, self-administration is surprisingly trouble-free.  This therapy has a direct chemical effect on the penis that inhibits and may reverse scar tissue formation.  In many cases, prostaglandin can produce an erection adequate for intercourse within 10-15 minutes of administration.  If prostaglandin itself does not produce a sufficient response, it can be used carefully in combination with oral medications.  Dr. Scott Miller will also recommend prostaglandin use earlier in patients with risk factors such as hypertension and diabetes.  Some highly motivated patients also choose to start this medication early.

Important points to remember:

• The goal of erectile rehabilitation and long-term maintenance of function is achieving a full erection twice weekly either naturally or by artificial means.  Extended periods of time without erectile activity, in and of itself, can lead to decreased erectile function.
• The first three months are the most important.  Depending on erectile function at the time, Dr. Scott Miller will slowly withdraw therapies one at a time.  In some patients, the final tapering of the oral medications can occur many months after surgery.
• An aggressive approach is even more important in patients with mild erectile dysfunction prior to surgery (decreased quality, difficulty maintaining, or need for oral medications).
• If natural erections occur in the first three months, still continue every-other-day dosing of the oral medications.  Otherwise, a small portion of patients can experience a delayed decrease in erectile function.  Dr. Scott Miller will advise you on how to taper the medication.
• If sexual desire decreases, notify Dr. Scott Miller.  This symptom could indicate a low testosterone level.
• Alert Dr. Scott Miller or go to the emergency room for any erection that lasts for more than four hours.
• Never fall asleep with an erection.
• Do not smoke.  This habit has several direct negative effects on erectile function.
• If the progress of your rehabilitation changes significantly, notify Dr. Scott Miller.