Erectile Dysfunction after Bladder Cancer Treatment
- Bladder cancer, the fourth most common cancer among men, develops when cells that make up the urinary bladder start to grow and eventually develop into tumors.
- A radical cystectomy is a common treatment option for bladder cancer patients when the cancerous tumors become muscle invasive, or spread into deeper layers of the bladder wall. This procedures involves the removal of the bladder along with nearby lymph nodes, other organs in the pelvis and potentially other nearby organs as well.
- A radical cystectomy can cause erectile dysfunction because the prostate is often one of the surrounding organs usually removed during the procedure, and the nerves that allow men to have erections run right past the prostate. Sometimes, the nerves can be spared, but other times they might need to be removed altogether if the cancer is nearby.
- Even if a radical cystectomy causes erectile dysfunction, there are options to treat it including vacuum devices, the use of intracavernosal injections [injections into the base of the penis] and medications.
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A radical cystectomy can be an effective treatment option, but it also has the possibility of causing erectile dysfunction. In men, the procedure generally requires that the nearby prostate, seminal vesicles and the vas deferens be removed as well as the bladder itself. Although it can be an effective treatment, the removal of the prostate, in particular, can cause erectile dysfunction.
“The nerves that allow men to have erections run right past the prostate,” Dr. Shah said. “So, when we do this operation, if the cancer's not anywhere near those nerves, we can try to spare the nerves and push them away from the prostate, and we hope that the patient will have normal erections afterwards.”
Unfortunately, sometimes those nerves might even need to be removed if the cancer is nearby. Dr. Shah also explained that even simply pushing on those nerves could make for erections that “aren’t as good as they used to be.”
"For those men that get erectile dysfunction after surgery, a lot of times it gets better with time, a lot of times it doesn't,” he said. “And if it doesn't, and that’s something that’s important to you, then you have to ask your urologist about other treatments to try to fix that.”
Still, Dr. Dan Theodorescu, a urological oncologist and director of the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai, wants people to know that this is a “wonderful” and common operation that’s been perfected over many years. That being said, he knows that there are side effects like erectile dysfunction that can alter a person’s quality of life. It’s important to note, however, that the average age of men who have a radical cystectomy is a contributing factor to the cases of erectile dysfunction seen after the procedure.
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“Although the operation has been modified and improved to be as sparing of the nerves that control erectile function in men, it’s still an operation that significantly impacts that function in many men,” Dr. Theodorescu told SurvivorNet. “Especially because the men that tend to have a radical cystectomy for bladder cancer tend to be on the older side, so, already they have, in many cases, some impairment in that domain.”
But even if erectile dysfunction is something you experience following a radical cystectomy, there are things you can do about it.
“Fortunately, there are many ways to deal with the erectile dysfunction,” he said. “The uses of vacuum devices, uses of intracavernosal injection [an injection into the base of the penis] and other tools such as medications could be tried and are tried in patients that have a radical cystectomy to see if they can recover the erectile function they had before.”
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