I am a urological surgeon and I am addressing here a question that I encounter systematically: how to preserve or regain my erections after a prostatectomy ? The answer lies in three complementary aspects: early diagnosis, surgical technique and post-operative care.
Understanding why prostatectomy can affect erections
The nerves responsible for erections run in close proximity to the prostate gland. When the prostate is removed, it is essential to preserve these nerves: do not cut, cauterize, or stretch them. If these nerves are damaged, erectile function can be impaired, sometimes temporarily, sometimes more permanently.
Early diagnosis: the most important condition
The earlier prostate cancer is detected, the more conservative the surgical intervention can be. For a localized and small cancer, it is often possible to perform nerve-sparing surgery, which aims to detach the prostate while preserving the erectile nerves.
In some cases, when the tumor extends beyond the prostate and invades the nerve, nerve preservation is not possible without compromising cancer treatment. This is why screening and preoperative assessment are crucial: they determine the balance between cancer control and preserving sexual function.
The role of the surgical robot (Da Vinci)
For nearly fifteen years, the surgical robot has transformed prostatectomy. Its main advantages:
- Magnified view of the surgical field, which facilitates the identification of fine nerve structures.
- Extremely precise instruments allowing for microdissection and very delicate separation between prostate and nerves.
Thanks to these capabilities, robotic prostatectomy increases the chances of nerve preservation in situations where it is oncologically safe.
What happens after the procedure?
Even when the nerves have been perfectly preserved, there is often a delay before erections spontaneously return. Nerve tissue takes time to recover after surgery. During this period, several strategies exist to maintain the health of erectile tissue and promote recovery:
Main options to support erectile recovery
- Oral medications (PDE5 inhibitors): often prescribed to stimulate medical erections and maintain blood flow to the penis during the recovery period.
- Intracavernosal injections : when oral medications are insufficient, injections into the corpus cavernosum can cause an erection and help preserve tissue function.
- Vacuum device (pump): allows for the generation of a mechanical erection and can be useful in penile rehabilitation.
- Rehabilitation and follow-up : Regular follow-up with the urologist allows for adjustments to treatments and assessment of recovery. Rehabilitation aims to stimulate circulation and limit fibrosis.
Practical advice for patients
- Discuss with your surgeon before surgery the possible nerve-sparing nature in your case and the oncological implications.
- Learn about the technique : robotic surgery offers benefits for nerve preservation when indicated.
- Prepare for post-operative care : questions about medication, rehabilitation and devices to be used should be anticipated.
- Patience and follow-up : recovery can take several months. Medical aids are available to support this process.
Key points to remember
- Early detection of prostate cancer maximizes the chances of preserving the erectile nerves.
- Robotic surgery allows for more precise dissection and increases the likelihood of nerve preservation when possible.
- A recovery period is common; drug or mechanical treatments can help during this time.
- The surgical decision always depends on the trade-off between cancer control and maintaining sexual quality of life.
Every case is unique. Discuss your priorities openly with your medical team to develop a personalized plan. The combination of early diagnosis, careful surgical technique, and active post-operative care offers the best chance of preserving or restoring erectile function after a prostatectomy.
