Nerve regeneration after radical prostatectomy – Santis | Private London prostate cancer clinic | Experts in robotic prostatectomy

Nerve positive feedback after radical prostatectomy ( and the subsequent reappearance of erectile function ) normally does take some clock time, assuming that both heart bundles around the prostate gland were able to be preserved by the surgeon. This is because the nerves and arteries that control erections need clock to recover and heal. This article explains why this is the case, and what can be done to speed up the mend process .

Introduction to nerve regeneration

Three sets of nerves are significant when a man has sex :

  1. The nerves of penile sensation.
  2. The nerves that cause an erection.
  3. The nerves that control climax.

Because of their location, sandwiched between the prostate gland and the rectum, the second base arrange of nerves can be affected during radical prostatectomy. The other two sets of nerves can not be affected. Regarding climax after surgery, roughly 80 % of men describe climax as being evenly satisfying after surgery as earlier, 10 % say that it is better ( although no one can explain why ! ) and 10 % say that it is less intense.

Prostate nerve bundle

Why do nerves need to regenerate if they were not removed?

Nerves can silent suffer trauma and minor damage during a revolutionary prostatectomy, even if they were preserved. They need to be finely separated from the prostate itself which is to be removed, and that does involve bringing them into liaison with surgical tools which can leave them stretched, bruised and swollen. This limits how well they work. A good surgeon will of course seek to minimise this, and the more experience they are of handling nerves, the better the affected role consequence. Nerve fibres in this location are besides particularly susceptible to damage because they lack the common myelin cocktail dress ( insulating material ) of most nerves in the body. So some recovery time is required hera for the nerves to heal .
The second gear reason for a convalescence period is that the small arteries that travel through the prostate gland to the erectile mechanism are interrupted when the prostate gland is removed, so the blood stream through the other arteries to the penis has to increase to allow sufficient lineage run for erections. In some patients this summons takes time for the torso to adapt to the changes. This is not steel positive feedback specifically, but another aspect of the recovery procedure that patients should be mindful of .

How long does nerve regeneration take?

recovery of potency may be very rapid in younger patients and is sometimes immediate. however, for most patients the recovery is gradual and can take up to 3 years to plateau, although typically a patient sees a refund to erectile function after about 12 months .

Can I do or take anything to speed up nerve regeneration?

I recommend to my patients that they stimulate themselves ( or be stimulated by other means ) 2-3 times a workweek and take a Viagra pill at least once a workweek angstrom well. This encourages nerve positive feedback and increases blood flow to the penis. There are three tablets in the same class as Viagra that you can take : Cialis ( tadalafil ), Levitra ( vardenafil ) and Viagra itself ( sildenafil ). There is evidence that taking one of these tablets regularly after prostate gland surgery speeds recovery of potential. All three work by increasing lineage flow to the penis, and while they won ’ thymine give you an erection on their own, they make it easier to get one with foreplay .
not all patients want to take a tablet for authority and there is no compulsion to do sol. Please do be mindful that there are coarse side-effects associated with this increased blood hang, including headaches, facial flush and indigestion.

About nerve preservation

When is nerve preservation not done?

The term ‘ nerve preservation ’ or ‘ heart sparing ’ during root prostatectomy refers to preservation of this irregular set of nerves ( the ‘ cavernosal nerves ’ or ‘ neurovascular bundles ’ – NVBs ). When these nerves are not preserved it is not because they have been unintentionally damaged, but because either one ( rarely both ) or function of one has been removed to ensure that the cancerous cells are amply removed. This is known as ‘ cancer restraint ’ .
You can see how the location of the prostate cancer on the leave side of the prostate specimen below allowed full boldness preservation on this side ( you can ’ thymine see any tissue on this slope because it ’ mho been left behind in the patient ) whereas the tumor ( depicted as red ) on the right side of the prostate gland was invading the NVB, which meant that NVB removal on this side together with all of the tissue surrounding it was necessity for good cancer control .
Prostate extracted with cancer shown in red

Who has nerve preservation?

patient who are potent ( have normal erections ) are intelligibly exquisite to retain this and so are we. ampere well as allowing erections following surgery, heart preservation besides allows an earlier return to continence ( urinary control ) so we always practice nerve preservation whenever the cancer see allows it, which is in about 80 % of men. When the cancer is close to one of the nerves we might partially nerve save on that side if it is safe to do so and will discuss this with you beforehand if this seems probable.

The decision to nerve continue is taken after considering the patient ’ s existing erections, PSA flush, biopsy report, MRI scan, rectal interrogation under anaesthetic immediately before the operation starts and the way the NVB looks and feels during the operation. It is always discussed with patients before surgery .

What are the results of nerve preservation?

I published a study on steel preservation in 2011 on this – if you ’ d like to read more, chatter here to read the article. The results were as follows :

40-49 50-59 60-69 70+
2 nerves preserved 100% 91.8% 82.9% 60%
1 nerve preserved 100% 66.7% 50.1% 0%

We have besides created an interactional results calculator which gives you results charts for cancer cure, authority and continence.
View the Surgery Results Calculator

Other than nerve preservation, what other factors influence potency after surgery?

  • Age – the younger the better, as can be seen in the table above.
  • The ability to have erections before surgery.
  • Medication, especially for elevated blood pressure.
  • Other conditions, such as diabetes.
  • Psychological factors.

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