Life After Prostate Cancer

Erectile Dysfunction and Incontinence Following Prostate Cancer Treatment

In honor of Prostate Cancer Awareness Month, the providers at Utah Men’s Health are dedicating today’s blog post to patients and caregivers who have experienced a prostate cancer diagnosis. Erectile dysfunction and urinary incontinence are, unfortunately, two very common side effects after prostate cancer treatment. These issues can greatly affect your quality of life. Almost all men will report erectile dysfunction and urinary leakage after the first few months following prostate cancer surgery. The good news is many men will see an improvement after the first year, and there are treatment options to help.

Why Do These Conditions Occur?

The nerves that control an erection lie very close to the prostate, and can be injured during prostate cancer treatment. The urinary sphincter muscle may also be damaged during prostate cancer removal and/or radiation. When the urinary sphincter muscle is damaged it cannot contract and close off the flow of urine. This can cause stress incontinence, which occurs when you cough, sneeze, jump, or lift a heavy object.

  • Radical prostatectomy: Many men with prostate cancer are treated with a “nerve sparing” prostatectomy in order to remove their prostate. One of the goals of the surgery, depending on the extent of the cancer, is to spare the nerves adjacent to the prostate. These nerves are responsible for erections. Eighteen months after a radical prostatectomy, close to 60 percent of men said they couldn't get an erection on their own, according to a study published by the Journal of the American Medical Association. Stress urinary incontinence occurs due to injury to the urinary sphincter. Persistent incontinence after prostate cancer surgery can affect up to 16% of men.
  • Radiation: The symptoms of erectile dysfunction and incontinence after radiation are gradual, and typically seen at least 6 months or more after treatment. This occurs because, although the prostate is being targeted, radiation can damage nearby tissue and blood vessels. The bladder and urethra are nearby and will receive some degree of radiation; however, urinary leakage from radiation treatment is typically mild.

What Treatment Options Are Available for Erectile Dysfunction?

  • Oral Medications: Oral medications, like sildenafil or tadalafil, are a common first therapy. Following prostate cancer treatment, they tend to work in less men than any other treatment for ED. Some of this depends on your function prior to cancer, and the extent of the treatment. Many oncologists will use the oral medications for penile rehabilitation in order to restore good blood flow to the area while waiting for the erectile function to possibly return.
  • Vacuum Pump: A penile pump may be a good option if medications have failed or caused side-effects. These pumps are also used for “penile rehab,” which helps keep tissues healthy by encouraging blood flow to the penis.
  • Injection Therapy: This involves injecting medicine directly into the side of your penis with a very small needle each time you want an erection. Many men find satisfaction with injection therapy as it allows more spontaneity than the pills, without the systemic side effects. The therapy is most successful if you have had nerve sparring surgery, and patients report the small prick of the needle is well worth the erection they are able to obtain.
  • Penile Implants: These devices are considered a permanent solution for ED and last an average of 8-10 years. We recommend patients wait 12 months after prostate cancer treatment to consider a penile implant. This allows enough time to see if erectile function will return. Penile implants are completely concealed in the body and have the highest satisfaction rate out of all treatment options.

What Treatment Options Are Available for Urinary Incontinence?

  • Pelvic Floor Therapy – Pelvic floor physical therapy can help some men recover from urinary leakage after prostate cancer treatment. This includes Kegel exercises which consist of voluntary contractions of the urethral sphincter muscles. If you are unfamiliar with those muscles, imagine stopping your stream of urine. That is a Kegel contraction. Basically, all men will have incontinence for a period of time after removal of the prostate. Many men regain it over time, and with the addition of physical therapy.
  • Absorbent Pads – Some men use pads in order to control urine leakage. They are good for overnight use, but are not convenient if they need to be changed throughout the day.
  • Penile Clamp – A clamp is placed over the penis and controls urinary leakage by applying constant pressure to the urethra. They cannot be used for long periods of time and some patients have reported pain when in use.
  • Male Sling – A sling is made of mesh and implanted inside the body for patients with mild to moderate incontinence. It repositions the urethra and provides support to surrounding muscles. The sling works on its own and does not require action on the patient’s part. Some men report they need to wear a thin pad during the day in case of light dribbles.
  • Artificial Urinary Sphincter – This device is surgically placed for patients with moderate to severe incontinence. It is completely concealed in the body and mimics a healthy sphincter, allowing the patient to urinate when desired. A saline filled cuff keeps the urethra closed and a pump in the scrotum is pushed when the patient is ready to urinate. This device requires the patient to have the manual dexterity to manipulate the pump.

If you have been through treatment for prostate cancer and have urinary incontinence and/or erectile dysfunction, contact the providers at Utah Men’s Health . We are fellowship trained in men’s health issues and will be with you every step of the way on your road to recovery.

Life After Prostate Cancer