So, Dr. Scholz, a huge issue after prostate cancer surgery is sexual dysfunction. Can
you tell men what their options are to help mitigate this side effect?
Yes, and it's amazing to me that this—the way to get optimal recovery after an operation
isn't implemented with any kind of consistency. It's kind of sad. As we all know, after men
have a radical prostatectomy everyone becomes impotent for a period of time and then a lucky
minority will spontaneously improve over 6 to 12 to 18 months. During that time period,
when everyone is a downtime period, the urologist, I hear, will often advise taking some Viagra
or Cialis which has limited impact, honestly, and everyone sort of waits around. What do
you do? Just hope and pray that things will get better with time. Studies clearly show
that men that implement the early use of injection therapy to artificially create erections during
the downtime after surgery (during the shock period, so to speak) are going to—in the
long run—get much better recovery than when you compare that to the men who don't do anything,
they just wait around and see what happens.
The reason for that is probably because the muscles in the penis atrophy when they're
not used and when the nerves have been damaged or bruised—or whatever you call it—right
after the operation. These men aren't getting any erections at all and they can develop
irreversible atrophy, sadly. So, men that have radical prostatectomies should implement
injection therapy immediately after having a radical prostatectomy and they should artificially
induce erections at least once or twice a week to keep all the musculature and the blood
flow and everything normal awaiting the day when the nerves, the bruised nerves, will
recover and then spontaneous erections return. The men that faithfully implement a program
like that are much more likely to recover to a normal level of function than the men
that don't.
So, how do men get these injections? Is this something that a doctor has to prescribe?
Is it over the counter?
Yeah, so the urologists are very familiar. These are prescription medicines. This sounds
kind of barbaric to be giving injections in such a sensitive area, but the needles are
very tiny and once men have been acclimatized to the process, they tolerate it very well.
There is a process of finding the right dosage. If men get too big a dose, they can get an
erection that lasts too long which could be dangerous. So, this whole process is taught
in the urologist's office and then a prescription for a precise amount is given so they can
get it at the pharmacy and then start to do it at home. The training process is a little
involved and I've been a little disappointed in urologists. A lot of times it seems like
this gets, you know, shuffled under the rug and people maybe get one instruction and say,
"Here, here it is. Go figure it out." and if that's happening, people should look around
for another urologist that will take time with them so that they can get the right dose,
make sure they're doing it properly, getting the results that are expected. When this is
done properly, it works very well and it's an opportunity missed for men that have operations
and don't implement this type of a program right after the operation because they're
obviously putting themselves at greater risk for long-term erectile dysfunction if they
don't this right after the operation.
I know one helpline caller asked me if they should be taking Viagra or Cialis during the
penile injections. Do you suggest that? Or is that—they don't need need both?
Well, there's no uniform policy, but there are a number of urologists that are advising
combinations with pills, without pills, and it's all reasonable. There's sort of an experimental
approach to every individual. Some people are going to need large amounts of injectable
medicine. Other men will get by with very small amounts. So everyone has to find out
what works for them, but the idea of aggressively pursuing immediate results—I mean I'm talking
a week or two after the operation is completed and then persevering and ensuring that these
erections are happening on an ongoing basis—is essential for recovery.
Have you seen caregivers take a role in this at all? Have they been helping their husbands
help figure this out and do the injections themselves?
Certainly, yeah, some people are really squeamish about giving shots and so their significant
others can learn how to do it. It's a tricky and uncomfortable, very personal, area. Many
times people's libidos are low and we're not talking about trying to create erections for
sexual intercourse immediately; we're just talking about trying to create erections for
health. So, this is a normal process that men go through. Every night they get erections
while they're sleeping whether they know it or not, and that, unfortunately, disappears
right after surgery and that's why the recovery rates are so much lower in men that don't
implement in this —let's call it an exercise program right after the radical prostatectomy.
Would a Kegel regimen help while they're doing these injections in order to help strengthen
their erections over time?
Kegel exercises control the muscles that are for damming up the urine flow; doesn't really
have anything to do with the erectile function.
Alright, thank you.
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