The patient is encouraged to seek consultation early after surgery. In this program we like to see patients early after surgery (as soon as the urinary catheter is removed) generally within the first two months.
- We encourage patients seek consultation even before surgery if they are anxious about their postoperative sexual function.
- The patients are initially tried on oral medications for erectile dysfunction (such as Viagra, Levitra or Cialis). Realistically, about 20% of men respond to such drugs within three months of surgery, while 60% respond at approximately 18 months. Patients are given a prescription at the time of removal of their urinary catheter. They are encouraged to try out at least one such medication over the 2-4 weeks after their catheter is removed.
- If a patient is getting a penetration hardness erection with pills they are encouraged to obtain three erections per week using this medication. This does not mean they need to have sex three times per week, as it is the erection itself (and not stimulation or orgasm) that keeps the erection tissue healthy.
- If patients fail to respond to pills then they are encouraged to consider penile injections to give them erections. This therapy results in penetration hardness erections in 90% of men using them. The average erection occurs within five minutes and lasts approximately 20-30 minutes. Once again, the patients are encouraged to get three erections per week.
- Because response to pills improves over the first 18-24 months, patients are encouraged to reattempt the pills (maximum dose on 1-2 occasions) approximately every two months.
- Much interest exists among surgeons and patients in regular (daily or three times per week) use of erection pills after these forms of surgery. Early evidence suggests that this may be of some benefit. It is unlikely that this treatment alone will maximize the chances of erection function return. However, in the first year after surgery we use this as an addition to the main treatment.