Radical pelvic surgery (prostate removal for cancer, bladder removal for cancer and bowel/rectum removal for cancer) is surgery that is associated with erectile function problems. In the early stages after such operations virtually every man has problems with erections good enough for sexual relations to have to wait for 12-24 months before any significant erection hardness returns. Recent information suggests that a penile rehabilitation program may increase the chances of a man having return of his own erections.

The cause of erection problems after these operations is multi-factorial: (i) Nerve damage can lead to erectile dysfunction. Even though your surgeon may have done a “nerve-sparing” operation, the maneuvers that are used to protect the erectile nerves may temporarily cause the nerves to be damaged and it may be more than a year before they recover. (ii) There is some evidence that these operations may cause decrease in blood flow to the penis. (iii) Going long periods of time without erections is unhealthy for the tissue inside the penis (the erection tissue is a muscle) and is associated with damage to the tissue. The belief is that by encouraging a man to get erections using medication may keep the tissue healthy and this may lead to a better long-term erectile function after surgery.

The main determinants of long-term erectile function after such operations include:

  • Whether the nerves were spared or not: Some men have both of the nerves saved; others have one nerve spared, while others have a non-nerve sparing procedure. Sometimes the nerves cannot be spared. This is a decision that is made usually in consultation between the patient and the surgeon. Some men who are undergoing nerve sacrifice have gotten grafts placed at the time of their surgery.
  • Preoperative erectile function: the better a man’s erectile function before surgery, the better his chances of having return of functioning erections after surgery.
  • Patient age: the older the patient at the time of surgery, the less likely the patient is to have return of functioning erections.
  • Medical conditions associated with erection problems (diabetes, high blood pressure, high cholesterol levels, etc.) limit the chance of return of an erection good enough for sexual relations.