What about Sex after Prostate Surgery?

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Prostate Oncology Specialists, Inc.

Only 5-15% of men describe their sexual function as “undiminished” after prostate cancer surgery.[1] And I’ll venture that 0% describe it as improved. If you accept any degree of function as being potent, the best surgeons will preserve at least some degree of sexual function about half the time—using Viagra. (The official medical definition of “function” is anything stiff enough to “be stuffed in.” Seriously!) 

Loss of erectile function isn’t the only way to ruin intimacy. According to Dr. John P. Mulhall, author of the excellent book, Saving Your Sex Life: A Guide for Men with Prostate Cancer, after surgery, one out of five men ejaculates urine rather than sperm. Dr. Mulhall has coined the term “climacturia” to describe this unfortunate but common phenomenon.   
 
Operating on the Prostate is Difficult, Robotic or Otherwise 
Bad sexual function isn’t due to a lack of practice from surgeons. Over the last five years, the number of prostate operations are up 50%. Now, more than 70,000 men are taking a ride on the wild side every year.[2] All the excitement comes from the hope that robotic surgery can give improved results. But can the robotic approach justifiably claim a meaningful advantage over the older surgical methods? Yes, the scars are smaller, the hospital stay is shorter and serious bleeding occurs much less frequently.

However, for all the popularity of robotic surgery, study after study has unequivocally confirmed, that at least as it concerns the chance for preserving bedroom bliss, the robotic approach offers zero improvement over the older techniques,.  
 
And What about “Average” Surgeons? 
The rather dismal statistics I cite above are what is reported from the superstar surgeons, the most expert and skilled who are operating at famous university centers like Johns Hopkins or Memorial Sloan Kettering.

  Potency rates reported for “average” surgeons are decidedly worse. 

To give you an idea of the huge variation in talent from one surgeon to the next, simply look at how often all the cancer is removed.  The top surgeons are successful 90% of the time. However, reports show a huge variation in surgical skill. Even at large academic institutions some less famous urologists on staff are only successful at removing all the cancer in half of their patients![3]  
 
So what kind of quality might we anticipate from the “silent majority” of urologists working outside of academia at the community hospitals? If we look at the number of operations each urologist performs every year—an excellent indication of how often they can hone their skills—we need to be seriously concerned. For example, in New York in 2005, one in five urologists performed a single prostatectomy during the whole year.  Eighty percent of the urologists in New York did less than one operation per month.[4]  
 
Does Surgery Save Lives? 
The frightening risks of prostate surgery would certainly be justified if survival was dramatically better.

Yet despite the explosive increase in the use of surgery, prostate cancer death rates in the United States have only improved by one-half of one percent compared to 30 years ago. And experts aren’t even entirely sure that surgeons can take credit for this tiny difference. Other medical advancements besides surgery, such as PSA screening and earlier administration of hormone therapy, have also increased survival rates. 
 
If Not Surgery, then What? 
Almost any other kind of treatment, assuming it is administered by a well-qualified expert—seed implants, radiation, focal cryotherapy, hormone therapy, or active surveillance—will control cancer just as well as surgery and will be considerably less likely to ruin sexual and urinary function.  Beware of indulging that initial gut reaction to “just cut it out.” Instead of saving your life from cancer, all you may be accomplishing is the eradication of your sex life.      
 
1. Harin Padma-Nathan, Journal of Urology, Abstract 1402, 2003. 
2. Barbash, Gabriel, New England Journal of Medicine, 363:701, August 2010. 
3. Eastham, James, Journal of Urology, 170:2292, December 2003. 
4. Savage, Caroline, Journal of Urology, 182:2677, October 2009.

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