Recovery of Erections After Radical Prostatectomy

By Dr. William J. Catalona

Normally, men have erections every day. Thus, the normal physiology of the penis is to get an infusion of well oxygenated blood every day to keep the tissues healthy. After a radical prostatectomy, men usually have no erections for 3 to 6 months because of surgical trauma (manipulation and stretching of the nerves, sutures to control bleeding, etc.). Then erections begin to return as partial erections that gradually improve for up to 36 months. However, in the interim it is important to get blood into the penis at least 3 days per week to keep the tissues healthy. Blood flow is improved by several methods:

  1. Regular intake of Viagra-like medicines (I usually recommend Cialis 20mg/day because it lasts longer, but this drug causes some men to have muscle cramps and they have to switch to another);
  2. Vacuum erection device;
  3. Injections into the penis of prostaglandin-like drugs that increase blood flow (I believe this is the most effective and preferred method);
  4. Any sexual stimulation that causes erections normally. All patients should be encouraged to use one or all of these methods for sexual rehabilitation beginning one month after surgery.

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