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Nerve-Sparing Operations: The Miracle Treatment? Part II
(05/04/2004) by Ralph and Barbara Alterowitz
By Ralph and Barbara Alterowitz
Nerve-Sparing Operations: The Miracle Treatment?
Another bit of prostate cancer mythology is this: After a nerve-sparing operation, the man has the same level of potency he had before the surgery. We all wish it were true, but usually it's not.
The nerves responsible for erections run alongside the prostate, not through it. Because nerves run along blood vessels, surgeons can see the nerve-blood vessel (neurovascular) bundles. Although nerves are not visible to the naked eye, surgeons generally know the surgical landmarks. Therefore, it's possible to spare these areas. However, even when the neurovascular bundles are spared, the nerves are traumatized, and smaller ones are not seen and cut.
In 1997, the FDA approved a nerve-locating tool, the CaverMap Surgical Aid. UroMed, the manufacturer, said that the patented technology helps surgeons map microscopic cavernous nerves. The system is currently being used at the John Hopkins University and other centers of excellence. While the device is still imprecise, more precise technologies may come along now that a breakthrough has been made.
We know of a support group formed by a number of survivors who were operated on by a prominent surgeon noted for his nerve-sparing surgical technique. They shared their experiences and tracked how everyone fared. They found that although the doctor's statistics were very good, almost everyone experienced significant erectile dysfunction. Maybe there is a gap between what doctors consider "full function" and what patients perceive as "good."
Is Potency Known Immediately after Surgery?
Potency is rarely known immediately after treatment. Any therapy is a shock to the system. After surgery, it may take two years (and sometimes longer) to recover and to find out how potent you really are, although some medical centers quote shorter times. This has been confirmed by several survivors, but most survivors tell us that no one ever told them this in advance.
So if you recently had treatment and are now experiencing impotence, there is a possibility that your erectile function will improve over time, especially if you immediately begin manual stimulation and various other techniques.
Does Hormone Treatment Destroy Desire and Potency
With complete hormonal blockade, desire and potency will be minimal. However, current research on monotherapy with non-steroidal antiandrogens such as "flutamide and nilutamide show that libido and potency may be retained in 70-80% of patients." (Prostate Cancer and Prostatic Disease.)
Can Sex Stimulate Cancer, or Can I Transmit Cancer to My Partner During Sex?
A recent study reported that some patients decide not to pursue lovemaking because of concerns related to the disease itself. These concerns include a belief that sex will stimulate the cancer, and possibly transmit the cancer to their partners. Both of these are absolutely false.
Effects of Treatment for Benign Prostatic Hyperplasia (BPH)
Patients with benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate with resulting bladder outflow obstruction and lower urinary tract symptoms, can receive a treatment called transurethral resection of the prostate (TURP). Although providing the highest likelihood of relief of both prostatic symptoms and urinary flow obstruction, surgical intervention for BPH with procedures such as TURP can have a significant impact on the patient's sexual function. Two main symptoms affect sexuality: First, erectile dysfunction, with rates reported as high as 14%. The second effect is retrograde ejaculation, which means that the ejaculate flows back into the body instead of flowing out of the penis. This affects 68% of TURP patients.
Excerpted from, "The Lovin' Ain't Over: The Couple's Guide to Better Sex after Prostate Disease." Copyright 1999 by Ralph and Barbara Alterowitz. All rights reserved.
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