Erectile dysfunction after cystectomy has become a common affair. Researchers have focused on analyzing the prevalence of ED after cystectomy and looking for a way to limit the chances of sexual dysfunction.
However, they have revealed that there are some factors such as psychological issues, health-related risks for ED, partner response, age, change in lifestyle, body image, and sexual priorities, which are also responsible for erectile dysfunction.
At present, sexual dysfunction including ED is the most important complication of cystectomy. Although scientists and health experts are trying to make changes in the surgical approach that may bring some outcomes.
What Is Cystectomy?
Cystectomy is surgery in which the urinary bladder is fully or partially removed. Doctors mostly perform this surgery to treat invasive bladder cancer. However, cystectomy is also performed to benign some specific disorders that affect the bladder and urinary system.
At present, cystectomy has become the most eminent urological surgery. The process of this surgery for men and women is completely different. In men, cystectomy involves removing the prostate, seminal vesicles, and bladder. For women, this surgery includes removing ovaries, fallopian tubes, uterus, and cervix.
Why it’s done
Cystectomy is recommended to treat certain medical conditions including:
- Urinary bladder cancer or cancer begins and involves the bladder at a certain period of time.
- Defective urinary system (by birth)
- Inflammatory or neurological disorders, which have an impact on the urinary system.
However, depending on several factors such as your overall health condition, the reason for your surgery, and your preferences, the type of cystectomy and reconstruction can vary.
Benefits of cystectomy
Cystectomy is used to remove cancerous tissues from the bladder. This type of surgery has the potential to bring a huge change in your quality of life, still, you can lead a normal life after cystectomy.
After cystectomy, you’ll feel more confident to deal with your stoma. At a certain time, you can enjoy all interactions with people and your social activities like always you do. However, the main benefit of cystectomy is the improved chance of recovering from bladder cancer.
Risks associated with cystectomy
As we mentioned before, cystectomy is a complex surgical procedure where many internal organs in your abdomen will be manipulated. Hence, there are some risks associated with cystectomy, which include:
- Blood clots
- Heart attack
- Less commonly, death can happen after surgery
Additionally, this surgery not only removes the bladder but also creates a urinary diversion, that includes some other risks such as:
- Electrolyte abnormalities
- Urinary tract infection
- A blockage in one of the tubes that carry urine from the kidneys
- A blockage that hinders food or liquid passing through the intestines
Apart from these, erectile dysfunction after cystectomy is becoming severe day by day. Although it’s not life-threatening, still, it can be the biggest concern for people, especially men.
What can you expect from a cystectomy?
Before we’re going to discuss erectile dysfunction following cystectomy, we should have a closer look at the actual process of cystectomy. During this type of surgery, your bladder and part of the urethra as well as nearby lymph nodes will be removed. However, in men, the scenario is different, where the prostate and seminal vesicles are removed.
Cystectomy can be performed through three different approaches including
Open surgery: In this approach, a single incision will be used on your abdomen to access the pelvis and bladder.
Minimally invasive surgery: This is the approach where the surgeon makes small incisions on your abdomen. This is generally performed with special surgical tools to access the abdominal cavity.
Robotic surgery: This is a minimally invasive surgery where a surgeon sits at a console and operates the surgical tools by a remote.
However, your surgeon can partially or totally remove the bladder. Hereby, the whole surgical process can be either Partial cystectomy or Radical cystectomy.
Partial cystectomy: In this surgery, only the affected part of your bladder will be removed. Generally, lymph nodes situated nearby the bladder are removed to identify cancer buildup in the bladder.
The lymph node is a small bundle of tissue that plays a crucial role in filtering the lymph fluid and producing cells of the immune system. At the end of this process, the rest of the bladder will be repaired and stay in your body.
Radical cystectomy: Here the total bladder and lymph nodes will be removed entirely. For men, the vas deferens will be cut down and the prostate and seminal vesicles will be removed.
Erectile Dysfunction After Cystectomy
Although, erectile dysfunction after cystectomy has not been firmly established. Some clinical studies have found the significance of post-surgery ED. For instance, the rate of affected people is about 70% after radical cystectomy. However, evaluating erectile dysfunction after pelvic surgery is related to how erectile recovery is defined.
While some researchers and surgeons have said that adequate erections as the primary criteria for recovery of ED, others emphasize the quality of erections. There are certain factors including consistency of erections, preoperative sexual function, partner issues, loss of penile length, partner issues, and psychological issues, which are often overlooked.
Although erectile dysfunction is treated like all other urological diseases, some researchers have examined outcomes of sexual and erectile function after cystectomy. According to these studies, the impact of cystectomy on erectile function is identified as negative. For instance, 89% of the men who are treated with cystectomy could not maintain an erection after removing the bladder.
Several studies have also revealed the decline of erectile function significantly after radical cystectomy. While some other studies have shown the reduced sexual desire and sexual activity and inability to maintain erections after cystectomy.
Iatrogenic erectile dysfunction
As we mentioned before, iatrogenic causes of sexual dysfunction are mostly associated with the injury of the cavernous nerves. These nerves are located within the neurovascular bundle. Although a majority of patients experience erectile dysfunction after cystectomy and urinary diversion, some deleterious consequences are related to bladder removal.
Erectile Function Recoverability
The recoverability rates of erectile function after cystectomy can vary depending on the type of surgery, experience, and technique of a surgeon. The rate ranges from 20 to 80%. However, the age factor plays a huge role in the restoration of erectile function as a man experiences a significant decline in his strength as grows older. This is why the optimum recovery rate for older people is determined at 50%.
Causes of Erectile Dysfunction
Issues at any stage of the erection process can cause erectile dysfunction. Generally, an erection is established due to increased blood flow in the penis. Your sexual thoughts or direct contact with the penis can stimulate blood flow. That results erection of our penis. However, there are several causes that can obstacle the whole process of erections. You can read here about the details of erectile dysfunction.
Does Prostate Disease Cause Erectile Dysfunction?
When a person is at the early stage of prostate cancer it won’t cause ED, but an advanced form of prostate cancer can result in erectile dysfunction. The fact becomes worse when a person experiences an inability in maintaining erectile function after prostate surgery to remove tumors and radiation therapy.
There are certain medications to treat prostate cancer, which can also cause ED. For instance, hormone therapies can incredibly lower down a male’s sexual libido that leads to erectile dysfunction.
When Erection Issues Become a Concern
Necessarily, you shouldn’t be worried too much about erection problems as having issues with erections doesn’t mean you have erectile dysfunction. According to studies, trouble in getting or maintaining an erection is normal for up to 20% of sexual encounters. However, if the percentage goes up to 50%, that means you should consult with a doctor.
Treatments for Erectile Dysfunction
You may affect by erectile dysfunction for various reasons. It may occur due to overage (higher than 40), side effects of medicine, imbalance of hormones, cardiovascular diseases, diabetes, or any other physical problem and physiological problems. The doctor will treat you as per the diagnosis report for erectile dysfunction.
But anyone feels that he is suffering from erectile dysfunction after a Cystectomy operation then he must consult with his doctor. As earlier, we have said that the vas deferens will be cut down and the prostate and seminal vesicles will be removed during Cystectomy operation. It is the important reason for erectile dysfunction after the operation.
In this case, he may suggest medication like PDE5 inhibitor. In some cases, he may suggest injection in your penis or penile implants operation. But it has some disadvantages and is risky.
Still, if you feel more insecure with your sexual ability after a Cystectomy operation you can take some herbal medicine like Vigrx Plus, Prosolution. These medicines are a blend of various herbal and considered side effect free if the patient is above 22 years.
But it is always better to consult with the doctor who did your operation.
Lifestyle factors to reverse or even prevent ED
There are some easy but effective ways that can help you out to reverse, in some cases, to prevent erectile dysfunction. These include:
- Walking every day
- Eating a healthy diet
- Monitoring your vascular health
- Getting in shape and stay in shape
- Strengthening your pelvic floor
- Keeping yourself free from smoking
- Reducing your alcohol consumption
- Getting adequate, high-quality sleep
- Increase the frequency of sexual activity