October 25, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume I, Spring 1988

Treatment of Sexual and Urinary Incontinence

The goal of radical prostatectomy is the complete elimination of tumor without a major sacrifice in the quality of life. For various reasons this goal may not always be met. However, it is possible to restore quality of life in all patients.

There are three techniques for the treatment of sexual dysfunction. All have major advantages and disadvantages and, for this reason, they can be viewed in a continuum from the least to the most invasive and from the least to the most reversible. These techniques are the use of an external vacuum erection device, the self-injection of papaverine and phentolamine and the placement of a penile prosthesis. If sexual dysfunction persists after a reasonable period of time, you should discuss these options with me or with your local urologist.

The three options mentioned above can be considered sequentially. The least invasive is the use of the external vacuum erection device. This device is temporarily placed on the outside of the penis and a vacuum is created. By reducing atmospheric pressure the penis becomes engorged with blood and a small soft rubber ring is placed at the base of the penis. Although this is a very artificial procedure, patients all agree that it produces satisfactory erections and for some individuals this has been a simple solution to the problem. The next technique involves the self-injection of two pharmacological agents, papaverine and phentolamine, into the penis. A very tiny needle is used. This is successful in about 75% of patients and produces an erection that lasts for two hours. Patients can be taught this technique so that they can self-inject the medication. Although long-term results on large numbers of patients are not yet available, there is some concern that repeated injections may produce some fibrosis in the penis which might interfere with spontaneous recovery The most dependable means for return of sexual function is the placement of a penile prosthesis. This involves a minor surgical procedure in which one of a variety of prostheses is placed inside the penis. This enables the penis to be erect so that vaginal penetration and orgasm can be achieved.

Sometimes, serious problems with urinary control are unavoidable and require further management. Today, the best form of treatment for patients who have serious problems is the placement of an artificial sphincter which can return urinary control to normal. Most patients regain urinary control spontaneously This can take up to one year or longer in some patients and in all patients requires strict attention to urinary sphincter exercises when urinating.

 

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