erectile dysfunction and urinary incontinence after ...erectile dysfunction and urinary incontinence...
TRANSCRIPT
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Erectile Dysfunction and Urinary
Incontinence After Treatment for
Prostate Cancer
ANDREW GROLLMAN MD.
ALBUQUERQUE UROLOGY ASSOCIATES
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Overview
Most Common Treatments for Prostate cancer
Radiation
Prostatectomy
Side Effect of Those Treatments
Erectile Dysfunction (ED)
Urinary Incontinence
ED
Reasons
Treatment Options
Urinary Incontinence
Reasons
Treatment Options
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Treatment For Prostate Cancer
Radiation
External Beam Radiation
Proton Beam Radiation
Brachytherapy (seeds)
Prostatectomy(Surgical removal of the Prostate)
Open Surgery
Laparoscopic
Robotic
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Unfortunate Side Effects
after Treatment
1. Erectile Dysfunction
2. Urinary Incontinence
1. Urgency and Frequency (Radiation)
2. Obstruction (Radiation)
3. Stress Incontinence (Surgery)
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ED
Why Does it Happen
Erections largely controlled by a structure of nerves and blood vessels
called the Neurovascular Bundle
During Treatment (Radiation or Surgery), These nerves and blood vessels
are affected
This causes difficulties with erections after treatment
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Neurovascular Bundle
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The Neurovascular Bundle
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ED Treatments
1. Oral Medications
2. VED
3. Intra-urethral medications
4.Intra-corporeal Medications (Injections)
5. Penile Implants
Malleable
Inflatable
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ED Treatments
Oral Medication
Cialis
Two ways to take it (as needed or daily)
As needed…. 5,10,20mg
Daily….5mg
Viagra
Only can take on an as needed basis
25mg, 50mg, 100mg
Levitra
Also only on an as needed basis
2.5mg, 5mg, 10mg, 20mg
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Side Effects of Oral treatments for
ED
General medication side effects
Facial Flushing
Headache
Muscle Aches
Blurry Vision
Priapism
An erection Lasting over 4 hours
Very Rare
Need to go immediately to the Emergency Room
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VED
Vacuum Erection Device
Uses Pump to induce an erection
and then a Band to constrict
blood flow and Keep an erection
Lack of Spontaneity is the biggest
negative Factor
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Intraurethral Treatment for ED
MUSE
Alprostadil
Comes in Pellet Form that is injected in the urethral Meatus
Side Effects
Penile Pain and Burning
Priapism
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Intracorporeal Injections
Bi-Mix
Papavarine
Phentolamine
Tri-Mix
Alprostadil
Papaverine
Phentolamine
Need To Be shown how to use this for the first dose
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Side Effects from the Injections
Penile Pain
Penile Bruising
Priapism
Much more common than with oral meds
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Penile Implants
Used as a last resort when all other treatments have failed
Requires a surgical procedure
Two Types
Malleable
Inflatable
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Malleable Penile Implants
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Inflatable Penile Implants
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Inflatable Penile Implants
Requires a Surgical Procedure to place them
Complications from penile Implants
Erection does not feel the same
Erection likely will be shorter
Infection of the implant
Erosion of the Implant
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Urinary Incontinence After
Treatment for Prostate Cancer
Two Main Types of Incontinence
Urgency, Frequency
Stress Incontinence
The type of incontinence depends on what treatment is received
Radiation tends to cause urgency and frequency
Surgery tends to produce Stress Incontinence
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Urgency and Frequency
(Urge Incontinence) Urgency
The sudden and compeling urge to go to the bathroom with very little warning
Frequency
Going to the bathroom too often
After Radiation
Occurs due to the irritation of the Urinary Bladder
After Removal of the Prostate
Occurs due to removal of the obstruction that was previously there
Surgery Itself can irritate the bladder as well
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Treatment for Urgency and
Frequency
Oral Medications
Oxybutynin, Ditropan, Vesicare, Toviaz Myrbetriq
Most have side effects of dry eyes, dry mouth and constipation
Intra-vesicular mediations (Medicine put in the bladder)
Botox
Nerve Stimulator Devices
Posterior Tibial Nerve Stimulation
Interstim
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Stress Incontinence
What is it?
Involuntary leakage of urine with increase in abdominal pressure
There is no one reason why it occurs
Main reason is likely from the disruption of the normal anatomy after the
prostate is removed
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Stress Incontinence after Prostate
Removal
ALWAYS Happens
The severity varies dramatically between individuals
Tends to Resolve and improve spontaneously
Kegel Excercises help speed up return to normal urinary function
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Treatment of Stress Incontinence
1. Kegel Excercises
2. Male Sling
3. Artificial Urinary Sphinchter
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Kegel Exercises
Pelvic Floor Strengthening Excercises
How?
Imagine you are urinating and then you are told to stop your urinary stream
Squeeze and hold for about 10 seconds
Do this 10 times in a row for at least 4 sets per day
The more the better
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Kegel Excercises
Expect to see improvement in Stress Incontinence within weeks to
months
Improvement usually measured by number of Pads needed
Stress Incontinence usually resolves with this method within a year
but everyone is different
If the stress incontinence is still a problem after a year……….
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Male Sling
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Male Sling
Surgical Placement
Inceases resistance in the urethra to prevent leakage
Complication
Infection,
Erosion
Urinary Retention
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Artifical Urinary Sphinchter
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Artificial Urinary Sphincter
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AUS
Also Requires Surgery To place
Requires Manual Dexterity in order to be able to function it
Complications
Infection
Erosion in to the Urethra
Mechanical Failure
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Conclusions
All Treatment for Prostate Cancer can cause side effects of Erectile
dysfunction and urinary incontinence
Many of these conditions are self limited and will resolve on their
own
There are many good treatment options for both conditons
All Treatment options do have their own set of possible side effects and complications