Benign Prostatic Hyperplasia & Erectile Dysfunction

Many men who have benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate, also experience erectile dysfunction (ED). Although BPH does not itself cause this condition, some of the treatments used for BPH can do so. For example, finasteride (Proscar), an antitestosterone drug prescribed for BPH, has been linked to ED in 3.7% of men who use it and to diminished libido in 3.3%. But alpha blockers such as terazosin (Hytrin), tamsulosin (Flomax), and doxazosin (Cardura) can improve the symptoms of BPH with a lower risk of sexual side effects.It’s uncertain whether transurethral resection of the prostate (TURP), a surgical technique often used when medication fails, also causes ED. A 2007 prospective study of 1,014 European men concluded that TURP did not affect self-assessed quality of erections, although it can cause semen to back up into the bladder rather than exiting the tip of the penis through the urethra (a phenomenon called retrograde ejaculation). While harmless — the semen simply mixes with urine in the bladder before leaving the body — this can impair fertility.

Stepping in early after cancer treatment

Penile rehabilitation is an umbrella term for a variety of evolving therapies intended to preserve sexual ability after prostate cancer treatments. First introduced by European physicians in 1997, the strategies usually involve frequent use of oral or injected medications, alone or in addition to interventions like the vacuum pump. While still controversial, these therapies are available at some major teaching hospitals.

Nerve damage following radical prostatectomy can derail the impulses that trigger erections. When the damage is temporary — a condition called neuropraxia — the nerves may recover enough to enable a man to have spontaneous erections. But such repair work can take up to two years. Unfortunately, in that time, collateral damage may occur.

During erections, oxygen-rich blood courses through blood vessels into cells of the penis. Research suggests that when the penis is flaccid for long periods, the low oxygen level causes a loss of flexibility in some muscle cells of the corpora cavernosa, the two columns of erectile tissue flanking the sides of the penis. Gradually, these cells change into something akin to scar tissue that seems to block expansion even when the penis swells with blood. And, in fact, blood may drain away from the penis rather than fill it, according to some imaging studies.

While less is known about how radiation causes ED, experts speculate that there are similarities. Radiation harms the lining of small blood vessels, though the damage may take months or years to manifest.

By stepping in early, often within one to three months of surgery, penile rehabilitation may help restore erectile function by regularly enhancing blood flow to the penis, thus possibly avoiding the buildup of scar tissue. And it may help a man return to sexual activity sooner. Preliminary studies are small but promising. Larger, randomized trials are needed to determine how effective different approaches are, along with optimal timing for starting therapy.

 

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