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ERECTILE DYSFUNCTION IN THE TREATMENT OF PROSTATE CANCER
Complications of prostate cancer treatment
Despite nerve-sparing surgery or the finest brachytherapy, nearly all men treated for prostate cancer experience some degree of impotence during the first months of treatment.The reason for this is that the nerves and blood vessels responsible for erection are very delicate and sensitive to any slightest injury.
During the year in men, with the integrity of nerve fibers, a gradual improvement is noted. This means that after a year, half of the patients who underwent nerve-sparing surgery have the same erection as before treatment, and after two years - in 75% of patients.
In patients who underwent radiation therapy, these indicators are better, but at the same time, they are characterized by a longer recovery period for the lost function. After brachytherapy, impotence occurs in 25% of men, and after external beam radiation therapy - in 50%.
If the patient underwent treatment that was not aimed at preserving the integrity of the nerves or was carried out by a non-specialist, the erection situation deteriorates significantly. If the patient suffers from diseases in which there is a violation of blood flow in the vessels (diabetes mellitus, atherosclerosis), then this also significantly impairs the restoration of erection.
Erectile dysfunction treatment
Let's first look at how an erection occurs. With sexual stimulation along the nerves that run along the penis, the impulses along them reach the muscles. These muscles relax and blood fills the cavernous bodies of the penis. They look like a sponge, which in this case is "saturated" with blood. At the same time, thin valves close the lumen of the vessels of the penis, as a result of which blood cannot flow through the veins.
Currently, many methods have been proposed for the treatment of impotence. These are medical treatment, special mechanical devices and surgical methods.
Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) are the most well-known medications for the treatment of impotence. The mechanism of action of these drugs is that they relax the muscles of the penis, allowing blood through the blood vessels to fill the corpora cavernosa. On average, these drugs begin their action one hour after ingestion. The effect of Viagra and Levitra lasts an average of 8 hours, and Cialis - 36 hours. About 75% of men who have undergone nerve-sparing prostatectomy or selective radiotherapy report the effectiveness of these drugs.
These drugs are not suitable for all patients. Many men at the age when they are undergoing treatment for prostate cancer can also suffer from heart disease, in particular angina, for which nitrate drugs (nitroglycerin) are taken. The above three drugs that are used to treat impotence change the mechanism of action of drugs that are used to treat angina pectoris. As a result, the patient's blood pressure may drop sharply. These drugs affect the mechanism of action of alpha-blockers, drugs used to treat prostate adenoma.
When a patient cannot use these drugs or does not want to, he has the opportunity to use some mechanical devices.
One of these devices is a vacuum device that creates an erection mechanically by forcing blood into the cavernous bodies of the penis. After that, a special rubber ring is put on the base of the penis, which prevents the reverse flow of blood. Approximately 80% of men in the United States who have had a prostatectomy find the use of such devices effective. It should be noted that the imposition of a rubber ring on the base of the penis leads to a cessation of blood flow to the organ, so it must be removed immediately after intercourse.
Surgical treatments
Surgical treatments for impotence are used in cases where all other methods do not give the desired effect. One of the most common methods used is the insertion of implants. An erection is created.
The effectiveness of this method reaches 100%, while 70% of men who choose this method remain with these implants even after 10 years.
Surgical treatments, including the one indicated, are performed under general anesthesia, so they are not suitable for patients with concomitant diseases that are a contraindication to surgery.Prostate Eating
IMPOTENCY IN PROSTATE CANCER
Side effects of prostate cancer treatment
Despite nerve-sparing surgery or the finest brachytherapy, nearly all men treated for prostate cancer experience some degree of impotence during the first months of treatment.The reason for this is that the nerves and blood vessels responsible for erection are very delicate and sensitive to any slightest injury.
However, during the year in men, with the integrity of nerve fibers, a gradual improvement is noted. This means that after a year, half of the patients who underwent nerve-sparing surgery have the same erection as before treatment, and after two years - in 75% of patients.
In patients who underwent radiation therapy, these indicators are better, but at the same time, they are characterized by a longer recovery period for the lost function. After brachytherapy, impotence occurs in 25% of men, and after external beam radiation therapy - in 50%.
It is worth noting that if the patient underwent treatment that was not aimed at preserving the integrity of the nerves or was carried out by a non-specialist, the erection situation worsens significantly. In addition, if the patient suffers from such diseases in which there is a violation of blood flow in the vessels (diabetes mellitus, atherosclerosis), then this also significantly impairs the restoration of erection.
Erectile dysfunction treatment
Let's first look at how an erection occurs. With sexual stimulation along the nerves that run along the penis, the impulses along them reach the muscles. These muscles relax and blood fills the cavernous bodies of the penis. They look like a sponge, which in this case is "saturated" with blood. At the same time, thin valves close the lumen of the vessels of the penis, as a result of which blood cannot flow through the veins.
Currently, many methods have been proposed for the treatment of impotence. These are medical treatment, special mechanical devices and surgical methods.
Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) are the most well-known medications for treating impotence.
The mechanism of action of these drugs is that they relax the muscles of the penis, allowing blood through the blood vessels to fill the corpora cavernosa. On average, these drugs begin their action one hour after ingestion. The effect of Viagra and Levitra lasts an average of 8 hours, and Cialis - 36 hours. About 75% of men who have undergone nerve-sparing prostatectomy or selective radiotherapy report the effectiveness of these drugs.
However, these drugs are not suitable for all patients. Many men at the age when they are undergoing treatment for prostate cancer may also suffer from heart disease, in particular angina, for which nitrate drugs (nitroglycerin) are taken.
The above three drugs that are used to treat impotence change the mechanism of action of drugs that are used to treat angina pectoris. As a result, the patient's blood pressure may drop sharply. In addition, these drugs affect the mechanism of action of alpha-blockers, drugs used to treat prostate adenoma.
In the case when the patient cannot use these drugs or does not want to, he has the opportunity to use some mechanical devices.
One of these devices is a vacuum device that creates an erection mechanically by forcing blood into the cavernous bodies of the penis. After that, a special rubber ring is put on the base of the penis, which prevents the reverse flow of blood. Approximately 80% of men in the United States who have had a prostatectomy find the use of such devices effective. It should be noted that the imposition of a rubber ring on the base of the penis leads to a cessation of blood flow to the organ, so it must be removed immediately after intercourse.
Surgical treatments
Surgical treatments for impotence are used in cases where all other methods do not give the desired effect. One of the most common methods that is used is the introduction of implants.
An erection is created.
The effectiveness of this method reaches 100%, while 70% of men who choose this method remain with these implants even after 10 years.
It is worth noting that surgical methods of treatment, including the one indicated, are performed under general anesthesia, so they are not suitable for patients with concomitant diseases that are a contraindication to surgery.
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Methods of treatment of prostate cancer are constantly being improved. This has significantly reduced the severity of side effects. Still, it is important to understand how and why these effects appear. It is equally important to know how best to minimize these effects.
In the treatment of prostate cancer, there are usually six categories of side effects:
Intestinal dysfunction
Erectile dysfunction (impotence)
Infertility (impaired fertility)
Effects associated with decreased testosterone levels
Side effects of chemotherapy
Some symptoms may require immediate medical attention, and some are not so terrible for the patient.
Urination disorders are divided into urinary incontinence, which can be of varying severity, and irritation of the urinary tract, which are manifested by pain and burning during urination, as well as frequent urination. Urinary dysfunction is the most common side effect of prostate cancer treatment. Especially during surgical treatment (prostatectomy).
This complication occurs in approximately 25% of men undergoing surgical treatment for prostate cancer. Within six months after treatment, they are forced to use special absorbent pads. About a year after treatment, the percentage of such men decreases to 10.
With external radiation therapy, there may be irritation of the mucous membrane of the bladder and urethra, or swelling of the prostate. Most of these symptoms improve over time without any medical intervention. In 10% of men, these symptoms may persist. After 2 years, drug treatment is required to eliminate them.
After brachytherapy, urinary symptoms are more pronounced. During the first six months after the implantation of radioactive seeds, these symptoms occur in 70% of cases. This requires medical treatment. After two years, the number of such patients decreases to 25%.
In order to cope with the symptoms of side effects after radiation therapy, drugs that improve urination are usually used. All patients who have undergone radiation therapy for prostate cancer are prescribed alpha-blockers (tamsulosin, terazosin). They are taken for a few weeks and discontinued as symptoms improve.
If medical treatment is not successful, minimally invasive methods are used.
One of these methods is the introduction of collagen into the urethra. After this procedure, the urethra becomes denser, and the lumen narrows. This leads to a reduction in the symptoms of urinary incontinence. More than half of the patients after such a procedure have a positive effect, but it does not last long.
Surgical methods allow you to get a longer effect. The surgical procedure involves inserting a loop of silicone or tissue from the patient under the urethra. This loop is attached to a muscle or bone. The urethra is then released from the pressure exerted on it by the overflowing bladder. This procedure is effective in 70% of men after prostatectomy.
Intestinal dysfunction
Impaired bowel function is diarrhea (frequent loose stools) and fecal incontinence, as well as bleeding during bowel movements. These side effects are most common with external beam radiation therapy. The appropriate selection of the course of radiation therapy and the dose of radiation allows to reduce the risk of this complication.
Impaired bowel function during prostatectomy is rare, and in the first weeks after surgery. This side effect is the result of the "addiction" of the body to the increased volume after the removal of the prostate.
In 10% of men, 2 years after treatment, diarrhea persists up to several times a week, and bleeding from the rectum increases from 5% immediately after treatment to 25% after 2 years.
In patients who underwent intensive modulated radiation therapy, after two years, the incidence of bowel dysfunction remained low and amounted to only 5%. The same was observed with brachytherapy, in which the incidence of this complication is low.
If this complication occurs, you should consult a doctor, and not self-medicate.
Treatment for this complication is to use a non-irritating diet.
To treat this complication, sea buckthorn oil enema, vitamins A and E and other drugs are used that promote healing of the affected rectal mucosa.
Impotence (erectile dysfunction) due to prostate cancer
When undergoing nerve-sparing surgery or fine-tuned brachytherapy, in the treatment of prostate cancer, during the first months of treatment, almost all men experience impotence in varying degrees of severity. The nerves and blood vessels responsible for erection are very delicate and sensitive to any slightest injury, this is the cause of impotence.
With the integrity of nerve fibers during the year in men, there is a gradual improvement. The same erection as before treatment is noted in a year in half of the patients who underwent surgery using the nerve-sparing technique, and after two years in 75% of patients.
These indicators are better in patients who have undergone radiation therapy, but at the same time, a longer period for the restoration of lost function is characteristic. After remote radiation therapy, impotence occurs in 50% of men, and after brachytherapy in 25%.
If the patient has undergone treatment that was not aimed at preserving the integrity of the nerves, the situation with erection worsens significantly.
Also, if the patient suffers from diseases such as diabetes mellitus, atherosclerosis, in which there is a violation of blood flow in the vessels, this also significantly impairs erection recovery.
A lot of methods have been proposed for the treatment of impotence. These are surgical methods, drug treatment and special mechanical devices.
Surgical treatments
Surgical treatments for impotence are used when all other methods fail.
One of the most common methods is the introduction of implants. The effectiveness of this method reaches 100%, while 70% of men who choose this method remain with these implants even after 10 years.
The best-known medications for treating impotence are sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These drugs relax the muscles of the penis and allow blood through the blood vessels to fill the corpora cavernosa. These drugs begin their action one hour after ingestion. The effect of Viagra and Levitra lasts about 8 hours, and Cialis 36 hours. 75% of men who have undergone nerve-sparing prostatectomy or selective radiotherapy report the effectiveness of these drugs.
These drugs are not suitable for all patients. These three drugs change the mechanism of action of drugs that are used in the treatment of angina pectoris. As a result, the patient's blood pressure may drop sharply. In addition, these drugs affect the mechanism of action of alpha-blockers of drugs used to treat prostate adenoma.
In the case when the patient cannot or does not want to use these drugs, he has the opportunity to use some mechanical devices.
One such device is a vacuum device. It creates an erection mechanically, forcing blood into the cavernous bodies of the penis. After that, a special rubber ring is put on the base of the penis, which prevents the reverse flow of blood. The imposition of a rubber ring on the base of the penis leads to a cessation of blood flow to the organ, so it must be removed immediately after intercourse.
Male infertility due to prostate cancer
With surgical treatment or radiation therapy, despite all kinds of attempts by doctors, a man becomes infertile after treatment.
During the operation, the prostate gland itself, the most important organ involved in the formation of sperm, and the seminal vesicles "storage" of sperm, which are involved in the formation of its composition, are removed. Removal of the prostate and seminal vesicles makes it impossible to ejaculate.
Radiotherapy also leads to infertility. Irradiated cells of the prostate and seminal vesicles cannot produce the necessary sperm components responsible for sperm motility.
Solving the problem of infertility
To date, medicine has made great strides in the treatment of infertility in men. However, the results of treatment do not lead to the restoration of fertility. They are just auxiliary methods to help fertilize the egg.
The most acceptable is the use of sperm from a cryopreservation bank. Prior to treatment, the man donates his sperm, which is instantly deep-frozen in liquid nitrogen. In this state, sperm can be stored for quite a long time.
IVF/ICSI is another method that allows you to fertilize an egg. In this case, spermatozoa are taken by biopsy using a syringe directly from the testicle. With the help of special procedures, the most viable spermatozoa are isolated. This is followed by a procedure known as in vitro fertilization (IVF). For this, an egg is taken from the woman's ovary. Fertilization is carried out outside the woman's body (in vitro). After a certain time, the resulting new organism is placed in the woman's uterus.
These methods cannot currently guarantee 100% success, but their effectiveness is gradually improving.