Pre-surgery exercises can save prostate patients’ love lives by reducing the risk of impotence

Any cancer diagnosis can be very painful, but for men who have been told they need surgery to remove a tumor that has invaded their prostate, the threat of becoming impotent from the procedure can be nearly as bad.

Radical prostatectomy involves removing the walnut-sized prostate gland located between the bladder and rectum to remove the cancer.

But the surgery carries a high risk of damage to the sensitive nerves and arteries that keep the penis in good condition.

Around 5,000 men a year in the UK undergo prostatectomy, and although modern techniques – known as nerve-sparing surgery – can reduce the risks, the UK Prostate Cancer Society warns that up to 80% of these patients subsequently experience erectile dysfunction severe enough to cease. jeopardizes their sex lives and puts pressure on their relationship. They may also suffer from incontinence.

But growing evidence shows that men’s risk of sex life can be radically reduced if given a “pre-habilitation” program that includes treatments and exercises to prevent or significantly limit loss of masculinity prior to surgery.

These include regular doses of the erectile dysfunction drug Cialis (generic name, tadalafil) a few weeks before surgery to dilate the small blood vessels that supply the genitals and improve their condition.

Along with daily exercises to strengthen a man’s pelvic floor muscles, regular use of a vacuum pump device is also recommended to create stronger erections by drawing blood into the penis, causing an erection.

The NHS already regularly approves many of these measures as part of a family doctor-supervised rehabilitation program to help men repair any surgical damage after their prostates are removed. But a growing body of research is showing that the benefits are potentially much greater if these steps are taken long before patients enter the operating room.

A former consultant in urology and sexual medicine at Good Hope Hospital in Birmingham and former president of the British Society for Sexual Medicine, Dr. “It’s really easy,” says Geoff Hackett.

“What’s the point of doing all this if damage has already been done during the surgery? If the nerves, blood vessels and muscles that control them go to the operating room in a healthier way, erectile and urinary functions will recover and recover much faster.’

A study published in the journal Oncology in April 2022 by researchers at the Korea University School of Medicine in Seoul compared the results of 21 men who took the medication with 20 men who took a daily dose of 5 mg of tadalafil two weeks before the prostate was removed. four weeks after surgery.

Twelve months after surgery, 80 percent of men who had previously taken the drug had regained most of their erectile function, compared with 71.4 percent in the post-operative treatment group.

“This suggests that preoperative penile rehabilitation may lead to better erectile function than a post-operative approach,” the researchers wrote.

Dr. Hackett says pre-administering medications like tadalafil helps improve blood flow in the penis and increases the chances of regaining full erectile function after surgery.

But she says the drug works best when a surgeon plans nerve-sparing surgery that minimizes damage to the small nerve bundles near the prostate that control a man’s erections.

Traditional prostatectomy, in which a large tissue margin is removed, as well as the prostate if malignant cells have spread, is more invasive, destroying sensitive nerves and blood vessels and limiting the effects of the drug.

However, daily tadalafil is currently only approved for postoperative rehabilitation by the National Institute for Health and Care Excellence (NICE) health surveillance institute.

Dr. “The problem is that there are still no large-scale studies proving its effectiveness before surgery, so it’s very difficult to get NICE to confirm this,” Hackett says.

“So men seeking further treatment often have to take tadalafil by special prescription. I see these patients all the time and would ideally recommend starting two to three months before surgery.

Similarly, other studies have shown that starting simple pelvic floor exercises before prostate surgery produces better results than when the patient is often too uncomfortable to do them properly.

The pelvic, obstetric, and gynecological physiotherapy group — an organization of physical therapists specializing in pelvic floor exercises — says the exercises strengthen two main muscles: the bulbocavernosum and ischiocavernosus, which surround the base of the penis, which act like a group of muscles. Male threads to keep the penis erect.

London-based private physical therapist Clare Bourne, who specializes in helping men prepare for prostate surgery, says the exercises can be done at home or on the train to work, ideally at least six weeks before surgery.

“One exercise is to imagine trying to hold the wind,” he says. This causes the pelvic muscles to contract.

Another is to gently lift the testicles by squeezing the pelvic floor muscles. Do this five or ten times and repeat three times a day.

He says the exercises stimulate the release of a protein, vascular endothelial growth factor, which stimulates the regeneration of nerves in the penis and increases muscle strength. Regular contraction of the pelvic muscles also stimulates blood flow to the genitals.

Besides the physical benefits, Clare Bourne believes pelvic “prehab” also helps men psychologically.

“For many, they’ve been told to work their pelvic floor muscles for the first time, and they often benefit mentally from knowing that they did everything they could before surgery to save their sex life afterwards.”

For a guide to pelvic floor exercises for men to prevent erectile dysfunction, visit thepogp.co.uk.