Erectile Dysfunction and Bladder Cancer -Treatment Options
Men who have non-muscle-invasive bladder cancer often receive radiation to the pelvis, which can cause erectile dysfunction. This can happen 6 months to 2 years after treatment and may go away on its own or get better with time. This is because the nerves that control erections run through or around the prostate, which surgeons often remove during radical cystectomy.
Radical Cystectomy
When non-muscle invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) spreads into deeper layers of the bladder wall, a radical cystectomy may be needed. This is a surgery that removes the entire bladder along with any nearby lymph nodes and other organs in the pelvis. When performed by an experienced team, this treatment is highly effective. Sex power is increased by taking Fildena 100. However, it can cause permanent changes in urinary and sexual function. In men, these changes can include erectile dysfunction.
For this operation, your urologist makes one long vertical surgical incision (cut) in the body between your belly button and pubic bone. They insert their gloved hands into the body cavity through this incision to access the bladder and tissues surrounding it.
To find and remove the tumor, a thin, rigid tube called a cystoscope is placed into the urethra. The urologist then uses the resectoscope to remove any tumors, and they can destroy more cells with a high-energy laser. They also make sure that the margins are clean, meaning there is no remaining cancer at the edge of the area they removed.
Afterward, your doctor can create a new way for urine to leave the body. Urine is sometimes diverted into a pouch worn on the outside of your body, or it might be redirected to a part of the bowel or another bladder. In some cases, your doctor might even put a neobladder inside the body, which is very similar to how a person’s natural bladder functions.
After a radical cystectomy, your doctors will probably ask you to move around a lot. This helps prevent complications like blood clots and promotes healing. Your doctors may also want you to take walks around the hospital and get up and down out of bed often, especially at night.
Researchers have found that many people who have had a radical cystectomy experience issues with their sexual functioning. This is mainly because the nerves that allow men to have erections run right through the prostate. Surgeons who perform a radical cystectomy tend to partially transect or remove these nerves when they are doing the procedure.
Transurethral Resection of the Bladder (TURB)
TURBT is the most common treatment for early-stage or superficial bladder cancer (non-muscle invasive). The doctor accesses your bladder through the urethra. A thin, flexible instrument called a cystoscope is then inserted into the bladder. It has a wire loop at the end that is used to remove abnormal tissue or tumors. These samples can be sent to a pathologist for examination. If the doctor can’t completely remove a tumor, they might use an electric current or high-energy laser to burn the remaining cells and destroy them.
After TURBT, the surgeon might perform a barbotage urine sample using normal saline irrigation to assess for possible bladder perforation or other surgical complications. They might also use a technique known as bipolar TURP to decrease the risk of developing low sodium in the blood (TUR syndrome). TUR syndrome can be life-threatening if it isn’t treated promptly.
The surgeon might also perform a procedure known as needle biopsy (NBI) to check whether the tumors are CIS or NMIBC. The surgeon inserts a fine needle into the bladder through the urethra. They then inject a dye into the kidneys and bladder so they can see the tumors better. A urologist might be present to assist with the procedure.
If a tumor is found, the doctor might need to re-operate to get more tissue for testing under a microscope and complete the removal. The patient might be given anesthesia to sleep through the procedure.
During re-operation, the doctor might also use a urethral catheter to fill the bladder. This helps the doctor remove any remaining tissue and ease symptoms such as painful urination. They might also insert a new catheter into the urethra to administer chemotherapy.
If you have non-muscle invasive bladder cancer, the doctor might put chemotherapy directly into your bladder straight after a TURBT to destroy any cancerous cells that weren’t removed with the first surgery. They might also give you medication to take by mouth or through a tube into your bladder that helps kill cancer cells. These medications are called immunotherapy or systemic therapy. They might be given on their own or in combination with other treatments such as radiation therapy, which uses high-energy X-rays to destroy cancer cells.
Intracorporeal Injection of Medication (ICM)
A cancer diagnosis and treatment can have a profound impact on a person’s quality of life. That’s why it’s important to talk with your doctor about the possible side effects of any treatment and how they might affect your lifestyle. This is called shared decision-making and it helps to ensure that you and your doctor are choosing treatments that fit your goals for the best possible outcome.
Many men undergoing large-scale, organ-removing surgeries for invasive bladder cancer experience erectile dysfunction (ED). This is primarily because of the preoperative injury to the neurovascular bundle that results in loss of erections following cystectomy and other surgery (see “Erectile Dysfunction After Bladder Surgery” below).
The good news is that ED after these intercourse may be treatable with a combination of techniques, including the use of Vidalista 20 prescription. This includes a range of oral medications and penile injections that increase blood flow to the erectile tissue. It’s also possible to perform nerve-sparing radical cystectomy, which reduces the risk of erectile dysfunction by maintaining function in the remaining bladder and urinary diversion system.
Oral phosphodiesterase type 5 inhibitors are first-line therapy for ED in men with bladder cancer, and many patients find that combining this treatment with an intracavernosal injection of vasoactive drugs improves their outcomes. This treatment, which involves placing a small amount of the drug directly into the penis’ intracavernal space, is effective and has been shown to improve patient satisfaction.
In addition to a variety of oral phosphodiesterase type 5 inhibitors, the U.S. Food and Drug Administration has approved several other medications for erectile dysfunction in men with bladder cancer, including nivolumab (Bavencio). These are given through a catheter inserted into the urethra and targeted to a specific area of the prostate.
Some systemic chemotherapies, such as cisplatin (Platinum), used to treat muscle-invasive bladder cancer, can cause erectile problems when they enter the body through the bladder and urethra. These drugs are often given before surgery as part of a treatment plan called neoadjuvant chemotherapy. If the chemo shrinks or stabilizes advanced or metastatic urothelial bladder cancer, it can be switched to maintenance treatment with immunotherapy, which has fewer long-term side effects.
Radiation Therapy
Often, cancer treatments like radiation or surgery cause changes that impact a person’s ability to have and enjoy sex. For example, a prostate or bladder cancer treatment that involves surgery to remove the prostate (radical prostatectomy) or radiation therapy to the pelvic area can damage blood vessels and tissue in the penis and pelvis, which can lead to erectile dysfunction. Sometimes, chemotherapies can also interfere with sexual function.
If a man’s tumor grows into the muscle of the bladder wall, he may need to have a surgical procedure called a radical cystectomy. This surgery removes the bladder, prostate gland, and usually the seminal vesicles. Men who have this type of surgery can still have orgasms, but they won’t be able to produce semen. This type of surgery can also affect a man’s ability to have erections and to get them back after an orgasm.
In these procedures, a camera with working tools is inserted through a patient’s urethra to scrape away the bladder tumor. Porten says that these procedures can interfere with a patient’s erectile functions by damaging the nerves that control erections and the fluid that makes up sex.
A new type of radiation treatment has been shown to preserve a patient’s ability to have and maintain an erection. This technique is called brachytherapy and involves placing radioactive seeds or ribbons in the body near the site of cancer, which stays in place for a few minutes to a few days. It can be used to treat many types of cancer, including prostate, bladder, cervix, head and neck, or body tumors.
This uses a machine outside of the body to direct a beam of X-rays at the site of cancer, and it can be used in conjunction with other cancer treatments, including chemotherapy. Different types of radiation delivery systems are available, including intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and stereotactic body radiation therapy (SBRT). All of these deliver smaller doses of radiation over long periods to reduce the risk of harming healthy tissues.