Chapter 14: Continence and Male Erection after Robotic Prostatectomy

Dr. David B. Samadi, Chief of Division of Robotics and Minimal Invasive Surgery for Mount Sinai School of Medicine, discusses continence and male erection after robotic prostatectomy. He says that with the majority of patients, they are dry within 3 months. Patients who wear pads do so for safety reasons. About 10% of patients struggle, but after time with the help of the team and exercises it goes down. Kegel exercises are often done wrong. It’s hard to educate. Everyone does it differently. But majority of patients in one year get their continence back and reduce need for pads. Factors for continence include obesity, improper or inadequate kegel exercises, lower urinary tract symptoms pre-op. He advocates conservative management with patients, counsels them to do their exercises, see their doctor every 3-6 months for improvement and heal at their own speed. Dr. Samadi says that preliminary studies show there is no strong data to support the use of Viagra after surgery. Insurance companies only give 6 pills at a time. Patients get drugs from India, etc. If erection comes naturally, doctor leaves it alone and it will get better. Sometimes Samadi prescribes low dose Viagra every night. 3 yr data is close to 90% of erectile function. If nerves are intact, then Viagra Cialis & Levitra will work.

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