Male Sexual Dysfunction · Sexual dysfunction - conclusion • Very common in cancer patients, especially in patients with cancer in the pelvic organs or in the genital organs •

Male Sexual DysfunctionLotta Renström Koskela

Sexual side effects of cancer treatment

More likely after treatment for cancers in the pelvic area and genitals

• Prostate cancer

• Bladder cancer

• Rectal cancer

• Anal cancer

• Colon cancer

• Testicular cancer

• Penis cancer

Older men are more likely to experience sexual dysfunction

LUTD meeting Copenhagen 2020 - Price of the cure

Sexual side effects

Inability to achieve or maintain an erection

Difficulty climaxing

Orgasm without discharge of semen

Weaker, less satisfying orgasms

Retrograde ejaculation

Loss of interest in sex

Pain during sex

Less energy for sexual activity

Feeling less attractive


Causes for sexual side effects - surgery

• Direct damage to nerves

involved in erection and

ejaculation

• Amputaion of the penis

• Removal of anal canal and

rectum

• Having a colostomy, ileostomy

or Bricker deviation



• Direct damage to nerves

involved in erection and

ejaculation

• Amputaion of the penis

• Removal of anal canal and

rectum

• Having a colostomy, ileostomy

or Bricker deviation




Intra fascial plane: fascia absent on the specimen (glandular tissue atmargin !)

Inter fascial plane: fascia partlypresent on the specimen

Extra fascial plane: fascia entirelypresent on the specimen

Causes for sexual side effects - radiotherapy

• Damage to nerves and vessels involved in erection

• Scarring of the anal canal and rectum

• Impaired testicular function

• Radiation proctitis


Causes for sexual side effects - chemotherapy

• Fatigue

• Lower libido

• Change in hormonal balance

• Neuropathy – uncommon to affect erectile nerves


Sexual dysfunction and infertility as late effects of cancer treatment. Leslie R. Schover et al. EJC Suppl.2014 Jun; 12(1):41-53

Erectile dysfunction - treatment

• Early penile rehabilitation after surgery

• Vaccume pump

• PDE5 inhibitors

• Alprostadil

• Transdermal gel

• Urethral aplication

• Intracavernous injection

• Invicorp - Fentolamin+Aviptadil


Erectile dysfunction – Erectile Implants


Erectile implants – pre operative evaluation

• Mental status

• Obesitas / hidden penis

• Diabetes

• Eye sight, hand function

• Penis length, curvature, fibrosis of corpora

• Micturition status, urinary flow, retention

• Patient expectations


Erectile implants – surgical technique


Erectile implants - complications

• Implant infection

• 1-3 % primary surgery

• 10-13 % revision surgery

• Mechanical failure

• 68 % revision free survival after 10 years

• 59 % revision free survival after 15 years

• Erosion

• 1-6 %

• More common in radiated patients

• More common with malleable implants


An update on the best approaches to prevent complications in penile prosthesis recipients . Sarah C. Krzastek and Ryan Smith. Ther Adv Urol 2019, Vol. 11: 1–9

Erectile implants - satisfaction

• 98% thought the implant gave a good or very good rigidity

• Patient satisfaction was 83-97% for the 3-piece inflatable implant and 64-

75% for the malleable

• 85-91% of the partners were satisfied with the 3-piece inflatable implant

and 75% of the partners for the malleable

• 25% of the partners thought that it felt unnatural

• In one study 92% used theire implants 1.7 times per week


Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany. Natali A, Olianas R, Fisch M. J Sex Med. 2008 Jun;5(6):1503-12. doi: 10.1111/j.1743-6109.2008.00819.x. Epub 2008 Apr 10.

Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Jorissen C, De Bruyna H, Baten E, Van Renterghem K. Curr Urol. 2019 Oct;13(2):94-100. doi: 10.1159/000499286. Epub 2019 Oct 1.

Erectile implants - satisfaction

• 98% thought the implant gave a good or very good rigidity

• Patient satisfaction was 83-97% for the 3-piece inflatable implant and 64-

75% for the malleable

• 85-91% of the partners were satisfied with the 3-piece inflatable implant

and 75% of the partners for the malleable

• 25% of the partners thought that it felt unnatural

• In one study 92% used theire implants 1.7 times per week


Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany. Natali A, Olianas R, Fisch M. J Sex Med. 2008 Jun;5(6):1503-12. doi: 10.1111/j.1743-6109.2008.00819.x. Epub 2008 Apr 10.

Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Jorissen C, De Bruyna H, Baten E, Van Renterghem K. Curr Urol. 2019 Oct;13(2):94-100. doi: 10.1159/000499286. Epub 2019 Oct 1.

Erectile implants – numbers per year

Sweden: ~ 50 (10 milion inhabitants)

Europe: ~ 2 000 (740 million inhabitants)

USA: ~ 20 000 (327 milion

inhabitants)

600 per year


Sexual dysfunction - conclusion

• Very common in cancer patients, especially in patients with cancer in the

pelvic organs or in the genital organs

• Sexual dysfunction in men is much more than erectile impairment

• It is important to address these problems with the patients

• Pre-treatment

• After treatment

• Sexual counselling increases compliance to therapies improving sexual

function and satisfaction


Rectal cancer surgery and radiotherapy in 2012

Has a colostomy, has previously had an ileostomy

Diabetes, APC-resistance

Plasma cell balanitis – circumcised but still have problems

Erectile function has decreased the last years and he can no longer get an erection

Just met a new partner

Has tried vaccume pump, PDE5-I and intracavernal treatment but it does no longer work


- 1966

Micturition:

• Takes a long time, has problems emptying the bladder,

• Goes up several times every night, IPSS 19.

Free flow with an obstructive curve

Residual urine is 230 ml

Can we give him an implant?


Erectile dysfunction

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Male Sexual Dysfunction · Sexual dysfunction - conclusion • Very common in cancer patients, especially in patients with cancer in the pelvic organs or in the genital organs •