In males, in addition to removal of the bladder, the procedure includes removal of the prostate and seminal vesicles. The portion of the procedure involving the prostate and seminal vesicles is essentially identical to that per-formed during a radical prostatectomy for prostate cancer. Thus, you share the same risks of erectile dysfunction after surgery as do men after prostate cancer surgery.
Over the last several years, techniques have been developed to preserve the nerves that travel next to the prostate on their way to the penis. If your surgeon is able to apply these techniques during your surgery, the odds of having a normal return of erections is improved.
The prostate and seminal vesicles produce the fluid that forms the ejaculate; thus with orgasm there will be no fluid ejaculation. Additionally, because the vas deferens is cut during the surgery, no sperm will be ejaculated.
Thus, even with normal return of erections and orgasm, it would be impossible to get your partner pregnant through intercourse. The testicles do continue to produce healthy sperm, however, making conception possible through in vitro fertilization. With modern techniques, sperm are removed from the testicle or epididymis, and eggs are removed from the woman.
The egg is fertilized by the harvested sperm and reimplanted into the woman’s uterus, allowing for a normal pregnancy thereafter.
Even without bladder or prostate surgery, erectile dysfunction is a very common problem. Fifty percent of men aged 40 to 70 are affected. Men with erectile dysfunction should talk to their doctor about the problem before surgery as well as after the recovery process.
Fortunately, several easy options are now available to treat erectile dysfunction, including pills, intraurethral therapy, injection therapy, vacuum devices, and surgically inserted prosthetics (see Question 71) .
Patient says:
My husband had a radical cystectomy and an ileal conduit and had no evidence of any cancer outside of the bladder wall. We were so scared, and then so relieved to hear this information. As time went on and we resumed our normal daily routines and became comfortable with his stoma and the bag, we decided to resume sexual relations.
Unfortunately, as a result of his surgery he couldn’t get an erection. Our doctor had warned us about this, so we felt comfortable discussing it during one of our follow-up appointments. The doctor prescribed some pills, but these didn’t work for my husband.
He then tried injection therapy. This has worked. Although he would prefer not to have to give himself a penile injection, he finds that this option was better than the other ones that were described. We are now able to lead a complete life, similar to before the surgery.