What is Nerve-Sparing Prostatectomy?
Prostate cancer is an oncological disease in aged men. Unwilling to attend an annual medical examination by a specialist leads to aggravation of this disease and its detection at late stages. There are many methods of therapy of this cancerous disorder, and surgery is one of them. If a man consults a physician timely, oncotomy will be performed without complications. But more often, patients consult a specialist when they have symptoms indicating the late stage. According to tumor size, disease state and localization of swelling, operation is conducted in various ways.
Widely-spread operation for tumor removal is radical prostatectomy. Prostatic gland is removed completely in case cancer is located in this gland; also adjacent tissues, neck of the urinary bladder, seminal vesicles and lymph glands are liable to dissection as well. Generally, oncotomy is performed at first or second stages of the disease, but in case metastases are present, it may be conducted at the third stage. Age of a patient is taken into account, since he must not be above 75 years of age.
Nerve-sparing prostatectomy is performed for prophylaxis of consequences of surgical treatment. Two fascicles controlling erection are located lengthwise the prostatic gland. During nerve-sparing prostatectomy a surgeon tries not to damage these fascicles. It is not always possible to remove prostatic gland without affecting nerves. This operation can spare not only fascicles, but also parts of cancerous cells. Surgeon estimates the degree of affection of neurovascular tissues by cancerous cells within the course of operation. He removes vessels and nerves regardless of patient’s request. It is explained by the fact that the result of oncotomy, whereas erection may be restored by means of prosthesis. Nerve-sparing prostatectomy is conducted in those who are diagnosed cancer at an early stage and tumor does not go beyond male gland. In case cancerous process affected nerves or grew into their cells, NSP is not performed.
After the operation, a patient is directed to reanimation where attending doctor examines his condition, observes his anesthesia recovery and conducts necessary therapeutic procedures. In order to check patient’s post-operative condition, the controlled tests are performed. If operation passed uneventfully, a patient is directed to a common chamber next day. He is prescribed antibiotics and anti-inflammatory medications. Stitches are taken out in a week. Recovering patient may get on with his work in a month reducing physical activities. Post-operative period lasts one year.
Experimental data of Cialis application
A growing number of patients suffering from prostate cancer undergo nerve-sparing prostatectomy due to which the problem of their rehabilitation and potency restoration becomes particularly pressing. The remedies of the first line for erectile dysfunction in these patients are phosphodeisterase-5 inhibitors (PDE5) and in particular, the medicine of prolonged effect, Cialis.
Prostate cancer is a serious problem of modern medicine. It takes the fourth position according to morbidity rate and the first position in regards to its increment among all malignant tumors in men. In the meantime, due to introduction of PSA test, the morbidity patterns changed toward the earlier localized forms. Thus, radical prostatectomy (including nerve-sparing operation) is performed for growing number of patients.
Erectile dysfunction after radical prostatectomy determines quality of patients’ lives considerably. Even after nerve-sparing prostatectomy, erectile dysfunction of various severity levels is observed in 65-75% of patients. It is particularly important for young patients who are more interested in preservation of erectile function. They more often become candidates for prostatectomy due to early detection of the disease. The first line medications for erection restoration after nerve-sparing prostatectomy are PDE5 inhibitors, since they are more convenient, safe and efficient in patients of this group. Recent large multicenter randomized study based on vardenafil demonstrated that PDE5 inhibitors are similarly effective regardless of the time of therapy beginning (right away or in a year after operation).
Learm more about PDE5 inhibitors: PDE5 inhibitors and Their Role in Erectile Dysfunction Treatment
One of the drugs belonging to this group is Cialis. It appeared in 2003. During the large multicenter randomized study, it was shown that Cialis’s intake after ambilateral nerve-sparing prostatectomy improved erectile function in 71% of patients against 24% in placebo group. The percentage of successful sexual intercourses was 52% for Cialis administration period and 26%, i.e. twice less for the time of placebo intake.
But Why Cialis?
Tadalafil is active substance of Cialis and differs from the two other remedies from this group (sildenafil and vardenafil) according to its chemical composition. The rate and degree of tadalafil absorption in gastro-intestinal tract do not depend on food and alcohol intake. Cialis elimination half-life is 17,5 hours, whereas it is 4-5 hours for sildenafil and vardenafil. Achievement of one or several erections after Cialis administration is possible within 36 hours. This fact allows a man to take Cialis not only right before sexual intercourse, but also long before it.
The duration of action and stability of tadalafil concentration in blood also give possibility to administer Cialis every day, and not only when required. Due to these particularities, Cialis is a preferable medication in the situations when it is hard to predict time of coitus and if sex occurs twice a week and oftener. In some cases, the indicated features of tadalafil are good self-confidence of patients and lower level of their anxiety in regards to time which passed from the moment of drug’s intake. This information is confirmed by data of research studies for selection of PDE5 inhibitor where Cialis was demanded by most patients.
Side-Effects
The medicine is prescribed in dosage of 20mg for the intake not oftener than once a day. Side-effects of Cialis are mild and decrease or disappear after repetitive intake. More often headache and dyspepsia are diagnosed. More seldom, backache, vertigo, nasal congestion, and myodynia are met. During clinical trials a number of patients refusing Cialis due to its side-effects was the same as a number of the ones who refused placebo. Like in case with other PDE5 inhibitors, Cialis cannot be taken simultaneously with nitrates. It cannot be applied by patients suffering from cardiac or cardio-vascular disorders and are counter-indicative to physical activity.
Thus, Cialis is the most convenient and effectives remedy for erectile dysfunction even for such complicated group of patients as the ones who underwent nerve-sparing prostatectomy. It has all advantages of PDE5 inhibitors, and due to particularities of pharmacodynamics, it allows prolonging the time frame and pills administration regimen. All in all, patients have freedom of selection and confidence in the result.
