Michael Metro, MD, Director of Reconstructive Urology at Temple University Hospital, discusses different interventions that can improve quality of life issues – such as erectile dysfunction and urinary incontinence -- for patients following prostate cancer surgery.
Doctor Michael Metro and I'm the director of Traumatic and reconstructive urology here at Temple University Hospital. So, after definitive treatment for prostate cancer, whether it's surgery or radiation, the two main quality of life issues that draw people to me are the ability to hold their urine after surgery. So that's incontinence or urinary incontinence and the ability to get an erection that they can function with. So erectile dysfunction. There's more medical interventions for erectile dysfunction than there are for incontinence. Incontinence. Unfortunately, sometimes is a surgical cure which guys that have undergone surgery for prostate cancer. So I'm not getting another surgery, but I can tell you it's a simpler procedure. There are outpatient procedures that take on the order of an hour to do with very high success rates, an incision that's underneath the scrotum, um as opposed to an abdominal incision that they may have had for their prostate cancer surgery for erectile dysfunction. There's a slew of medicines, both oral injectable medicine, there's mechanical ways to treat erectile dysfunction. So, pumps and then the definitive treatment is a surgical implant, an inflatable prosthesis that a patient can manually uh pump up to get an erection and um have a satisfactory sexual function for both he and his partner. The two main ways to treat incontinence surgically are to try to reposition the urethra to where it was before the prostate was removed. And this is done with a piece of material or mesh that basically pulls the urethra back to where it was when the prostate was in place. And that is uh somewhat of a simple permanent solution for patients that once it's healed and it's in place, they don't have to think about it anymore. Uh When men have more severe incontinence, uh, we, they've developed an artificial sphincter, which a sphincter is any circular, circular muscle of the body. And this is a balloon that goes around the urethra, it's totally inside the body. And when a patient feels like he has to void, he squeezes a small pump inside his scrotum which relieves the pressure on the balloon and he can void into the toilet instead of into his pads or underwear. The quality of life improvement for an artificial sphincter is one of all quality of life gold standards that we talk about. We say 85 to 90% of men are satisfied with their operative surgery and results, which is something in quality of life surgery that is very hard to meet. Um, the sling which is less invasive and a little less dependent on the patient and the right patient can be equally successful, but there's a bit of an art to figure out what patient is. A success, has a high success rate with a sling rather than a sphincter will work for most men. So that's part of my training is to figure out uh what which tool do I use for each patient. So some men that choose radiation for their primary therapy or require radiation after surgery for a recurrence of their cancer are plagued with some other issues. One of the more devastating problems is what's called a recto urethral fistula and that's a hole that occurs from the radiation damage between the urinary tract and the rectum. This requires at least two surgeons, usually a very dedicated urologist to fix the urinary tract and a dedicated colorectal surgeon to fix the fecal tract. And sometimes we require plastic surgeons to do things to interpose or put tissue in between the two holes that he and I fix. And once you have a dedicated team, the results are better and better.