Researchers Develop Technique to Restore Men’s Sexual Health after Pelvic Surgery or Radiation Therapy

Urologists at Sylvester Comprehensive Cancer Center and the Desai Sethi Urology Institute have developed a technique that can restore sexual function and improve quality of life in men who have had prostate, bladder, and colorectal cancer surgery. The technique also is an option for men who have had radiation therapy, laparoscopic hernia repair or kidney transplantation.

Sexual dysfunction and resulting quality of life issues happen often in men undergoing cancer surgery or radiation therapy to the pelvic area, according to the study’s lead author Bruce R. Kava, M.D., professor of urology and director of Men’s Health at the Desai Sethi Urology Institute, part of the University of Miami Miller School of Medicine.

“Pills for sexual dysfunction are often ineffective after pelvic surgery or radiation therapy. For many of these men, the most effective option to address their male sexual dysfunction is placement of an inflatable penile implant. Unfortunately, for this particular group of patients who have undergone prostate cancer surgery or radiation therapy, had their bladders removed, or had part of their colons removed or radiated, the traditional manner in which these devices are placed was simply not possible,” Dr. Kava said. “The technique we developed is a major advance because it provides a manner in which the device can be placed safely and accurately, without risking harm to the intestines, pelvic blood vessels or the bladder.”

Results from the study looking at the safely and effectiveness of the technique, called direct vision transfascial (DVT) approach to submuscular reservoir placement, are published in the Journal of Sexual Medicine.

In the study, authors reported on 107 DVT submuscular reservoirs placed in 100 consecutive patients that no complications occurred during surgery and no rectus hematomas occurred following surgery. Four patients, or 3.7%, had postoperative infections. In an average follow-up of 17.5 months, there was one reservoir herniation, one patient had auto-inflation and one required pump repositioning. Four implants malfunctioned between 69 to 108 months after the DVT approach.

The DVT approach is technically safe, though the authors noted a higher-than-expected infection risk. And it provided accurate reservoir placement for the majority of the 50 patients who had post procedure imaging, according to the paper.

“In all, 99% of patients had a functional implant at the end of the two-year study period,” Dr. Kava said.

Patients and doctors often do not talk about potential sexual side effects of cancer treatment, sometimes due to embarrassment and often because there are so many other important aspects of cancer care.

It’s time to have those conversations, according to Dr. Kava.

This study validates the DVT approach. Now, urologists around the world who learn the technique can offer these men a safe and highly effective concealable inflatable device that can be placed following robotic and open prostatectomy, cystectomy and other treatments, according to Dr. Kava.

Miller School researchers piloted the technique in 2019 in a paper focused on the erectile function and patient satisfaction with the DVT procedure. 

“Overall, erectile function as well as global sexual satisfaction and quality of life improved tremendously for these patients, and anecdotally for their partners,” Dr. Kava said. “Patients who are deprived of various aspects of sexual function due to treatment for cancer or another disease often develop anxiety, depression and loss of self-esteem. This technique offers those men the opportunity to restore a normal sexual life, which promotes enjoyment, pleasure, cohesion with their partners and resumption of self- esteem.”

Several U.S. urology centers have already performed the DVT technique and have responded with positive feedback, Dr. Kava said.

It is easy to learn,” he said. “We are planning a series of video tutorials to disseminate the technique to other centers both nationally and internationally. Those of us who developed the technique at the Desai Sethi Urology Institute feel this is a positive contribution to the field of men’s health and cancer survivorship.”

Other authors on the study include Amanda Levine, M.P.H.

Tags: Desai Sethi Urology Institute, Dr. Bruce Kava, Dr. Nicholas Hauser, Dr. Ranjith Ramasamy, Dr. Thomas Masterson, men's health, Miller School of Medicine