Ask The Experts

I have minor erectile dysfunction after surgery

Q I underwent a transurethral resection of the prostate (TURP) about seven years ago at the age of 65.

My prostate-specific antigen level (PSA) dropped to 0.72ng/ml. But it increased to 1.15ng/ml last year.

I have had minor erectile dysfunction after the operation.

My penis became shorter and it is not straight when erect. Thus, I am unable to achieve penetration during sexual intercourse.

I have not seen the urologist nor have I taken any medicine as I think I am already too old to have an active sexual life.

However, I am wondering whether my nerves were damaged during the operation.

What is the cause of my erectile dysfunction and can it be resolved so that I can achieve normal erections again?

While there are natural ways to increase your testosterone level, such as having a well-balanced diet, exercising, properstress and obesity management, keep in mind that these can only help so much, especially for people with advancing age.

A The slightly raised prostate- specific antigen level is not something to worry about.

It can fluctuate and may occasionally be higher due to several conditions.

A normal prostate-specific antigen range can go up to 4ng/ml due to conditions such as prostatitis or inflammation of the prostate gland, benign prostatic hyperplasia or prostate cancer.

Should your PSA level exceed 4ng/ml, then there is a 20 to 25 per cent chance of prostate cancer.

To eliminate that possibility, further tests such as a transrectal ultrasound and prostate biopsy should be done.

Your erectile dysfunction is unlikely to have been caused by the surgery you had, as the cavernosal nerve that is crucial for an erection is unlikely to be damaged by the procedure.

It is more likely to be damaged by other types of prostate surgery, such as radical prostatectomy.

TURP is done to treat prostate enlargement, while radical prostatectomy is performed to treat prostate cancer where the entire prostate gland is removed.

As the cavernosal nerve is near the prostate gland, it is at greater risk of being damaged when the gland is being removed during radical prostatectomy.

Unfortunately, there are no specific tests to check for cavernosal nerve damage.

It is possible to treat a damaged nerve by carrying out a nerve graft, but such procedures are rare.

It is more likely that your erectile dysfunction is a result of advancing age and/or a low testosterone level, which is very common.

While there are natural ways to increase your testosterone level, such as having a well-balanced diet, exercising, proper stress and obesity management, keep in mind that these can only help so much, especially for people with advancing age.

It is best to see a urologist, who can do an assessment to check your testosterone level, which includes a blood test.

Depending on the assessment, the urologist may prescribe hormone replacement therapy as a treatment plan.

Synthetic testosterone in the form of injections, oral tablets or topical creams may be given to you.

These help increase blood flow to the penis and increase the expandability of the penile tissue, improving your sex drive and the hardness of your erection.

Do keep in mind that even if you are undergoing these therapies, it is still good to continue to lead a healthy lifestyle, as it will complement your treatment.

If that fails as well, drugs like Viagra may be prescribed by your urologist to complement your treatment plan.

They work by increasing blood flow to the penis in order to help a man get and sustain an erection when he is sexually aroused or stimulated.

Dr Fong Yan Kit

Specialist in urology and consultant at the Raffles Urology Centre.

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A version of this article appeared in the print edition of The Straits Times on October 04, 2016, with the headline 'I have minor erectile dysfunction after surgery'. Print Edition | Subscribe