Treating ED post-surgery

In theory, all men should have the same service; NICE says that a man should be offered a vacuum device for post-op penile rehabilitation. NICE used to say that men should have daily dose cialis post-op but that was removed and left to individual ICBs (the new name for CCGs) and NHS trusts. Under NICE guidance, any man with ED as a result of prostate cancer or as a side effect of treatment for prostate cancer is entitled to:
- 4 muse pellets or
- 4 injections or
- as many viagra tablets as the patient says they need (e.g if a man says that he needs 30 per month because he is used to having intercourse every day, then he should be prescribed that many)

In reality, a lot of ICBs and NHS trusts are ignoring NICE guidelines and doing their own thing - some areas have blocked the prescribing of vacuums or daily cialis (or both) and limit men to 4 viagra / levitra / cialis tablets per month ... in effect, you are rationed to 1 sahg per week. Some NHS trusts have closed their andrology clinic and laid off the ED nurse specialist, leaving everything to the whim of GPs.

Add in to the confusion that an ED nurse or urologist can write to the GP requesting that they prescribe a treatment for you but the GP can refuse to do so due to cost (in effect, it comes out of the GP practice budget).  This is the same as when an oncologist recommends Prostap or Zoladex and the GP changes it to Degarelix, or vice versa.

You should be able to find your NHS trust prescribing guidelines for ED through a simple google search. 

Edited by member 23 Jan 2023 at 16:57  | Reason: Not specified

I don't know if it was just fate that I signed up to the andrology survey at UCLH just before my surgery. Any interaction with my sexual health/ED issues is solely dealt with by the consultant at the 3monthly appointments. Nothing at all from my GP Surgery or my local NHS Trust. I had already personally ordered vacurrect VED device before before my first appointment, and got my tadalafil tablets online before my initial appointment. However, at the second consultation, I was prescribed the injections which I picked up from the hospital pharmacy, it however still does not show up as a prescription on my record, (thankfully, I used the injection 2ce and it did not work) so not stressing about repeat prescription. I do however get 8 tadalafil tablets on a monthly prescription - My consultant told me there is no evidence that the daily dose of 5mg tablets is anymore effective than the 20mg twice a week!

What is apparent is that there is no plan for the attendant quality of life issues that occurs post prostate cancer surgery. Sadly, we just have to fend for ourselves and find out what works best. I don't know if this is as a result of the pandemic (pressures on the NHS) or was always the case even before the pandemic!