Both problems have now been attacked and the various alternatives have to be discussed with a urologist. For instance, newer pouches have a large internal reservoir and a small external opening (nipple) that requires self-catheterization to remove urine only two or three times a day. This is much more appealing cosmetically because the external nipple can be left uncovered or be covered with an adhesive bandage. In some cases in males a "neopouch" can be used—an attachment of a piece of bowel directly to the urethra—requiring no external pouch or catheterization at all. The neopouch cannot be used in females because of their short urethra.
Sexual function in males can also be improved by penile implants or by medication injected into the penis or inserted into the urethra before sex.
Radiation Radical external beam radiation therapy is an alternative to surgery in patients with
muscle invasive lesions. The attractive feature of radiotherapy is the possibility of preserving normal bladder and male sexual function. Radiation therapy is usually given daily over a six- to seven-week period. During treatment, some degree of diarrhea and rectal and bladder irritation are to be expected and are usually easily controlled by diet and appropriate simple medications. Severe late radiation toxicity (e.g., intractable hematuria , bowel obstruction) is rare with the use of moderate treatment, but it is not uncommon for patients to have mild bladder and bowel irritability and self-limiting bleeding due to radiation changes in the rectal and bladder lining tissues.
