Blood flow, venous valve control, nerve bundles and shrinkage

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DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 3/13/2008 12:29 PM (GMT -6)   
Sorry to show my ignorance.  I know that lack of blood flow, control of venous valves and lack of "stimulation" from the nerves cause ED problems........but
 
1. What restricts the blood flow after surgery and what causes it to improve (other than drugs such as Viagra that I assume dilate the vessels)?
 
2. What causes venous valve control to disappear?  to reappear?
 
3. Both my left and right nerve bundles were spared, which I know is a good thing....but what will cause these bundles to get back to doing whatever it is they do normally?
 
 
And on a different topic,
 
4. What causes the penis to shorten in some prostate surgery patients?  Does this improve at all with therapy?  Is it generally more pronounced when flacid or erect?
Danman Bob
Age 57
Prostate removal November 2007
Gleason score 9, PSA 14
Biopsy result - 9 of 12 sticks showed cancer
Despite high Gleason score, cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (1 to 2 pads a day)
Began using Osbon Erec-Aid Esteem manual pump for therapy mid-February 2008
Begain using Viagra 3 times a week December 2007 to stimulate blood flow


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4450
   Posted 3/13/2008 6:44 PM (GMT -6)   
1.  Lack of erections results in the lack of blood flow into the penis, resulting in maybe atrophy and loss of filling capacity within the cavernous cavities of the penis.  Normally, nocturnal erections occur 4 or more times a night, resulting in the filling, flushing and emptying of the penis.  Damage to the erection nerve bundles after surgery results in no getting the trigger for those critical nocturnal erections.
 
 2.  Good question- one that I am seeking more info on, also.  My understanding is that the same damage to the nerve bundles occurs to a different degree in individual men.  The veinous valve function is an intregal part of the process of erections.  The nerve bundles trigger the response to open the valves up, allowing blood flow into the penis, then closes off when a certain internal pressure inside the penis is attained, resulting in a sustained erection. When sexual orgasm is reached or stimulus is stopped, the nerves tell/allow the valves to open, emptying the penis of blood.  Regrowth and repair of the nerve bundles after surgery is required for the complete erection process to work properly. 
  
3.  Time, rehab efforts and luck are all part of it.  Regrowth/repair of the nerve bundles is slow, some say it takes 8 months or more to complete the process down the length of the bundle.  Using a penis pump and Viagra or other ED drug will help accelerate healing, according to some.  The scale of best results is first injection, then the pump, then Viagra.  Viagra isn't necessarily or used in this case for immediate erection response, but to help trigger those nocturnal erections needed for penile and nerve repair, along with its effect on dilating the veins in the abdomen and penis. 
 
4.  The jury is still out on this.  Some surgeons and patients swear this happens, others say it doesn't.  In my case, it appears I have lost about 3/4 inch flaccid, and none erect. 



James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   (Open) Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
11/15/07  1st Post-surgery PSA-0.01
01/14/08  Caverject started/stopped, aching.   .5ml Bimix started-success
 3/24/08   ED- 6 mts.-Viagra, pump, Bimix continues- no response

Post Edited (James C.) : 3/14/2008 7:25:45 AM (GMT-6)


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 3/13/2008 9:04 PM (GMT -6)   
I seem to remember Dr. Ahlering at UC Irvine saying that shortening was caused by the portion of the urethra being removed during the surgery.

Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

Erectile function--up and running!

 


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2269
   Posted 1/3/2011 11:02 PM (GMT -6)   
What kind of plumbing screw-up results in semen being replaced by urine during ejaculation?

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7584
   Posted 1/4/2011 1:13 AM (GMT -6)   
Fairwind,
Danman has not posted in a while but he has brothers that shared in this issue, especially in the early going. Each guy reacts to treatment differently with some that have unexplained successes and challenges. Since there is a stress on a sphincter after RP it has to fully heal after RP. Sometimes some men just have issues like this.

Hopefully Danman did eventually get this under control. It can be quite nerve racking to deal with any form of incontinence.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 227
   Posted 1/4/2011 6:11 AM (GMT -6)   
1. What restricts the blood flow after surgery and what causes it to improve (other than drugs such as Viagra that I assume dilate the vessels)?
2. What causes venous valve control to disappear?  to reappear?
3. Both my left and right nerve bundles were spared, which I know is a good thing....but what will cause these bundles to get back to doing whatever it is they do normally?
4. What causes the penis to shorten in some prostate surgery patients?  Does this improve at all with therapy?  Is it generally more pronounced when flacid or erect?

1.  I was told that there are two basic problems. Firstly, veins have been removed and these provide the blood pressure needed to 'pump' the penis to an erect state.  Then - Nerves have been damaged and these are used to control the valves used to restrict the blood OUTFLOW, and hence cause the erection.  Chemicals like viagra creates the chemical trigers to help muscles restrict the outflow and hence cause the pressure-build-up, and the erection.
2.  As per 1..
3. TIME, and the skill of the original surgeon, but a most disappointing comment comes from the Australian (NSW) Health Dept., that 2/3 of men (having had Nerve-Sparing RP) are effectively Impotent after 3 years, and this is a time when all should have returned to normal or at least as normal as possible.
4.  A deal of the penis mass is composed of the muscles that control blood-outflow.   As with ANY muscle, if you fail to exercise the muscle, then it WILL die and this will show in shrinkage.  Hence the need for the natural nocturnal erections and the exercise that it imparts to the penis muscle.  Failure of the natural exercises MUST be supplemented with artificial exercise via Viagra, Cialis, injestions etc. and regular stretching might help with any issue with shortened ureathra. Once muscle is lost ED is complete.
   .. .  Use it or Lose It
 ""What kind of plumbing screw-up results in semen being replaced by urine during ejaculation?""
Nothing to do with plumbing screw up..  All the usual ejaculation hardware is GONE-GONE, and you are left with a weakened bladder control, and when the signal is given to ejaculate, the only muscles available to respond lie in the bladder, and the weak flow control might have no hope in stopping any flow..
..
.

Post Edited (BuiDoi) : 1/4/2011 4:22:43 AM (GMT-7)


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 1/4/2011 7:39 AM (GMT -6)   
For sake of consideration..

NCI says "From 2003-2007, the median age at diagnosis for cancer of the prostate was 67 years of age" - Add a year or so until the "median" operation age for those going that route.. and your 68. 2/3rds of them being impotent after 3 years brings us to 71, having had major surgery. And cancer. And a 1/3 of them are still rocking - at 71.

"Median" is a tricky measurment for this condition - But that goes in both directions. I think it's a given that those on the younger side of the median have a better "%" ED recovery than those on the older side. So the "2/3rds being impotent". A 46 year old guy likely has better chance than the 76 year old guy. I would think.

I understood the "shrinkage" to be a simpler one to figure..? You have a connected, essential body parts {___________) and then you remove about an inch in the center (____ ____). When you attached the two remaining sides, they are in inch smaller? (__).

Just thinking.


Hey, happy NY and wishing for great news for each and better news for all.

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 574
   Posted 1/4/2011 9:19 AM (GMT -6)   
about the reason for shortening, I first thought that some of the uretha is removed thus the shortening. I now doubt that simple explaination. The part of the uretha that is removed is between your external urinary sphincter and the bladder. The external sphincter is the one you are left with after the RP and this sphincter is part of your pelvic floor muscle structure and this remains in its former place. So the uretha lenght between the pelvic floor and the glans of end of your penis should be the same. I think it must the nerve issues sort of like the shrinkage from swimming.
Ron

dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 145
   Posted 1/4/2011 10:55 AM (GMT -6)   
Regarding the urine squirt on orgasm, I am 99.99% dry and can cough, sneeze, lift pretty heavy objects like commercial vehicle batteries without a problem but I will always get a squirt of urine at the moment of orgasm. This is not a dribble but a spurt under pressure and I would like an answer as to how this happens technically.
Incidentely this takes place without a full erection as I have had ED problems before and after sugery. Preop I put down to BP meds.
Anybody have an answer ?
 
All the best from England.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4450
   Posted 1/4/2011 12:38 PM (GMT -6)   
The best I can describe it is male orgasm is nerves triggering muscle to spasm or convulse. Even though our liquid part of orgasm has been removed, we still have the muscle part intact. At the same time, we , being men, had 2 sets of valves controlling urine flow, just exactly for the purpose of overcoming that powerful muscular contractions of orgasm. After surgery, we lose the main and stronger on the two, and only have one remaining. Hence, when we orgasm now, we still have the same muscle movement and force involving adjacent areas to the bladder, but with only one valve left to control any forceful issue of urine.

Here's a little more descriptive of it. The way I understand it, the main sphincters are on the outlet of the bladder and down into the prostate gland, so when the gland is removed, the sphincters go with it, and the resulting outlying sphincters, below where the bottom of the prostate was, are pulled up and stitched to the bladder opening, hence your weaker muscles/valves post-surgery. I hope I got that right.

Quoting them: Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder into the urethra, the tube that allows urine to pass outside the body.

Here's a link to some general info. about sex, surgery and loss of ejaculate.
www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinMen/SexualityfortheMan/sexuality-for-men-with-cancer-ejaculation-and-treatment
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Jan & Feb.
ED-total-Bimix 30cc

Post Edited (James C.) : 1/4/2011 10:41:14 AM (GMT-7)


knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 574
   Posted 1/4/2011 1:22 PM (GMT -6)   
adding to what James said, as I understand it, the first sphincter, the one at the bladder neck stays closed during orgasm. the other sphincter that is still remaining after prostate removal opens at the time of orgasm which allows the fluid that carries the semen to escape from the penis. This now allows the urine to escape since we no longer have the sphincter (at the bladder neck) that would normally hold urine during sex. All this happens automatically , the bladder neck sphincter, that we no longer have, is an involuntary muscle that we have no consious control over, gets it's signals from the system of nerves in the bladder and some other things down there, we normally can consciously control the remaing sphincter but at time of orgasm it opens automatically so that we can impregnate someone. I am sure that there is a lot more going on as my  " learning" in this area is just from surfing the net, but this does somewhat explain the urine during orgasm. just another gift from PCa.
ron 

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4450
   Posted 1/4/2011 1:24 PM (GMT -6)   
ron, thanks for adding that, I forgot to go far enough with my explanation. blush turn

As a side note, I find that I can actively do a strong kegel and keep urine in, but it does detract from the experience and even some of the pleasurable contractions.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Jan & Feb.
ED-total-Bimix 30cc

dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 145
   Posted 1/4/2011 2:29 PM (GMT -6)   
Thanks for your responses, sure makes things a little clearer. The spasms during orgasm must be very strong to overcomes the remaining sphincter muscle as I have said during normal day to day activity I remain dry, so I would assume that the sphincter must be quite strong also.
I will try to do a kegal at the right moment but as you say that would probably dampen the feeling of the orgasm.
 
All the best from England.

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 227
   Posted 1/4/2011 4:46 PM (GMT -6)   
.
Based on the assumption that the 66% ED figure is correct, and I can only assume it is, (As I don't know one RP friend who is not adversely affected by ED)... Then we all have to take something or inject or pump or whatever prior to 'participation'..
So just make sure you completely void your bladder and the chances of a squirt will be minimised.
 
re.  the shortening - I am confident that the bladder is pulled down a bit to compensate for the shortened Urethra.
Check your Ureathro-Cysto-Gram (???) and see the conical shape of the bladder
If shortening was an issue, caused by Urethra shortening, then it should have been short Post-Op and possibly regains some length as the Urethra stretches.
BUT - my length was the same post-RRP, and has shortened since, suggesting that it is more to do with the lack of use, and the inability to pump it up to 100%, when you do get the chance.
 
"Even though our liquid part of orgasm has been removed, we still have the muscle part intact."
I suspect that this is not entirely correct, but close...  Most of the muscular-activity is devoted to squeezing the ejaculate fliuds, so I presume that ALL the Ejac' muscles/nerves/veins are removed with the Prostate. 
I would suggest that it is just the general abdominal contractions that cause the problem..
 
With the 66% ED figure -- Don't forget that this is AFTER 3 years, when we were told "All should be fine".. 
They make the point that the figure for Post-RP to 12Mths., must be dramatically higher..  probably 99%
I speak to a good few men and NONE of them are claiming Normal function, and most are resigned to "Other Activities"..  with normal activity seeming just too much bother !
I am finding that the (Alternate use) of the nasal-spray..  nono   .. is easily the most natural  ??  ( If anything can again be considered 'Natural' ) --- "Have a squirt, give it a squirt and come out to play "
 
PS --"3. Both my left and right nerve bundles were spared, which I know is a good thing....but what will cause these bundles to get back to doing whatever it is they do normally?"
 
One Doctor, critical of the concept of Nerve Sparing and reporting the real and adverse ED at 3 years, commented that nerve sparing was like carefully paring a strip of apple-skin , stem to stern, from the apple and then removing the apple leaving the skin-strips behind.  You must take ALL the prostate material away, just leaving this slice of the outer capsule..
How difficult would that be, when you can't even see the nerve, and can barely see the nerve sheath.  How difficult would it be to not bruise or nick or stretch (and break the inner nerve)
Why do we wonder why things don't work the same?  I NOW wonder, why anything works at all !   .. . It's all quite fascinating.. and frustrating..
..
.
 

Post Edited (BuiDoi) : 1/4/2011 2:58:27 PM (GMT-7)

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