New York Times article "On sex After Prostate Surgery, Confusing Data"

60 years old

Dx March 2007

Pre-Surgery Gleason 3+3 = 6

Clinical Stage: T1c

Biopsy: 1 in 10 positive

Da Vinci: June 7, 2007 

Post-Surgery Gleason 3+3 = 6

   Clear at margins

First Post-PSA Sept 07 = <.01 (Hooray!!)

47 at Diagnosis.

1/06 PSA 3.15

1/07 PSA 4.6

10/07 PSA 5.06

Biopsy 3/07 just suspicious

Biopsy 11/07  1 of 12 with 20% involvment

Gleason (3+3)6

T1c

Father died of Pca 4/07 at 86.

www.roboticoncology.com

Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC

No visible cancer. Saved both nerve bundles.

Based on my own experience and the comments of people on this site and others, I think the article correctly portrays the reality of sex after surgery. 

Many doctors "sugar coat" the sex issue with their patients.  I don't know if that is a service or not. The question comes down to "returned to normal".  Even younger men who have regained some sexual function admit that it is "different" than before surgery.

I blame the doctors who did not tell the truth.  My urologist kept saying "If you are motivated, we can find an answer for you".  The answer so far is NO.  It is not the same, it is not as good and in my case can only be accomplished with a shot.

The NY Times tells the truth. 

Biopsy 10/16/06

T2A,  PSA 4.7

Gleason 4+4=8 right side

adrenocarcinoma of prostate

DaVinci Surgery 01/16/07

Post op report,confirms Gleason4+4=8

no extra extension/invasion identified

age 65

no continence problems

Back on the golf course...

90 day PSA  less than 0.01 (undetectable)

Six Month PSA still undetectable

Dealing with ED problems with Caverject/Viagra

nine month psa slightly elevated + .02

As one can tell from reading my history below, I too am in recovery from DaVinci Prostatectomy.  I am 64 and am approaching one year anniversary of my surgery February 5th.  My PSA's to date have all been undectable.. and I thank the Lord for that as this is my first priority.  I am about 95% cured from incontenence, what remains is uncontrolled dripping when I squat or when standing and having a couple of beers.  This is my second priority and am pretty much satisfied with incontenence issue but still doing Kegel in hopes I can strengthen my sphincter control.

Regarding sex after the surgery, there was no intercourse until my tenth month when I began using Trimix.  Up until that time it was manual stimulation only by myself and between my wife and I as I progressed through the different stages of Viagra, Levitra, Cialis, Muse and the pump. The Trimix allows me to experience intercourse with a wonderful climax but only with help from my wife supporting my penis.  My erections are not as strong and upright they use to be and not able to remain inside without her assistance..another minus.  But you do what you can...

There were no erections for ten months, some swelling but no erections.  The pump was OK but reections did not stay and the rings were not good.  For a male this not healthy nor fulfilling for any degree of satisfaction.  Climax without an erection is OK, but just an erection alone by itself without any intercourse or climax is a human need and ultimate physical completion for a male.  This is nature and the way it is.  It's like stretching your muscles for exercise, if you can't stretch completely because of physical conditions the body always lies in a state of need without resolution.

My libido cycles on an about one week basis where we use to say "horny" as kids.  This is human nature for most all males wether or not they admit it.  The call is there no matter what age and I do need intimacy with my wife even without intercourse.  So today I have the call, what do I do with it?  I have no natural erections, the only med that helps is Trimix.  And YES, I would prefer natural erections on demand and I could also settle with a pill for life.  BUt so far not the case and I am beginning to get discouraged but not hopeless.  We have to continue moving forward.  I do not plan at this time to have any implants down the road so if I do not recover I will most likely stay with Trimix as long as I can.  I'll take what I can get and live it...I can do that.

I would like to see responses from those that have had DaVinci and have recovered to natural erections and in what time frame after surgery.  Any real stats or inputs on this?

From the little I know I would believe the New York Times article.

I pray we can all recover from the cancer and have strength to deal with rest.

Marc

married 41 years, good strong erections before surgery.

DaVinci Prostate Removal February 5, 2007

2/12 samples malignant.

Catheter removal 2/13.

Viagra 25mg every other day from 2/14 to 5/12.

Tried Viagra 100mg on occasion-no erections.

Incontinence almost gone after three months.

No pads, occasional  dribble.

Lavitra every other day 5/12 to 7/22.

Muse 1000mcg - no help (50% at best).

Cialis twice a week 7/25 to 11/6/07.

Vacuum pump daily/twice a day 8/2 and going - no help.

Begin Trimix injections, two low dose per week, 11/05/07.

Currently, vacuum pump and low dose Trimix twice per week each.

Trimix in office - 0.10cc.  Low dose set at 0.05cc

First drug induced erection 10/8/07....Wow!

Natural erections - 0 as of 10/25/07.

PSA's, three to date undetectable.  Thank God!

Geon

married 41 years, good strong erections before surgery.

DaVinci Prostate Removal February 5, 2007

2/12 samples malignant.

Catheter removal 2/13.

Viagra 25mg every other day from 2/14 to 5/12.

Tried Viagra 100mg on occasion-no erections.

Incontinence almost gone after three months.

No pads, occasional  dribble.

Lavitra every other day 5/12 to 7/22.

Muse 1000mcg - no help (50% at best).

Cialis twice a week 7/25 to 11/6/07.

Vacuum pump daily/twice a day 8/2 and going - no help.

Begin Trimix injections, two low dose per week, 11/05/07.

Currently, vacuum pump and low dose Trimix twice per week each.

Trimix in office - 0.10cc.  Low dose set at 0.05cc

First drug induced erection 10/8/07....Wow!

Natural erections - 0 as of 10/25/07.

PSA's, three to date undetectable.  Thank God!

Geon

In my case, at 10 weeks after my DaVinci, I can get some swelling without drugs but not a true erection. Obviously I'm hoping for improvement with time.

John

Gene,

May I ask why the ED specialist switched you from trimix to quadmix?

Marc

married 41 years, good strong erections before surgery.

DaVinci Prostate Removal February 5, 2007

2/12 samples malignant.

Catheter removal 2/13.

Viagra 25mg every other day from 2/14 to 5/12.

Tried Viagra 100mg on occasion-no erections.

Incontinence almost gone after three months.

No pads, occasional  dribble.

Lavitra every other day 5/12 to 7/22.

Muse 1000mcg - no help (50% at best).

Cialis twice a week 7/25 to 11/6/07.

Vacuum pump daily/twice a day 8/2 and going - no help.

Begin Trimix injections, two low dose per week, 11/05/07.

Currently, vacuum pump and low dose Trimix twice per week each.

Trimix in office - 0.10cc.  Low dose set at 0.05cc

First drug induced erection 10/8/07....Wow!

Natural erections - 0 as of 10/25/07.

PSA's, three to date undetectable.  Thank God!

Geon

Geon, You first, then StrictlyInc...

I did not ask the doc why he switched and he didn't really say.  But here's what I think:  I told him about my difficulties in really getting hard enough to easily penetrate.  So he injected me and came back in about 15 minutes.  He used whatever medication he kept in his office.  It probably was not quad-mix. 

It got up to I suppose about 80% (It didn't "stand up", mind you) and I think by the time he came in it had gone down just a little.  He felt around on it (very professionally) and indicated I should be pleased with it, but that he thought he could help me do better.  One thing I have not mentioned here is that I do have diabetes.  It did not hinder me prior to surgery and my sugar numbers have never been real high.  When I mentioned that to him, he felt again, especially around the base and said that he could feel some ________ (I can't remember the word he used, but it was in reference to the sugar problem).  He said (which I did not know) that it did not matter the stage of diabetes.  All diabetes causes erection problems.  He then said, "I really think you were headed for problems with erection whether or not you had surgery."  That was a shocker.  So maybe the quad prescription instead of the tri was related to that. 

StrictlyInc,

Thanks for the link again.  I really want my wife the read the article.

Well, yes, I am thankful I didn't lose any size.  Or at least I don't think I did.  I don't exactly understand why one would lose size with the surgery, but I guess it has something to do with shortening the uretha.  I had never heard the ligament thing either and can't help but wonder if he was just redirecting my focus for the "lift" or if it is a fact.  Has anyone else ever heard that before?  I suppose it does not matter, except I've read several here mentioning theirs did not stand up like old times either.

Gene

07/05 - Biopsy: Suspicious looking cells. 

12/27/06 - Biopsy

1/24/07 - Dignosed cancer: Gleasn Grade: 3+3=6

02-14-07 Radical Open Nerve-sparing surgery

Pathology Stage of cancer: T2c

4-18-07: First Post-Op psa = 0.011

05/31/07: Cystoscope reveals "Stricture"

06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure.

8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.

8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news! Still leaking.

8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05

8/31/07:  First Bio Feedback session.

9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. 

9/26/07 - Started injections 

10/27-07 - Began using clamp at uro's encouragement.

1/6/08 - Still incontinent & impotent... and still "down."   

60 years old

Dx March 2007

Pre-Surgery Gleason 3+3 = 6

Clinical Stage: T1c

Biopsy: 1 in 10 positive

Da Vinci: June 7, 2007 

Post-Surgery Gleason 3+3 = 6

   Clear at margins

First Post-PSA Sept 07 = <.01 (Hooray!!)

Thanks for bumping this -- appropriate in view of the other impotence statistics thread we have going. There are many interesting comments on the NY Times article here: http://well.blogs.nytimes.com/2008/01/14/sex-after-prostate-surgery/

Like you, I have never heard of the ligament thing. But after some reading, I think they would be the ligaments that ....

[Remainder deleted to comply with forum rules]

Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores

7 March 2008, RRP, non nerve sparing

Two nights in hospital; catheter and staples out after 7 days

Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm

6-week PSA: 0 

Post Edited (Piano) : 6/3/2008 8:16:29 PM (GMT-6)

Cindy,

Many here use alldaychemist.com for Viagra and similar meds......MUCH cheaper than in USA.

It is your business, of course, but I would suggest that your husband consider a medically approved pump and injections fairly soon if Viagra is not doing the trick alone.

Best wishes to both of you.

DanMan

Nerve-sparing, open prostate surgery November 13, 2007

Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer

Post-op pathology stated that cancer was confined to the prostate

Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)

100 MG Viagra 3 times a week beginning December 2007

Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008

30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008

Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008

Cindy,

I am not yet having unassisted erections, but studies have indicated that using the pump and/or injections leads to a higher eventual success rate for return of so-called natural erections (frankly, just using Viagra would be considered quite "natural" enough for me.  Would love to get to that point.)

When I began using the pump, my penis had been inactive for about 3 months.  It did not even look like its old self while in a flaccid state.  After using the pump for a while, it looks more like the old, pre-surgery penis.  More important, it is getting better blood flow from the pumping, which helps protect the internal tissues.  I try to pump daily.  Some here such as JamesC and Piano pump a couple of times a day, I believe.  Pumping is a chore...not painful but not erotic either....but I feel it is someting I need to do consistently.

Most urologists and studies seem to believe that injections are even more helpful as therapy than the pump.  In addition, injections cause erections, usually within 10-15 minutes of injection....and yes, one injection = one erection.  I am still experimenting to find the best formula for me, but have had some 80% erections with low doses when I hit the target area correctly.  Doctor gave me a tip Friday on using a more reliable injection technique, so I expect to find the right dose/formula for me soon, once I get a better aim...

The injections sting a little bit, but when using small insulin needles, it is not really bad.....just the thought of injecting one's self there is a bit troubling...lol.

My urologist believes strongly in using Viagra (or Cialis, Levitra), a medically approved pump (my insurance paid for most of the cost of mine) and injections......not one vs. another.......so I am using them all.  He is of the "use it or lose it" school of thought.

Hope this helps a little bit.

Nerve-sparing, open prostate surgery November 13, 2007

Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer

Post-op pathology stated that cancer was confined to the prostate

Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)

100 MG Viagra 3 times a week beginning December 2007

Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008

30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008

Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008

Post Edited (DanmanBob) : 5/25/2008 3:02:17 PM (GMT-6)