The erection question

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VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 6/26/2008 9:43 PM (GMT -6)   
OK, my husband and I were talking and realizing we really didn't understand why there are no erections after surgery. We understand the sperm part but what exactly makes it so you can't have erections. He is doing fine in the department of completing the act but softly, if you know what I mean. I take care of it for him. He just doesn't want to go try the pump yet. He just can't get past the thought, that he didn't even have to think about it before and now......
Would love some medical imput on what the deal is with this.
Thank you. confused


Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
viagra up to 100 a day and feeling some change. Keep our fingers crossed.

Post Edited (VaFan) : 6/26/2008 9:49:50 PM (GMT-6)


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 6/27/2008 4:41 AM (GMT -6)   
The nerves are necessary for good function.
 
When the nerves are disrupted or removed during surgery, this  results in urinary and erection problems, which is why surgeons try to preserve one or both nerves whenever possible.
 
Even when both nerves are saved, they usually suffer some disturbance so even in an ideal situation the healing process can take some time.

VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 6/27/2008 6:50 AM (GMT -6)   
Thank you. With all that has gone on, we never even thought about the reason for this, just figuring it was part of the process. But last night, when my husband was feeling pretty down, I wanted to get the exact answer so he would feel better about the process.
Thank you again
C
Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
viagra up to 100 a day and feeling some change. Keep our fingers crossed.


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 6/27/2008 9:29 AM (GMT -6)   
vafan,
 
Why the reluctance to use a pump?
 
Mine was paid for by insurance and it was strongly recommended as therapy for the internal penile tissues.  Doc told me that even after I started using injections, I should continue pumping daily and taking my Viagra 2 or 3 times a week.
 
I do not use the pump for intercourse, just therapy.  It is not painful and while not fun to use, I do believe it is helping me.
 
Just my two cents on that particular topic.
Danman Bob, Born 1951
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


Rolly_m2007
New Member


Date Joined Jun 2008
Total Posts : 1
   Posted 6/27/2008 1:56 PM (GMT -6)   
hello everyone. I am new to this forum, and I guess a little out of the loop, so to speak. I had a prostate operation on January 17, 2007. since then I have not been able to have an erection, but have been able to, I think, orgasm in a soft way. I am concerened that I will never have an erection. I live in a small town, with an idiot of a doctor, my urologist is 3 hours away, and the urologist who did the operation isd about 11 hours away. I have no one to chat to about this, and feel lost and very confused.
If you can help, please do
 
Edited to correct wording to clinical usage.

Post Edited By Moderator (James C.) : 6/27/2008 4:34:33 PM (GMT-6)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 6/27/2008 4:33 PM (GMT -6)   
Rolly, VAFAN has opened you a seperate thread to address your questions, OK?  Look on the main page for it, with your name in the Subject

James C.
Co-Moderator- Prostate Cancer Forum

Age 61
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
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
5/7/08 ED- Viagra, pump, no response- Trimix .075ml continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0


VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 6/27/2008 5:00 PM (GMT -6)   
Danman,
Thank you and I'm going to try and get my husband to call the doctor on Monday. It won't hurt to try it, right?
Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
viagra up to 100 a day and feeling some change. Keep our fingers crossed.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 6/27/2008 5:32 PM (GMT -6)   
VaFan,
The nerves that for want of a better word reroute the local blood supply into the penis thus engorging the cells with blood under pressure and keeping it there (and therefore erect) are located next to and into both left and right sides of the prostate. During surgery (and/or radiation) these nerves may need to be removed (they sometimes have tumour in them) or as they are very sensitive can be easily damaged. Thus their ability to alter the blood flow can be severely affected. If the nerves are not affected then erection ability is not compromised while if only one side is removed then you are partially compromised. If both sides are removed then there can be no redirection of the blood supply, so no erection results. They can and do recover to varying degrees over time. There is a procedure called a sural graft where nerves are taken from either the leg or abdomen and grafted to the erection control nerves in an effort to hasten their recovery. It unfortunately does not have a particularly good success rate. As DanManBob says, this is why it is important to mechanically or chemically keep everything in working order. Recovery is dependent on maintaining a good blood flow in the area and by inflating the penile cells you are keeping everything from atrophying and leading to eventual recovery.

Rolly_m2007,
Welcome to the forum you will find a mine of information here and a great swag of very good people who are more than happy to supply it. As you have found there is no connection between the ability to have an orgasm and the ability to achieve an erection. They are completely separate things and one is not dependent on the other. There is no question you can ask which will not receive a helpful answer by people who are in the same boat as yourself and have been through exactly the same things with exactly the same feelings and frustration and hopes. There also is no such thing on this site as a silly question. At the top of the page there is a search box............put in a key word and if its been mentioned before you'll find the answer.............if that doesn't work then ask away.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable

Post Edited (BillyMac) : 6/27/2008 5:41:56 PM (GMT-6)


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 6/27/2008 5:57 PM (GMT -6)   

VaFan,

Many doctors include the use of Viagra, levitra, and others to help in the recovery of erectile function.   Not just for sex, but in a routine fashion (3 times a week or so) to assist the blood flow into the areas needed for erection to keep them "healthy" with oxygenated blood.  The pump also helps, but I do not think the overall effect with oxygenated blood is the same.  An amusing side effect of the pump/rings was sometimes a larger erection than I have ever had and with the veinous blood color looked darn near like a weapon and scared the wife...  not actually, but it sounded good...  :-)

Anyway, I am 14 months post-op and no longer use the pump, but still use Viagra (actually a generic version) for sex.  I currently get about a 75-80% erection this way which is good enough for penetration.   I have not yet had any meaningful "natural" erection greater than 20-25%, but I have heard healing can continue for 2 years or more.  In simple terms, my doctor considers my current ED  state as a "B" instead of an "A".   Maybe I buy some apples for the "teacher" to get that "A"...  :-)

pasayten

 

 


After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 


VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 6/27/2008 7:12 PM (GMT -6)   
BillyMac,
Thank you, thats exactly what I needed. Its hard to explain to others that want to know also. Hope they can take it! I guess before March I would have never believed it myself!

Pasayten.
You made me laugh so hard!!
Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
viagra up to 100 a day and feeling some change. Keep our fingers crossed.


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 6/28/2008 1:05 AM (GMT -6)   
Hi VaFan,
I am sorry your husband is feeling that way. I was looking at the pumps before I went for surgery, but thankfully I have not needed one. I was preparing myself I guess you could say. But it has been less than 3 months for him so those nerves are still healing. Keep doing what you have been doing for him. He is fortunate like I am to have a great wife !!! :-)
Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible but not as easy to maintain as pre op. As of 6/18/08 with Lavitra a full erection easily maintained is now possible. I am pleased with the progress so far. Married to same wonderful woman for 39 years.
She is still beautiful and sexy as ever. A great help in my recovery !!


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 6/28/2008 6:07 AM (GMT -6)   
i was provided viagra 6 weeks after surgery. 25M a night and one 50M 2 nights a week. it is working a little. it was for the erection and blood flow. i was more concerned about incontinence than ed at first. now i am working the ed issue. like incontinence, i believe it just takes time and patience.
 
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
4 week and 6 week PSA .04 (undetectible)
continence ok during day - 1 pad
night time different story
kegel's twice a day 20 reps


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 6/28/2008 7:40 AM (GMT -6)   
For the new prostatectomy guys I will share my experience with erections, or lack thereof. I am a year and a half post op. I have been through the Viagra rehab and have used the pump. I have been using injections for over a year. It is important that men intervene in the process of erections in order to keep the penis in shape as is done naturally with nocturnal erections before prostatectomy. I inject myself two to three times a week for this purpose. Sometimes we have sex but not always. I can tell that my penis is getting closer to being back to normal erection size prior to surgery. If injections are not your thing then use the pump. Today I can get about a 50% erection with no assistance standing up but not lying down. My surgeon says that he has seen improvement occur over three to four years. I have started to study on implants as the loss of spontaneity has impacted our sex lives. I am not ready to make that decision yet.

By the way my orgasms are at least as good if not better then before the surgery. VaFan, do not wait on your doctor to tell you what the next steps should be. Take charge and learn what is being done by others. Try the pump and if in two or three months the erections have not improved then consider injections.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 6/28/2008 6:35 PM (GMT -6)   
Tamu,

Thank you and I read this to my husband. I feel like you put it in perspective that he has to be proactive with this. He keeps saying he wants it to all come back naturally. I think he is finally realizing after all these posts from y'all that the pump is the next step.
Thank you again for helping
Cindy
Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
viagra up to 100 a day and feeling some change. Keep our fingers crossed.


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 6/28/2008 7:02 PM (GMT -6)   
Hi Vafan
I will add my 2 cents for what its worth, but those nerves no matter how much they are being preserved , they are pulled and pushed on during surgery, and like any other nerve in your body take a long long time to heal, especially with a delicate process like erection.

I think that you husband actually doing REAL well and way ahead of the curve at the time period you at ....if you already can have him have a soft erection , partially and an orgasm , it is truly great , most men after RP do not have any progress for at least 6 months.
I had an open RP back in June 2007 , just over a year now , and only at the 9 months mark start feeling some significant changes , and progressing slowly since then , but at my one year visit my Uro assured me that i am doing a great progress with 70-80% erection without any assistance and almost at 90% usable erections with generic Viagra.
I also start using the pump at the 6 month mark for rehab , and ********** at least 2 to 3 times a week as well.

positive attitude , patience , and rehab is essential for a faster recovery.
i hope my experience and thoughts can help you and hubby ..
Good Luck
Keep us posted ...
GB
:-)
April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response.
3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.
1 year visit on June 13 2008 woohoooo!!!

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!


VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 6/28/2008 7:21 PM (GMT -6)   
Gbinab, Thank you.
I am so greatful for all the input. It really was never explained to us that the nerves were in such turmoil at the time of surgery (although we should have figured that one out). We thought "nerve sparing" was a sure thing for the future times. Thank you again for writing. Every bit helps as you know.
Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
viagra up to 100 a day and feeling some change. Keep our fingers crossed.


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 6/29/2008 8:21 AM (GMT -6)   
Sure thing VaFan that is why we here .. for suport and knowledge

keep positive , and keep posting ..
GB :-)
April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response.
3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.
1 year visit on June 13 2008 woohoooo!!!

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!

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