Posted 11/23/2008 3:37 PM (GMT -6)
David, here's some generalized answers. A through search using keywords 'non-nerve sparing and ed' will get you some further details.
The short answer, and blunt honest opinion, is the removal of both nerve bundles will not allow for regaining natural erection function in the large majority of cases. That's the basic answer. There's also some qualifiers. Some studies have shown that nerve regrowth can occur, at a slow rate and over a long period of time. The danger is that the penis will atrophy from non-use in the meantime. That's why penile rehab, in the form of pumps, ed drugs, and injections are used to keep the blood flowing and the tissues expanded regularly. Even then, the nerve regeneration may never happen.
If it never happens, then you are left with 3 alternatives with current scientific advances. First, ed drugs such as Viagra and the others will have no effect, as they work on the nerves that have been removed. That said, the use of injections will get the job done, as it affects tissue and valves, and not nerves. So the current 3 type injection drugs, in some form, will likely give you an erection capable of starting and sustaining intercourse. It's no guarantee, but the majority of injection users have adequate response to it. That's a whole different area to study and discuss, which we won't do in this short answer.
Penile pumps are also an option. Successful use of them is high, but they can be problematic, some men can't manage to use them to get and keep a full erection capable of intercourse.
The third option that is available is the penile implant. They are becoming more common now, and there's several guys here who have had them and can better tell you their stories concerning them.
There's also a couple, at least, of guys here who have had non-nerve sparing surgery and can tell you what they experienced, as far as ed is concerned.
As you can find out shortly, when the catheter is removed and things heal a little, is you are capable of an orgasm in a flaccid state. Erections and orgasms aren't tied together. That's why the options of the pump, injections or implant is still available for you. Good manual stimulation with hand, oral or vibrator will give you an orgasm, in the large majority of men. Your sex life, married or not, isn't gone forever, just the circumstances and how you can adapt to it is different, but still doable... Don't dispair, there's several different ways to deal with the situation.
Here's a cut and paste from an article I found while researching and answer for you:
Radical prostatectomy is an operation that completely removes the prostate and the surrounding tissue. Prostate surgery can be:
* Nerve-sparing (keeping intact the nerves which lead to the erection chambers and provide the stimulation for erection)
* Non nerve-sparing (not preserving these nerves)
Even if the majority of the nerves are preserved in the surgery, temporary ED is common.
When the nerve-sparing technique is used, particularly bilateral nerve-sparing, permanent ED is less common than with non-nerve sparing surgery and recovery often occurs within the first year or two following the procedure.
ED from a non-nerve-sparing procedure is common and recovery of erectile function after a non-nerve-sparing technique is unlikely though not impossible.
Erectile function following surgery depends on an individual patient's age, anatomy, extent of cancer and preoperative sexual function.5 Most studies report that 50-80% of men who have a radical prostatectomy have some degree of ED for the first year after surgery even if the surgeon is able to spare all or part of the nerves.6 Even in bilateral nerve-sparing surgery, return of erectile function may take up to 12-24 months. Eventually though, erections adequate for vaginal penetration return in 40-80% of men. Unilateral nerve sparing technique produces results that are intermediate between bilateral and non-nerve sparing surgery. Also, duration of time from the surgery to treatment for ED can play a role in the effectiveness of different therapeutic options.
Other sexual complications following radical prostatectomy include the absence of ejaculation or dry orgasm (orgasm without discharge of semen) in all cases, and loss of penile length in some men.
Do men respond to PDE5 inhibitors after having prostate surgery?
The first line of treatment for ED following prostate surgery is oral medications, such as phosphodiesterase-5 inhibitors (PDE5i) - sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®). about 70% of men respond in some fashion to oral drug therapy in the post-operative setting.
Since these drugs are designed to increase blood flow to the penis upon sexual stimulation, they require intact nerves and arteries. Men receiving the nerve-sparing prostatectomy generally have a better response.
Does self-injection therapy used after prostate surgery help erectile function?
Penile self-injections provide very effective treatment of ED after prostate cancer surgery. Some studies report that penile self-injections can achieve a 95% success rate. Self-injection therapy is usually used after trying oral medications because of the convenience of oral therapy.
The role of oral, self-injection, intraurethral and vacuum therapies after treatment for prostate cancer:
For men who have had surgical or radiation treatment for prostate cancer, evidence suggests that oral, self-injection treatments started soon after treatment may improve the chances for later recovery of natural spontaneous erections. Oral therapy can be used with any of the three PDE5 inhibitor drugs. There are three vasodilator drugs used for self-injection therapy:
* phentolamine and
* Alprostadil, a type of prostaglandin E 1.
Injection of Alprostadil may cause penile pain. If this occurs, lowering the dose of Alprostadil and/or mixing Alprostadil with papaverine and phentolamine may reduce or eliminate the pain. The prescription drug called MUSE is used in intraurethral therapy.
Penile implants are a third line therapy, with a success rate of about 80-90%. They are the single most reliable form of treatment for erectile dysfunction, and they provide an excellent solution to the problem of erectile dysfunction.
Co-Moderator- Prostate Cancer Forum
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
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.