GBINAB, this may be the study you are commenting on:www.clevelandclinic.org/ReproductiveResearchCenter/docs/agradoc267.pdf
If so, and if you can fight your way thru the technical jargon, there's a few answers there. The way I read it is:
Fibrosis is much more likely to occur soon after treatment and the onset of ed, if no ed treatment it taken, such as pump, pills, or injections. Here's a cut and paste from it, along with an answer to your midnight erections question. Neuropraxia is the condition of no nerve triggering function being present, if I read it right: On page 2, left column.
Nocturnal erections have been implicated in
preserving normal erectile function by providing
regular tissue oxygenation. The lack of any erections
during the period of neuropraxia has been
implicated to produce persistent penile hypoxia.
The hypoxia in consistently flaccid penis may
These initial reports have shown
that penile hypoxia is the key factor in collagen
deposition in hypoxic cavernosal muscle and PGE1
reduced the expression of TGF-b1.
PGE1 mentioned is the injectable drug prostaglandin. Just before this , they also mention that using the ed injection drug prostaglandin will offset fibrosis. This is something that has been mentioned a lot, but the first that I have ever read of someone stating that early use of injections will speed rehab and healing.
Further on they burst the bubble by saying the following then talk about
other causes for fibrosis and the effect other thing may have in veinous leakage.
date, the penile hypoxia explanation remains theoretical.
In fact, other possibilities may explain the
collagen replacement in the penis following RP.
Further scientific work is needed to prove that
hypoxia actually occurs in the penis following RP,
and that this is the mechanism for tissue damage in
Similarly, User et al.16 in 2003 demonstrated
significant apoptosis in the cavernosal smooth
muscle and high proportion of trabecular smooth
muscle has been replaced by collagen. Similarly in
human models, Iacono et al.17 from Italy recently
studied the changes in penile biopsy before and after
RP (2 and 12 months). They reported a significant
decrease in the elastic fibers and smooth muscle
content, and a significant increase in the collagen
content in the postoperative biopsies compared to
the biopsy before surgery. This smooth muscle
fibrosis has been implicated in reduction of penile
length that occurs in significant proportion of men
following RP. These studies have further confirmed
that neuropraxia from transient cavernous nerve
damage plays a central role in cavernosal fibrosis.
Progressive cavernosal fibrosis produced due to
persistent penile hypoxia has been shown to
produce veno-occlusive dysfunction. Mulhall
et al.18 in 2002 reported the incidence of venous
leak increases with the postoperative time interval.
They showed that the incidence of postoperative
venous leak was 14% at 4 months, which increased
to 35% between 9 and 12 months. Similarly,
They also further along mention several studies that showed early use of pills and or injections had a big impact on the length of time and the percent of capacity regained in regaining erections.
This one study indicates that there is definite or probable evidence that the "use it or lose it" principle applies, either by musterbation, pump therpy, pills or injections for guys with nerve sparing surgery. Some of the studies were never started, some were theoretical lab studies and some actually were done on humans. Overall, I read that the key is early and often infusion of fresh blood into the penis both for nerve regrowth, penile tissue rehab, and to combat fibrosis. Pumping and midnight erections help, but the real effect is when the pills and injections are used in combination. Well, that's the way I read it, maybe I am reading more into it. Maybe I am more desperate to see some justification for what I do daily. lol
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing
open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.
Post Edited (James C.) : 1/8/2009 9:09:24 AM (GMT-7)