Fibrosis ? a real concern after RP

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GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/7/2009 8:03 PM (GMT -6)   
I have read recently some studies and research about developing  Fibrosis as a result of ED following  RP but there was no study to point how long in ED state it takes (meaning the penis being flacid) to develope such condition .
 
seem that early penile rehab after RP promotes early return to nactural erection much sooner than NONE  and with higher probability if a nerve sparing was performed
 
Anyone familiar of how long it takes to develope that condition ? or if correctable? and if even mid night spontanous erections count as penile rehab and prevents fibrosis
 
any input would be appriciated ... thanks and good luck
 
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.

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!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
PSA  still Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 

Post Edited (GBINAB) : 1/7/2009 6:06:32 PM (GMT-7)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/8/2009 11:06 AM (GMT -6)   
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
induce fibrosis.

Also quoted:
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.

To
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
the penis.12–15
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)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/8/2009 11:51 AM (GMT -6)   
James, what you posted was way over my head, I wish it could be condensed and re-translated to a lower level. From what I was able to get out of it, sounded informative. Right now, my poor "fellow" is either in a deep level coma, or still under the influence of the annethesia from November, lol. Probably just my imagination, but I swear it looks only half as long as before in its flacid state. Until I can at last get out my catheter tube, still not overly interested in trying to slap it awake, lol. I thought there was an old say, "let a sleeping weiner lay", or something like that.

David in SC
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, further tests/treatments 1/9/8.
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/8/2009 4:46 PM (GMT -6)   
Basically, it is saying that after surgery, the penis can suffer from lack of fresh blood bringing oxygen (hypoxia) into the penile tissues. This can be caused by the after effects of the surgery because some blood vessels may have been removed (a remote possibility) and by the lack of erections, either nocturnal or the regular ones we got before for sex and such. Because we do not normally regain erections for an extended period of time post-surgery, we can develop fibrosis inside the penis, from the lack of adequate oxygen to the tissues and from the lack of exercising the penis by inflating and deflating it with erections. The longer it goes before function returns naturally, the more likely fibrousis will develop and with it, a possible shortening of the penis because of the fibrosis. That is speculation on their part, I think, and may not happen. BUT...a large proportion of men do complain of shortening post-surgery. It makes me suspicious of the claim, as most report shortening immediately after surgery.

Now, neuropraxia is the condition of having damaged nerves that control erections. The studies seem to say that early use of ed rehab, in the form of using pumps, pills and injections will decrease the time for healing to take place, by regularly providing oxygenated blood to the penis and abdomen, resulting in accelerated regrowth and healing of damaged nerves up inside the body and the infusion of the penile tissue inside the organ. These nerves inside are those that are closely attached to the prostate and must be cut away carefully, but they still are usually damaged or traumatized even with the best surgeons and techniques. These nerves are not to be confused with those that trigger orgasms, which are located further out/off the prostate and are not damaged or involved in the removal of the prostate.

Sexual urges are controlled by the brain, for the most part, so anything lacking in that department can't automatically be blamed on the surgery as the cause of it. Some studies do say that some small amount of testostrone production is removed when the prostate is removed, resulting in lowered sex drive, but I haven't seen anything definite on that issue.

The main opinion in the study is that early and regular erections can reduce and accelerate growth, repair and rehabbing of the penis and nerves. They seem to lean toward the use ed pills to keep penile and abdominal tissue oxygenated, and the use of injections are providing the best and quickest form of treatment for repairing of the nerves that are a part of the recovery of erectile function. Hence the 'use it or lose it' theory. This is what I was told here and elsewhere when I first was diagnosed and I began a close study of my options. That's why I am doing such an intensive program myself, but so far the results have been very disappointing. Buy hope prevails, until 2 or 3 years out.

I hope I have described it more in everyday terms and you can uinderstand it. tongue
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 2:50:05 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/8/2009 5:24 PM (GMT -6)   
Thanks James, that was a lot easier to digest and understand, and makes sense, had never really thought about it before in those terms.

David in SC
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, further tests/treatments 1/9/8.
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 1/8/2009 5:52 PM (GMT -6)   
I'm not a fan of the "lack of oxygen" theory causing fibrosis. Even a fully flaccid penis has some blood flowing through it -- as I know by stabbing mine with a needle! Also it still feels warm and has my usual skin color. So I am sure there is some oxygenated blood there.

To me it seems more reasonable that the stretching effect of an erection is responsible for keeping fibrosis at bay. Helps to keep tissues elastic -- as with other parts of the body.

I'm interested in hearing from men who have no erections (by any method!) at all for a period ranging from months to years. When you do finally have erections return -- what is their quality and is there any evidence of fibrosis? In my case, I was without erections for only a month, and at their best they were then fully comparable with what they were before surgery.

No fibrosis after a month of inactivity -- I sure others here can top that.
Age 63. Other than cancer, in good health; BMI 20
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
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/8/2009 6:24 PM (GMT -6)   
Thank you james for your rsponse i wil read  that    link as well  as all the responses here  ...



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.

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!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
PSA  still Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/10/2009 1:49 PM (GMT -6)   

Piano ,the reason i was posting this post was that i recall myself at   about  8 or 9 months post op  when i start gettng into more agressive rehab and used the pump as well as oral meds... kind of recalling my penis  was almost  at the same length as  pre op   when i had full erection by the pump... then i got into kinda of "remission" with rehab and  was kinda of busy with other things for few months (that is after i had usuable erections with only oral meds for couple of months between 10 and 12 months out) and now at 18 months post op i noticed it is harder for me to get full erections  , and usuang the Pump does not stretch my penis to the full size i used to see (as i kinda of recall where it "ended up" at the Cylinder of the pump) and it falls about an inch shorter ...even when it is fully erect...  so  was  wondering if the break in rehab had  anything to do with it , or maybe fibrosis  had a part in it ....

thanks for your post ..

Piano said...
I'm not a fan of the "lack of oxygen" theory causing fibrosis. Even a fully flaccid penis has some blood flowing through it -- as I know by stabbing mine with a needle! Also it still feels warm and has my usual skin color. So I am sure there is some oxygenated blood there.

To me it seems more reasonable that the stretching effect of an erection is responsible for keeping fibrosis at bay. Helps to keep tissues elastic -- as with other parts of the body.

I'm interested in hearing from men who have no erections (by any method!) at all for a period ranging from months to years. When you do finally have erections return -- what is their quality and is there any evidence of fibrosis? In my case, I was without erections for only a month, and at their best they were then fully comparable with what they were before surgery.

No fibrosis after a month of inactivity -- I sure others here can top that.


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.

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!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
PSA  still Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


anglophile
Regular Member


Date Joined Apr 2008
Total Posts : 82
   Posted 1/10/2009 9:47 PM (GMT -6)   
Purgatory, you said, "Probably just my imagination, but I swear it looks only half as long as before in its flacid state."

Didn't your doctor tell you about this before your surgery?

Mine did. It IS shorter because they pull the urethra coming out of the bladder and connect it to the penis across the area where the prostate used to be. The effect is to pull the penis "back," making it shorter.
Age 59 - diagnosed in Jan. 08 after biopsy
da Vinci Robotic Prostatectomy 4/11/08 - both nerves spared
Catheter removed 4/25/08
Prostate Pathology: Gleason Grade 6 (3+3)
5 wks post-op Continence: 1 pad night, 2 during day
7 wks post-op Continence: 2 pads every 24 hours
First post-op PSA at 7 wks: >0.1
14 wks post-op Continence: 1 pad days, no pad nights
Post-Op PSA at 5 months: >0.1
7 months post-op Continence: First pad-free day/night!
7 1/2 months post-op Continence: No more pads!
(ED is a different story)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/11/2009 10:16 AM (GMT -6)   
Nah anglophile, subject never came up between my dr. and I. I had read online, can't remember the source, that it is a myth about your penis being pulled back in to make up the difference, and how they make the bladder move toward the urethra instead. So said, I know what I can see, and I'm pretty sure it's much shorter now then before, though the poor fellow is still in a deep coma of some sorts.

David
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/9/9 - pre-op, 1/13/9 - corrective operation scheduled at St. Francis
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/11/2009 10:17 AM (GMT -6)   

Hi Anglo

This is probably a common issue  by many , however i have read and heard that a VED penile rehab early on after RP can fix that problem by stretching back the musceles  not to a fully situation as pre op but close to at least...

anglophile said...
Purgatory, you said, "Probably just my imagination, but I swear it looks only half as long as before in its flacid state."

Didn't your doctor tell you about this before your surgery?

Mine did. It IS shorter because they pull the urethra coming out of the bladder and connect it to the penis across the area where the prostate used to be. The effect is to pull the penis "back," making it shorter.


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.

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!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
PSA  still Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 1/11/2009 9:13 PM (GMT -6)   
Ya know, I can't say little "johnny" looks shorter, but I swear "johnny" has rotated 30-45 degrees to the L side since surgery. I know he hung straight down before prostatectomy but there is definately some rotation there, I don't know why. I guess it really doesn't matter but it is interesting.............
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