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New Member

Date Joined Mar 2007
Total Posts : 8
   Posted 5/12/2009 6:45 AM (GMT -6)   

My DaVinci procedure was completed in February 2007.  I experienced some problems for several months following the surgery and finally they had to do another procedure and found a clip daggling in my bladder which came loose and caused serious infections. It was no ones fault as I may have caused it to come loose by trying to do too much too early. In any case, once that was resolved I began to get back on the recovery track.  In time the incontinence subsided, with the occasional exception of a small leak with I sneezed but the ED has yet to be resolved.  I did the Cialis and Viagra for nearly 9 months, I began with the MUSE about 6 months ago and the best I have been able to experience is a very slight and not at all performance level erection, with some very minor pain.This has been the challenge for me.  My PSA is still "undetectable" which is where I place the most value.  However, I'm now, at the age of 58, still very interested in resolving the ED problem.  Someone on the chat forum said that it maybe that more men are having this problem with the DaVinci than earlier reported.  I'm not sure but I am interested if anyone may have experienced a similar experience with me with the Cialis, Viagra, pump and then MUSE and it still did not work but the injections did.  I have an appointment with my surgeon a week from Friday to discuss next steps and would welcome any advice.  Thanks. 

DanMc:  57yrs. old/55@Diagnosis....6.1 PSA with 3 + 3 = 6 Gleason and T1c. Diagnosed from elevated PSA. 4 of 14 biopsies positive. DaVinci was best option given my research.  Very good final pathology immediately following surgery, margins and lymph nodes negative. PSA "0" at first test 90 days following surgery, second PSA at nearly 6 months: "0.0". One year anniversary: PSA "0"!!! 

Regular Member

Date Joined Nov 2008
Total Posts : 299
   Posted 5/12/2009 9:19 AM (GMT -6)   

You didn't say if you had both nerves spared but I will assume that you did. I had the open surgery with right side spared. I had no luck with Cialis at all, Viagra will give me a half erection, MUSE did nothing but give me pain. However, Caverject, Edex and Trimix all worked great. I also take Levitra which works much like the Viagra.

But I am having nocturals again so I figure that I'm still healing and getting better. I using the lowest dose of Trimix currently.
Age 60
PSA 2007 4.1
PSA 2008 10.0
Diagnosed April 2008
Biopsy: 6 of 12 cores positive
Gleason 4 + 5 = 9
CT and Bone Scan negative
Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared
Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th
lymph nodes negative
PSA Sept 28, 2008 0.00
PSA Jan 22, 2009 0.00

Regular Member

Date Joined May 2009
Total Posts : 60
   Posted 5/12/2009 9:35 AM (GMT -6)   

I'm beginning to believe (well, actually, I've believed this for quite some time)  that it is NOT the treatment option, but the treatment provider who is the crucial factor in the outcome.  Da Vinci seems to be used more and more (and in my opinion this makes perfect sense because of the extra resources made available by the robotic system), but this only means that more open RP surgeons are moving (and probably very reluctantly) to robotic, and are at the very bottom of their learning curve.  This could explain the variability in RP outcomes.

Federal privacy legislation has been a boon to the less talented surgeons, as no one within the medical community wants to talk about any aspect of a patient's care -for fear of losing his or her job.  So, no one is going to warn you about a poor surgeon, unless you are within the inner circle.  People gossip, everyone knows  -except you.

The Da Vinci robot DOES NOT carefully tease the nerves away from the prostate capsule, remove the prostate,   and then re-make that all-important connection from the bladder neck to the urethra.  The surgeon does this, using the tools the robot provides.

It follows then, that it is the surgeon who is responsible for the outcome.  Some surgeons have consistently good outcomes.  Doesn't it make sense that the newly diagnosed PC patient seek out this surgeon, if surgery is indeed his choice?

This argument probably holds true for the other methods of treatment.


James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 5/12/2009 10:25 AM (GMT -6)   
Dan, I had open RP, but other than not having tried Muse, I am very similar to your experience. Injections work, pumps work, but are a failure for intercourse, pills do nothing.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 5/13/2009 12:00 PM (GMT -6)   
I'm about 7 months post-op, the da Vinci procedure.  I've taken it slow regarding the ED matter.  When I first started the Cialis and Muse regimine post-op I didn't see much progress.  Then I stopped taking the medications three times weekly as suggested by my Urologist.  I'm doing that maybe once a week.  Last night, after the Cialis/MUSE treatment - for the first time since the surgery I achieved an erection about 90% of what I'd have had pre-surgery . . . without manual stimulation.  My Urologist tells me it generally takes his patients a year to year and a half to see measurable progress regarding erections but that if there's a sensation "down there" erections should return at sometime in the future.  Whether my erections will return without the use of Cialis or comparable medications I don't know - but, time will tell.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0


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