Post Operative ED Question

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Regular Member

Date Joined Apr 2010
Total Posts : 90
   Posted 7/19/2010 12:30 PM (GMT -6)   
about 3-1/2 weeks ago  (25 June 2010)  I had a DaVinci assisted nerve sparing radical prostatectomy. 
So far evevrything is going great.
Incontinence is non-existent and starting the 3rd week after surgery I am doing full 8 hour days at work without a problem.
My question is: The surgeon (highly experienced) told my wife he did his best to spare the nerves. I am not sure what that means and I don't see him again for another month.  I have been on a 5mg daily does of Tadaladil since 11 May.  So far I have had zero response.  The tadalafil was working great before surgery.
I would appreciate hearing the experiences of others about this subject

Age : 56
Diagnosed 3/29/2010
Placed on 5mg Cialis daily on 6/2/2010
Started pre-operative physical therapy on 6/2/2010
PSA 2.7; Gleasen (3+4) Biopsy 2 cores of 12 25% positive
DaVinci surgery 6/25/2010
Post Surgery
    Final Biopsy report
   5 slides of 35 showed 2% positive for cancer
   Clear Margins
   Final Gleason (3+4)
Incontinence:  None
ED:  Still dead as a door knob
        Still taking 5mg Cialis Daily

Regular Member

Date Joined Jan 2010
Total Posts : 363
   Posted 7/19/2010 1:02 PM (GMT -6)   
The nerves that send the signal for erections are attached to the outside of the prostate. When "sparing the nerves" the doctor removed the nerves from the prostate before removing it from the body. Picture peeling wet tissue paper off of a large grape.

The nerves are usually beat up and take time to heal. I had open surgery on March 1 of this year, had my first "usable" late last month. Progress was slow but steady. EVERY man seems to recover differently, some function with the cath' still in, others end up using injectable aids.

Best of luck to you
Dave in Durango CO
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04 06-07-10 PSA <0.04
05-03-10 1 week without pads

Regular Member

Date Joined Feb 2010
Total Posts : 111
   Posted 7/19/2010 1:28 PM (GMT -6)   
Hi Woodworker:
Your numbers, to me suggest you should have an excellent recovery, even the party boy! Can't quite figure out your surgeons "did the best he could" as he either did or did not save the nerves. Perhaps a month is not quite enough time. Are you seeing any eye candy as without some encouragement or stimulus the medication alone isn't going to do it. Maybe mama can do the dance of the seven veils or something

74 - Vatikutti DiVinci @ Henry Ford February 10th 2010 - 2 of 7 cores positive - Gleason 3+4=7 - 106 grams - nerves spared / margins clear - 25 MG Viagra (generic Silagria) nightly. Used 50 MG for parties prior to and it works the same now. While I quit pads two months out dripping when partying is a problem thus for us a turnoff.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 7/19/2010 1:38 PM (GMT -6)   
Woodworker, sounds like the rest of our recovery is going great, if you are already totally dry and able to work full time so soon after surgery. The ED part is not a quick or easy process for the vast majority of prostate surgery guys, you may be expecting too much too soon. Even with "spared" nerves, it doesn't indicate that they are ready for use this soon after surgery. You have still been through a major, complex, and invasive surgery. Hope the rest of your recovery goes so well for you.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 7/19/2010 7:39 PM (GMT -6)   
HI Wood,

The 5mg Cialis is a very weak dose for recovery from surgery. You may want to go with the much stronger 50mg of Viagra as a daily recover regimen
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function

Regular Member

Date Joined Jun 2010
Total Posts : 84
   Posted 7/19/2010 8:36 PM (GMT -6)   
First please remember to double check with your Dr. first before you proceed with any such treatment.

I did go to a different site and harvest a "penial erectile rehabilitation regimen" for you. Link Follows:

Be patient with yourself, a radicle in any form is major surgery and it does take a while to heal. Please consider asking and meeting her expectations.

Start with a nice warm bath or shower and lots of skin care when complete. We all need to feel good after so invasive a procedure. She also needs to know you will not break but that yes, your injured but she and how you feel about her is still important to you.

I guess what I'm saying is change the focus of your time together. Neither of you are the same once cancer walks into your life. Admit that and open a conversation about some of the new issues facing you both discussed with the other. Reach back into your very private places and find the humility to be afraid and vulnerable again.

In these circumstances many couples have found ways to reconnect and love in a wholesome and rewarding manner. This journey is far more then mechanical, it is emotional.

Good fortune on your journey and Best Wishes for a good recovery.

*Age 60 when presented to GP on 3 Aug. 2004 with elevated PSA of 13.8.
*Referred to Urologist. Biopsy and bone scan in Oct 04.
*Pathology report in Nov 04. Initial Results are T2cNoMo carcinoma of prostate gland.
*Had a RPP on 14 Feb 2005. Boy talk about irony look at that date again.
*Dr. called 3 days after surgery. I want you both in my office tomorrow morning, we must talk now.
*"I wish to apologize because I misdiagnosed your condition. Biopsy of your organ says Staging is T3bNoMo. Please accept my apology."
*At that moment I fell in love with my Dr. and have never changed my mind.
*Followup radiation of the prostate bed started early June 05 and ran 42 sessions.
*All PSA checkups to date, 5 1/2 yrs, are undetectable.

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