need opinions on ED,

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knotreel
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Date Joined Jan 2006
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   Posted 10/14/2010 10:44 PM (GMT -6)   
For the last several months I have suspected that I was going to need an artificial urinary sphincter. Today I went to a specialist and had a urodymanics test and  systoscopy. I will need the AUS, no doubt. Very short sphincter and poor bladder pressure retention. The surgeon I am seeing can also do the penile implant while doing the AUS. I am confused about what to do next. I will have the AUS put in but I have had no medical advice on my ED problem because all my focus has been on the urinary issues.
 Here is my situation, I had bad ED before the radical RP, bad being defined by me as being sucessful less than 50% of the time using the pump. Without the pump about 0% chance of an erection that was usable. I was told by one of the Drs during pre op visits that I had classic leakage symptoms. Up to that point I had not tried injections or pills. Now I am 10 months post RP ( both nerves spared) and with viagra and the pump my erections last less than a minute below leaking down to where it is not useful.  I have been taking viagra every other day for the last 9 1/2 months. I have been told that  leakage like mine is will probably not be overcome by injections. My Doctor that will be doing the AUS is about 400 miles away. As it now stands I think it is just up to me on what to do next. He sugested a doctor closer to my home that i could try if I wanted to try the injections before added the penile implant to my AUS surgery. So does anybody have some advice for me? I think it would be a minor miracle if injections would work, do they work for somebody that is a bad off as me? Are thet worth a try? Naturally, I would not like to have the penile operation for many reasons but having just one operation on that sensitive area is preferable to me.
Ron
 

Worried Guy
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Date Joined Jul 2009
Total Posts : 3734
   Posted 10/15/2010 1:23 AM (GMT -6)   
Ron,
Sorry to hear your news. It's a frustrating place to be.
If it were me, (and I am in the same boat with you) before I did something as radical as penile surgery for ED, I'd give an $80 prescription of Bimix or Trimix a try. What have you got to lose? If it doesn't work then think about it.

As for the incontinence, brother, I understand the frustration. about 1 month ago, my leakage curve began to flatten out and I have seen no progress since. At 15 months, I'm considering a sling but will wait another 3 months before doing anything.
Good luck,
Jeff

Piano
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Date Joined Apr 2008
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   Posted 10/15/2010 4:22 AM (GMT -6)   
I agree -- injections are worth trying first. If you can get a really solid erection (which injections, trimix in particular, can give), you may find that the venous leak is much reduced compared to what it is with a lesser erection.

When using the pump, to stop your erection subsiding so quickly, have you tried more constriction -- extra or stronger bands?

Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4835
   Posted 10/15/2010 6:13 AM (GMT -6)   
Tripple Ditto on trying the injections.
 
Pills didn't work for me but the injections do.
Age 55 - 5'11" 215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6
06/25/08 - Da Vinci robotic laparoscopy
05/14/09 - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
Growing old is mandatory; growing up is optional..

knotreel
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Date Joined Jan 2006
Total Posts : 654
   Posted 10/15/2010 6:31 AM (GMT -6)   
I have a vacurect and also a "side off band" pump. Neither seems to be effective enough for work now. The tighter bands do hold a little longer but don't seem to be enough for a usable errection plus I get the hinged effect making penatration look impossible to me. Since my incontinence has been so bad I reallly haven't focused much on this issue but now I feel it is time to get some direction to go on since my thought is to have just one sugery session.
jeff, I hope you can make some more progress. I never have had any curve, just 100% leakage unless I was laying sown or sitting. My AUS doctor does not predict any outcome other than it will help, that could range from pretty much dry to ,well, not so dry. It's sorta a crap shoot. Having a really short sphincter rules out the sling he said and the AUS will be helpful but how much is the question. But I see little choice for me on the incontince issue.
Thanks for the advice, I guess I should give the shots a try.

Post Edited (knotreel) : 10/15/2010 5:37:36 AM (GMT-6)


Paul1959
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Date Joined Nov 2007
Total Posts : 598
   Posted 10/15/2010 6:39 AM (GMT -6)   
Give the shots a try....but generally, if ED was bad before surgery, there is no way it's going to be better after surgery. If you can live with the incontinence for another couple moths to try the injections, go ahead, but many, many pca guys have both done at the same time.
Paul
www.franktalk.org ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/15/2010 2:10 AM (GMT -6)   
I have tried the three pills with little benefit, and Caveject is effective but useless because of the dramatic pain.


I have found that a Nasal-Spray works the best for me

Vardenafil (Levitra) plus Phentolamine as Spray



The only irregularity is that instead of up the nose, it's up the penis.

The result is a rapid response, short lived event, with NO unpleasant side effects.

Just So close to a 'natural' event..



It is rapid acting because it is absorbed into the blood of the penis - exactly where you want it in the first place..



It is intended to be absorbed by soft-tissues , so ANY soft tissues will do. The ureathra fills the bill perfectly !

.

.

Post Edited (BuiDoi) : 12/16/2010 12:08:58 AM (GMT-7)


Worried Guy
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Date Joined Jul 2009
Total Posts : 3734
   Posted 12/15/2010 3:33 PM (GMT -6)   
BuiDoi,

BuiDoi said...
I have found that a Nasal-Spray works the best for me
Vardenafil (Levitra) plus Phentolamine as Spray

The only irregularity is that instead of up the nose, it's up the penis.


What the? Nasal spray up the urethra. I never heard of that.
Has anyone else here tried it?
That seems to be safer than building up scar tissue.
Jeff

Piano
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Date Joined Apr 2008
Total Posts : 847
   Posted 12/15/2010 3:51 PM (GMT -6)   
Phentolamine is a minor component of bimix and trimix -- I think! Papaverine is the major component. If the Phento can be aborbed via the urethra why not the other components?

An experiment for those with bimix or trimix available: What happens if you dribble your brew down the urethra perhaps via a syringe without the needle?

I suspect it probably won't do much, as most who have tried the much more expensive trimix gel (also inserted via the urethra) have been disappointed with it.

Worried Guy
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Date Joined Jul 2009
Total Posts : 3734
   Posted 12/15/2010 4:00 PM (GMT -6)   
I've got Trimix but I can't imagine squirting it in to my urethra. It just seems... so... wrong. Maybe if I get brave. It's not that expensive.

Remember I'm one of those wimps who need to use the autoinjector because he does not like needles.
Jeff

Post Edited (Worried Guy) : 12/15/2010 4:00:40 PM (GMT-7)


James C.
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Date Joined Aug 2007
Total Posts : 4462
   Posted 12/15/2010 4:40 PM (GMT -6)   
Worried Guy, he's talking about a mix of phentolamine and (I think) a Viagra pill that is being used some in AUS. Seems the application is spraying it into the nose, not using nasal spray. They get it in a spray and maybe a lozenge for rectal use. They were conjecturing using it as a liquid, similar to the MUSE, into the urethea.

Piano, I am looking for a oral syringe now, I am gonna try the bimix and see. Done under sterile conditions, I don't see that it could do any harm, right? I suspect the results will be weak and disappointing.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Feb.
ED-total-Bimix 30cc

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/16/2010 2:07 AM (GMT -6)   
NO guys - It's as specified above - Vardenafil (Levitra) plus Phentolamine as Spray -
It is what those fools use for "Very Expensive" ED treatment..
You know - the ones on the radio, constantly claiming they can cure anything ED .

Just understand the basics. It's mixed as a nasal spray, so it's oK to spray it into your sinus area. It is ALSO available as a suppository Lozenge, so it's safe in the other end. I assume that you could ingest it.
So it becomes a logical step - IF it is safe in your head and your bum, and "They" sell similar materials for injecting into the penis, then it is only reasonable to presume or assume that it is safely absorbed through the urethra (LIKE MUSE).

I doubt that anyone else will have put these facts together and realised the potential of urethral absorption, and taken the chance .
The beauty is that it DOES give a near instant and normal response, without ANY unpleasant side effects, other than those that Levitra would otherwise give you.
The Phento' has a 19 minute half life in the blood, so it enhances the whole show, and because it is absorbed into the Penis Blood, it acts right there, rather than having to be carried there by the blood stream..

I can assure you that it has given ME hope that I did not previously have.

BUT - Don't expect to see it approved by the FDA.. I doubt that anyone will PAY to have it tested and approved !

PS - I actually don't like it up the nose, as it stings so much, you feel you want to rip your nose off -- I was most surprised that the feeling in the penis was most minor..

PPS - Don't forget that the Nasal-Delivery system is based on a 20mg dose of Levitra, in a single 'puff'.. I would suggest that this is a deal more concentrated than what constitutes Bi or Tri-Mix.
I think that I am suggesting that it only takes a 'Puff" in the eye to make it fly.
A suitable quantity of Bi/Tri would likely take too long to absorb through the urethra, and most would dribble out before being absorbed.
The "Puff" of the Nasal-Delivery product, barely wets the urethra.
.
.

Post Edited (BuiDoi) : 12/16/2010 12:43:37 AM (GMT-7)


knotreel
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Date Joined Jan 2006
Total Posts : 654
   Posted 12/16/2010 9:30 AM (GMT -6)   
An update from OP. IPP scheduled for 1/11/11. This will be done as a tag team operation with Dr T Boone (AUS) and Dr. L Lipschultz (IPP).
I thought about the injections but what brought me to my decision was i am tired of worrying about errections, will it get hard? how long will it last? how to fit the equipment and proceedures into a pleasant experience for my wife and me. The real mover in this decision was that I had to have the AUS and adding the IPP seemed good to me.

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4110
   Posted 12/16/2010 9:36 AM (GMT -6)   
Knotreel I think your making a wise move buddy.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better
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