ED prognosis when only one set of nerves spared

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Veteran Member

Date Joined Sep 2010
Total Posts : 2648
   Posted 11/16/2010 12:45 PM (GMT -6)   
Does anyone have any statistics or personal experiences about the likelihood of the return of sexual function when only one set of nerves can be spared?
I know that every case is unique, that age and health and other issues need to be taken into consideration, and that undoubtedly some can cite cases where both sets of nerves were taken but function returns, but what is the general likelihood for those of us who lost one set of nerves.  Sexual function was just fine prior to surgery and health otherwise is excellent.
I'm 3 months post-surgery and doing the re-hab activities that everyone talks about and remain hopeful, but just how hopeful is realistic? 
I'd appreciate any thoughts on this.
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays all negative.
DaVinci surgery late August at Advocate Condell, Libertyville IL
Negative margins; negative seminal vesicles
Smooth recovery; 18 holes of golf at 4 weeks.
Continence OK after 7 weeks. ED continues

Jerry L.
Veteran Member

Date Joined Feb 2010
Total Posts : 3042
   Posted 11/16/2010 2:07 PM (GMT -6)   
I fall into that category of having only one set of nerves remaining. I find that it gets better every month and that the little blue pills help a lot. My doctor says it could take up to 2 years until I reach the best it will get.

Give it time.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 11/16/2010 2:31 PM (GMT -6)   
One of our regulars, Purgatory who is taking a break at the moment, lost only one set of nerves and had no ED at all.

Veteran Member

Date Joined Mar 2009
Total Posts : 739
   Posted 11/16/2010 2:35 PM (GMT -6)   
I have 1 and 3/4 nerves left, doc had to take 1/4 of one side. ED after 2 years, I can achieve about a 90% erection, which is good enough to get the job done. Started having nocturnal erections about 8 months after surgery. I take 25mg of blue pill, daily for maintenance dose.
[100mg tablet cut into 4]. Have tried without the pill, but not as successful. It is still early for you, and hopefully you will start seeing some improvement in the coming months.
I know you hate hearing this one but .........be patient !

Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everday in Everyway, I get better"

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4069
   Posted 11/16/2010 2:38 PM (GMT -6)   
And many of us had both sets of nerves saved yet still have great problems with ED.. I am younger than you and in excelent health still the big E plagues me.

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
Only issue at this time is ED

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4818
   Posted 11/16/2010 3:08 PM (GMT -6)   
I was spared one set and am dead as a door nail. Trimix on the other hand helps a ton.
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..

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 11/16/2010 4:00 PM (GMT -6)   

bro. piano is correct. i saw his post to your question. my left nerves were removed in my open surgery. due to difficulties, surgeon was unable to access and/or remove right side nerves, surgical notes stated "right nerves left, and appeared damaged" or something to that extent.

its true, i have never experienced a day of ED. i was on a catheter for 63 straight days after surgery. even my surgeon won't take credit for the lack of ED. He is still amazed.

i have never used a pump, never used any ED drugs, never did an injection. after the cath was finally removed, was able to have full natural errections.

since then, i have had 6 stricture corrective surgerys, 2 months of SRT, and most recently, this severe ileal conduit surgery, and despite that, not a hint of ED.

the only difference, ever since SRT, can still orgamsn as easily, and still lasts as long, but the "good" feeling part no where as intense as before SRT.

i came on to answer your post, as i think its important, and i want it to give hope to you, that even with one nerve, all things are possible. i know mine might be a fluke, but it is a fact none the less.

good luck to you, as you find an answer.

david in sc, now going back off line
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Veteran Member

Date Joined Sep 2010
Total Posts : 2648
   Posted 11/16/2010 6:02 PM (GMT -6)   
Thanks, David.  I appreciate your coming on to say that.  I had seen a post a while back where you mentioned that you had never experienced ED.  With all the other stuff, you certainly deserve that as compensation!

Regular Member

Date Joined Feb 2009
Total Posts : 216
   Posted 11/16/2010 6:44 PM (GMT -6)   
I lost my nerves on one side and have had no ED problems from day one after my open surgery and I was also about the same age as you
[table border=0 cellSpacing=0 cellPadding=0 width="100%" height="100%"]
[tr ][td class=msgThread2 height="100%" vAlign=top]

1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/09 24 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear
open surgery 7/27/09
Prostate Gland weighting 34 grms lost one nerve bundle
Gleason upgraded to 3+3 Tumour not close to prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
First PSA Nov 2009 was 0.06
April 2010 0.08
Nov 2010 0.07
Continence 99% occasional stress dribbles no ED from first day after catheter removed

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 11/16/2010 8:28 PM (GMT -6)   
My nerves were spared, both sides, but so far nothing..I think there is more to it than just nerves..They cut many blood vessels during the operation and they are just as important as the nerves..

You read all these threads and you get the feeling they are getting pretty good with incontinence but they have a ways to go with ED...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

Terry Herbert
Regular Member

Date Joined Sep 2010
Total Posts : 92
   Posted 11/16/2010 10:14 PM (GMT -6)   
If you go to my site at EXPERIENCES and click on the Surgery links you will see the experiences of over 500 men who chose surgery. Some had excellent outcomes, some less so
Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: Aug '07: Intermittent ADT: PSA 2.3 Aug '10

It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey

Regular Member

Date Joined Oct 2009
Total Posts : 103
   Posted 11/16/2010 10:47 PM (GMT -6)   
I'm at 100% using 50mg of viagra. Works every time now. I started seeing some recovery at 8 months. It keeps getting better for me so far.


English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2209
   Posted 11/17/2010 5:46 AM (GMT -6)   
Like David/Purgatory I have had no ED
The surgeon told me he was able to do nerve-sparing surgery, but gave no details.
Sure little Alf takes longer to rise to the occasion that he used to and my sex life is not ideal as I have other issues such as not having orgasms, but I am pretty satisfied.

Nerve-sparing is to my mind a very vague description. it suggests that their is aircraft style duplication of identical sets of control wires and if they remove one the system will function perfectly on the back-up: this is not the case.

Nor is it the case that there is just one nerve down the right and one nerve down the left or even one nerve bundle down each side. It is more like there is a whole mesh/net of nerves all over the surface of the prostate. One suggestion that has been made is to imagine that the nerves are like all the white stuff on an orange after you've peeled it. So also imagine what it is like for a surgeon trying to remove the orange while leaving the white stuff intact.

It is clear that while some men have had nerves left behind they don't seem to have had the correct nerves left behind.
It also seems to me that a combination of stimuli via several nerves must be what is needed to achieve, maintain and be able to use an erection. For instance I find it very difficult if not impossible to get an erection on my own even with p*orn: erotic thoughts don't give me erections they just tend to make a bit of urine dribble out of me. However, as soon as my wife gets involved it's easy to perform.
I also have a different level of erectile function depending on whether I am standing, lying, sitting or kneeling.

And as well as nerves the blood supply to the penis needs to be in good shape.

From what I've gleaned from the guys at HW with post-PCa ED it seems clear that it requires a combination of remedies to get and keep things working:, pumps pills and injections, and even then that may not be enough as some guys are opting for implants etc.
On the subject of implants, I have also wondered if there is any way that men could be given an implant that left them with permanently enlarged penis, the same way breast implants leave a woman with permanently enlarged breasts. (In the case of an erection caused by blood it's dangerous for it to last too long as the blood stagnates, for want of a better word, but if the erection was just due to there being silicon in the penis the blood could surely be happily flowing elsewhere. It might take a bit of getting used to, but more akin to having a leg in plaster than a false leg perhaps.

Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
BMs weird
14 Sep 10 PSA <0.1
Erections OK
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