post prostatectomy trimix injection experience

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michael12675
New Member


Date Joined May 2011
Total Posts : 2
   Posted 5/22/2011 4:49 PM (GMT -6)   
Hello all
i a m new to the site. now 6 weeks since my uncomplicated robot assisted prostatectomy on april 9th 2011.
catheter for 7 days with initial incontinence for 2 weeks beginning at 4-5 pads , but at 3 weeks down to 1 pad for protection only with minimal saturation.Doing kegels regularly.No significant pain p the injection except a day of spasms.
taking oral cialis 20 mg every other day with modest erection 1 week after catheter removal
urologist suggested i try trimix intracavernosal injection (papaverin/phentolamine / alprostadil with 12/1/10 concentration mix) as there may be short term and long term benefit for spontaneous erection ability quality along withother benefits.Immediate sustained strong erection lasting about 3-4 hrs. required ice and sudafed to reduce erection. M
My concern is that i have tried the injection 3 times with a decrease in the dose each time and while erection duration has decreased ,I have experienced increased a 4-5 fold increase in incontinence after each injection.I have urologists and pharmacists along looking all over the internet and have found no reference to this or explanation for it.
The obvious answer is to stop the injections, but i'm not interested in that option at this point.Has anybody else experienced this.If so did this incontinence go away over time (ie 1-2 months later), or did a change to a lower dose or a different injection mixture help
Pathology :
52 y/o
prostate 60 gm.
nerve sparing bilateral
gleason primry 3+3 , scattered ares with 3+4 gleason
margins clear-no extraprostate invasion or prostate capsule invasion
seminal vesicles clear
perineural invasion pos
20 % involvement with both sides noted to have cancer
post-op psa to be done at 8 weeks per my urologist

If anybody has had any experience with this increased incontinenece please let me know
thanks,
M

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 5/22/2011 9:00 PM (GMT -6)   
No incontinence with bimix injections for me.
I'm a little surprised that your doc recommended injections so soon after surgery - mine had me try pills, then a pump, and didn't go the injections route for a year or so.
You might try bimix - it is the same but without the alprostadil. I don't know if it would make any difference or not, though. I have had straight alprostadil injections (caverject) as well without incontinence changes. Does the incontinence last a long time or just a short duration?
Jeff
Gleason,3+4;PSA 7.9,Nerve-sparing RRP,03/2008(Age 48 then),pT2c, 60g, neg margins; perineural & lymphatic invasion;3 lymph nodes removed,clear; seminal vesicle invasion:absent;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; retest <0.1; scans clear;monthly results from Jan 2010:0.2,.2,.17,.17,.24,.31,.29,.41, IGRT SRT started 8/4/2010, PSA@5 weeks in: .17,after:.12,.10,.06

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 5/23/2011 2:05 AM (GMT -6)   
Hi Mike,

You are only 6 weeks post op ? It is really soon IMO to be on injections. May I suggest the 1st step before injections is to be pad free ? My Dr did not have me try Trimix until 5 mos post -op

I would imagine that just squatting then standing back upright will case a leak, or sneezing, even laughing, how about getting up from a seated position. The cause of your 4-5 fold increase in incontinence is likely simply that your body has not learned yet how to hold back the urine flow.

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 5/23/2011 3:21 AM (GMT -6)   
I would go with ->"The obvious answer is to stop the injections" for a week or two to see what happens.

Ausboy
Regular Member


Date Joined Mar 2011
Total Posts : 92
   Posted 5/23/2011 3:55 AM (GMT -6)   
Hi m12675
I was 10 weeks post op when I visited the uro, he had me on low dose 5mg cialis daily from 2 weeks post op nothing major happening other than slight feelings that something was stiring. We had agreed on continue 5mg cialis with a boost once or twice a week of either V or L and use VED daily, see what happens for 1 month. When I saw Uro he said he wanted to start injections now and advised this therapy fills whole lenght of penis with blood not just outside part, he said has had good results with others once dose is right. So back to mens health doc for training and prescription for unimix yep not bi or tri just single dose of whatever, haven't filled script yet will do this week have to go to a compounding pharmacist not many about. Then try injections up to three times per week and keep in touch with doc via email to monitor progress. Not looking forward to self injecting but if it gives some spontaneity to the process I'll be happy. Interestingly I asked about tri and bi and he said start with uni then progress if needed, so see where we end up. look here it is a link to explain the early injection therapy
http://palpable-prostate.blogspot.com/2007/08/ed-after-prostatectomy-part-2.html

As for your incontinence have you tried a VED, I was similar to you pretty dry after about 5-6 weeks just minimal leak 1 or 2 drops per day, sometimes. It got better immediately after using ved, weird I know but maybe something got stired up? I have had a couple of wet nights on red wine shocked must be that alcohol is diuretic and also puts you in a deeper sleep? has happened three times each time after a few glasses of red.
I would continue injections as penile therapy and for sex and pad up!
goodluck
age 49, dx 21-01-2011 PSA 5.6
12 cores all positive >80% in some, Gleason 3+3=6, T2B
RALP 10-03-2011, post OP pathology, Gleason 4+3=7 and 1% 5+4=9
Prostate 50g, 48mmx40mmx40mm, largest tumor 48mmx34mmx24mm, extensive PIN also present, EPE left apex .2mm, perineural invasion, clear margins closest was .7mm, lymph nodes not checked.
path stage pT3A Nx Mx R0
post OP PSA ? 11/5/2011 - 0.03

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 5/23/2011 12:23 PM (GMT -6)   
Mike: I am shocked that your Dr would start you in injections so quick. Your Dr is just the opposite of mine (the one if departed company with) he would not start me on injections even after a year. Had to find a Uro that would get me going again. Since them I have tried Caverject, BiMix and TriMix. All three work great. Yes I do think that starting the injections have a way of waking up that bad boy down there.

Ausboy mentioned leaking with Red Wine. I will second that and also have a problem when I have a few beers. Even now after 2.5 years of surgery I need to be careful when drinking.

Best of luck with you quest for wood! Do keep us posted. I still say the injections is the best thing that happened to me after my surgery.

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

michael12675
New Member


Date Joined May 2011
Total Posts : 2
   Posted 5/23/2011 1:08 PM (GMT -6)   
Hey thanks for all the commentary
The decision by the urologist just depends on how conservative he is.I have heard of some starting it immediately after the catheter is out and others after after time and everything else has failed.Also the urologist would have to believe it has some long term effect.
The thinking behind starting the injections early(there different opinions even in the research that i have looked at)is that by doing so, you might be able to get a sooner return to stronger more medicine free injections.Also there is some research that says that it may inhibit penile shortening which some people describe.They also try the viagra and vacum devices for the se same purposes
For now I am laying off the injections and continence is improving after a few days off the injection.
i'm thinks that maybe the muscles are strong enough to withstand the muscle relaxation from alprostadil and or maybe overuse of the muscle from the prolonged erection .It doesn't make complete sense ,but that's my best guess.alchohol ,increased activity and later time in the day tend to worsen my incontinence
Thanks again
mike

North49
Regular Member


Date Joined Feb 2011
Total Posts : 83
   Posted 5/24/2011 8:04 PM (GMT -6)   
I wouldn't say it's too early for injections, waiting a year is way too long IMO. However, you are only 6 weeks out so don't expect to be completely dry while you implement various therapies. I think the injection route early gets the best recover result so there may be a bit of a trade off.

I've tired bimix in single and double strength and will likely discuss the option of just papaverine with the compounding pharmacy. I'm finding the higher strength phentolamine is dulling the sensation and pretty much makes orgasm with penetration impossible. I also tried the trimix gel suppository and the burning from the PGE1 was too much to bear.

I'd keep up the VED exercise though and augment with injections 3 times a week.
PSA 5.6 - 04/2010 - DRE positive
PSA 6.7 - 09/2010
Biopsy - 09/2010 - Age 53
T2b/c Gleason 7, 4+3
PSA 8.2 - 12/2010
RRP - 12/2010
pT3a, Gleason 7, 3+4, 20% PCa
pNO
Negative margins and seminal vesicles
RP 37.3 g
No further treatment recommended.
PSA <0.01 - 03/2011 - 3 month post-op
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