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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2006post RLRP ED questions
i had my surgery oct 31st. incontinence went from a diaper for 2 wks after catheder removal to 2 or 3 pads per day. my psa is 0.015. i have been taking 50mg viagra since 9 days after surgery. i have been masterbating daily with a wet noodle for about 3 weeks. the 1st time i could not feel the orgasm. currently, i barely feel it. i saw an ed specialist today that i was referred to by the NY Ed specialist Ridwan Shabsigh, who in turn,was recommended in this chat room. Shabsigh is of the school of thought that the injections are the most effective treatment to recover erection post surgery. the ED specialist i saw today dissagreed. he said it is currently ok for occasional use for intercourse but not recovery of ED. he stated he is involved in research which demonstrates that immediate use of viagra (within 4 days after surgery) is critical. he was talking about a muscle that starts to deteriorate 48 hrs after surgery. i told him that i didn't start it until 9 days after surgery. he said to keep using it since it might still be ok and that everybody is different. i left his office feeling depressed since i was thinking that i missd the boat and i didn't hear what i expected about the injections. this evening i have been talking to a few patients who had the RLRP over a yr ago and they indicated that they started the viagra/levitra/cialis about the same time as i did and their ed recovered. it recovered over an avg 8 mth period. it went from 0 to 1 or 2 in about 2 or 3 mths then 4 in about 4 mths then 6 in about 6 mths etc. then i began to wonder about the muscle the ED specialist was talking about. it's the one that opens and closes to let the blood flow in for the erection and out afterward. why would that start to permanently deteriorate after 4 days? if he is correct, then why did the other post surgical guys i talked to still have a recovery? am i supposed to believe him? what do i do with this information, forget it? what about the ED specialist in NY? am i supposed to believe him about the injections? sounds like i should believe the post surgical guys i talked to over the specialists. they are the ones that already went through what i am going through with the same surgeon . gary > i had my surgery oct 31st. incontinence went from a diaper for 2 wks > after catheder removal to 2 or 3 pads per day. my psa is 0.015. i [quoted text clipped - 31 lines] > > gary > he stated > he is involved in research which demonstrates that immediate use of > viagra (within 4 days after surgery) is critical. Masturbation with a catheter in place? Sure -- if you want to tear your urethra up . . . and then try peeing through it! I d o n ' t t h i n k s o. I.P. >> he stated >> he is involved in research which demonstrates that immediate use of [quoted text clipped - 5 lines] > > I.P. I believe this research just involves dosing with the Viagra, certainly not encouraging sexual activity during that very early time. >>> he stated >>> he is involved in research which demonstrates that immediate use of [quoted text clipped - 7 lines] > I believe this research just involves dosing with the Viagra, certainly not > encouraging sexual activity during that very early time. THAT'S a relief. I.P. my wife, who was at the ED specialist appointment with me today corrected me. he said that it would recover optimally if the viagra were started during the 1st 48 hrs or at least the 1st 4 days following surgery. that did not mean that the muscle wouldn't recover. it might just take longer or it might not recover with as well. however, it is a muscle and it is possible that the viagra might exercise it enough if started after 4 days to still get a good recovery. because everyone responds differently it is hard to predict individually. i am assuming from his comment that his research findings are statistically based. gary > i had my surgery oct 31st. incontinence went from a diaper for 2 wks > after catheder removal to 2 or 3 pads per day. my psa is 0.015. i [quoted text clipped - 31 lines] > > gary > i have been masterbating daily with a wet noodle for about 3 weeks. > he said to keep > using it since it might still be ok and that everybody is different. i [quoted text clipped - 3 lines] > yr ago and they indicated that they started the viagra/levitra/cialis > about the same time as i did and their ed recovered. When I had my surgery, I wasn't started on Viagra until six weeks later... or more. > deteriorate after 4 days? if he is correct, then why did the other > post surgical guys i talked to still have a recovery? am i supposed to > believe him? what do i do with this information, forget it? what about > the ED specialist in NY? am i supposed to believe him about the > injections? > sounds like i should believe the post surgical guys i > talked to over the specialists. Sounds like you ought to get your mind of your crotch. I cannot speak to the quackery of your doctors; I don't know them. But, outside of weightless, I'd bet the most quack show up in the ED field. Take a reasonable approach to long life and quit worrying about seeing how many differing opinions you can get.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > Sounds like you ought to get your mind of your crotch. I cannot speak to > the quackery of your doctors; I don't know them. But, outside of > weightless, I'd bet the most quack show up in the ED field. That should have read: "weight loss, I'd bet the most quacks show up in the ED field." > about. it's the one that opens and closes to let the blood flow in for > the erection and out afterward. why would that start to permanently > deteriorate after 4 days? That makes no sense. After they stuck me with the Lupron needle, my noodle went limp for over a year. Maybe I had some "deterioration" but I can get up to 80% firmness without Vitamin-V, that's enough for a woo-hoo good time if I think real hard about nosing the tip slowly into a wet, slippery, squealing, gasping woman. 90+% on Vitamin-V, of course that's all of 5 inches but who's measuring. All I can say is, do what feels right, keep pullin'. If it helps, think about my "petite-ami" from 25 years ago, the twenty-something, curly haired, grad student who could suck a golf ball through a garden hose. -kh IMHO, the most important thing for you to do is relax, accept the fact that getting erectile function back takes time. I had one nerve spared back in 2002 when I was 64, and I got my function reasonably back in 6 months. If you do any reading in this group, you will see that that is in the early range of erectile recovery. One to two years is, I think, more common. My first erections were with the help of Viagra at 6 months. I started out with 25 mg and then 50 mgs. Neither did anything for me. But when I went to 100 mgs, voila. Now I can get by without it, but it is better with 25 mgs. The more anxious you get about erectile function, the more difficult it will be to recover it. (And please note-my first doses of Viagra came months after the surgery. As far as I know, the value of an immediate Viagra regemin (sp?) is, right now, just a theory.) >i had my surgery oct 31st. incontinence went from a diaper for 2 wks > after catheder removal to 2 or 3 pads per day. my psa is 0.015. i [quoted text clipped - 31 lines] > > gary the ED doctor said that viagra exercises the ED muscle that permits the blood flow to the penus. it does it with nitrous oxide that causes the muscle to contract. would you say that using a chemical to cause contraction gets the same effect as pushing against resistence. if the muscle contracts, why am i not getting blood flow for the erection? does it have something to do with the nerve bundle? gary > IMHO, the most important thing for you to do is relax, accept the fact that > getting erectile function back takes time. I had one nerve spared back in [quoted text clipped - 44 lines] > > > > gary I really havent done any research into the biology of erections. All I am saying is that it is very early after surgery to be expecting erections. > the ED doctor said that viagra exercises the ED muscle that permits the > blood flow to the penus. it does it with nitrous oxide that causes the [quoted text clipped - 59 lines] >> > >> > gary Claude it seems that the kegel exercise speeded up the healing of my incontinence. that treatment is based on the school of thought that muscles can be rehabilitated by exercising them. that is why viagra is being used, to exercise the muscle that controls the blood flow into the penus. it seems that the injections (which is also a chemical) would also exercise the ED muscle. the difference being that it would actually complete the blood flow. that is why i am asking why the blood doesn't flow when viagra exercises that ED muscle? if it's because of the nerve bundle, then why does the injection work? does anyone have the answer to that question? gary > I really havent done any research into the biology of erections. All I am > saying is that it is very early after surgery to be expecting erections. [quoted text clipped - 62 lines] > >> > > >> > gary > Claude > it seems that the kegel exercise speeded up the healing of my [quoted text clipped - 9 lines] > why does the injection work? does anyone have the answer to that > question? Gary, You should read the description of what takes place during a normal erection in a book such that that by Scardino or Walsh. The 'muscle" is smooth muscle tissue, that has to RELAX for an erection to occur. It is not a matter of exercising it in the sense that you would exercise a voluntary muscle such as one in your arm or leg. That relaxation takes place because certain chemicals are generated in your penis which signal the erectile tissue to relax and let more blood in. It is the engorgement with blood that produces the erection. This is a multistage process involving different enzymes. In a normal man, the process is initiated by a nerve signal from the erectile nerves, and those are damaged during surgery. As these nerves heal, erections will begin to return. Even without those nerves, however, if you inject the right chemicals directly in the penis, an erection should follow. What Viagra does is to allow the usual biochemical process to begin when the nerve signal is lessened. If the nerves are destroyed, Viagra won't work. But if the nerves are working somewhat, but not enough to allow an erection, the use of Viagra may still encourage some relaxation of the erectile tissue and increased flow of blood to the penis. If I understand it correctly, if a man goes without an erection for a long time, the erectile tissue may become less flexible. The point of using Viagra early, I think, is to prevent that by encouraging early blood flow. As best I can tell, Viagra shouldn't have much effect on how fast the erectile nerves recover, but perhaps there is something I don't know. I didn't use Viagra until something like 6 weeks after surgery, and then only sporadically because it didn't do any good. I did use a pump. I used it both to have intercourse and also on occasion for practicing. Before surgery, I'm sure I had regular nocturnal erections, but after I started using the pump, I probably didn't have anything close to that with the pump, just about once or twice a week. Still after about 18 months erections returned, and now I do reasonably well with some Viagra, sometimes with nothing. And I was 67 at the time of surgery, so my chances were not as good as yours should be. I would recommend that you concentrate on resurrecting your sex life, possibly with a pump or injections, and not be concerned about what else will happen when. thank you Leonard i am also almost 67 yrs old, so i am in your catagory. since the muscles in the penis that controls the blood flow works on the basis of relaxation, then the chemicals in the injection would seem to be a natural method of getting the blood flow by causing them to relax. the ED doctor said that it was important to rehabilitate the muscles. doesn't that mean to get them to relax? geting blood into the penis also seems to be important for healing,as you indicated. it just seems to me that the injection does both whereas the pump only gets the blood into the penis. if the viagra gets blood into the penis, why doesn't it get erect? based on your explanation, the nerves are not dissableing the chemical that prevents muscle relaxation. so what good is it to take viagra unless the nerves recover? is it that we don't know when the nerves recover so we are covering our bases? besides, even a little bit of nerve recovery helps get some blood flow? so, is the bottom line that we want both muscle relaxation and blood flow and the injection does both, the pump does blood flow and viagra initially does neither but will progressively do both as the nerve bundle recovers? for now, wouldn't the injection be the way to go? Gary > > Claude > > it seems that the kegel exercise speeded up the healing of my [quoted text clipped - 50 lines] > possibly with a pump or injections, and not be concerned about what else > will happen when. Gary, Leonard is exactly right. First, you're VERY early in your recovery so try to relax. Many folks are started on an ED drug at about 4 weeks after surgery. This is to help relax the muscles and improve blood flow BUT..as was pointed out...the NERVE healing is the key to spontaneous erections. The injections work so well because THEY get blood to fill up the penis even WITHOUT the nerves. Time and healing is the key. Use the pump and ED drugs and keep trying as you heal. I'm about 20 months out...and though I get some increased size with the ED drugs...not enough for a usable erection. Orgasms...yes (from the beginning)...but no spontaneous erections. The nerves get beat up sometimes during surgery and take longer to heal. Best wishes, Ron B. Chicago > Claude > it seems that the kegel exercise speeded up the healing of my > incontinence. That . . . and/or healing. I.P. Leonard i read the books about the erectile nerves,as you suggested, but i could not find an explicit explanation about how the erectile nerve in the nerve bundle gets the information to send to the brain. what information does it send? gary > > Claude > > it seems that the kegel exercise speeded up the healing of my [quoted text clipped - 3 lines] > > I.P. > Leonard > i read the books about the erectile nerves,as you suggested, but i > could not find an explicit explanation about how the erectile nerve in > the nerve bundle gets the information to send to the brain. what > information does it send? "Me so horny." I.P. I.P. where does that nerve get that information? if that is all it gets, how does that differ from what the brain gets from other sources like visual and touch? why is this nerve so impotant in relation to the erection? gary > > Leonard > > i read the books about the erectile nerves,as you suggested, but i [quoted text clipped - 5 lines] > > I.P. > I.P. > where does that nerve get that information? > if that is all it gets, how does that differ from what the brain gets > from other sources like visual and touch? why is this nerve so > impotant in relation to the erection? > gary >>> i >>> could not find an explicit explanation about how the erectile nerve in >>> the nerve bundle gets the information to send to the brain. what >>> information does it send? >> "Me so horny." Oops, sorry. You assumed my joke had a real message. Sometimes they do, but not this time. I've never studied this aspect of our new lives because a) I don't consider these details to be of any practical use for us laymen and b) if my uros and I can't even get me out of pads yet, I surely can't solve my ED beyond diligent practice. My surgeon removed what he felt was required to optimize my chances of survival, and that included at least one set of nerves. He also decided real time against a sural nerve graft, considering how unlikely it was to help in my case. At two years post-op, I have improved a little bit since my one-year point. My penis will engorge on blood, but with only maybe 75% rigidity at peak and not for long because the blood flows back out again before it's done its job. Viagra made no obvious difference, and I'm not going to bother with any artificial aids. I.P. |
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