Dear RML,

I had done a lot of research on this subject and written a whole lot
about "penile rehab" starting last November.  (See "Sex After
Surgery", (11/11/06) and "Sex After Surgery - Update" (11/13/06).  In
the latter msg, I presented some evidence in response to a question
which was basically the same as yours.  I always rely on credible
sources, be they hospitals, people, journals, etc.

Apparently, people found the above posts useful, because I got a lot
of good feedback about them.  So, I would like to provide an update on
this subject, very briefly.

"Penile rehab" is a nascent field -- there's not a whole lot known
about it.  However, when I did my research back in the fall, I did not
come across a single article that said Viagra and other PDE5's worked
to restore natural erections.  There was one report based on a study
done by the mfr which I discounted, and another study which scientists
found to be flawed.  There was (almost) no positive info relating to
Viagra and "penile rehab".  (It was shown to help preserve smooth
muscle tissue.)

You can't prove a negative, so the burden would be on you and whoever
believes Viagra to be effective for restoring EF to present some
evidence of this.   As a matter of fact, I have posted this msg or
variations of it everywhere and invited people to submit contrary info
and I haven't gotten anything.

However, things do change quickly in this arena, and so I did an
updated search of this topic yesterday and came up with certain
promising, and maybe even probative, articles.  I still have to digest
them.  I can't really do any heavy thinking right now because my
husband's being in medical limbo is making me tired, depressed and
muddled.  So for the moment, I will have to think "lite".

But here is a summary from the Johns Hopkins website:

"A relatively new strategy in clinical management after radical
prostatectomy has arisen from the idea that *early induced sexual
stimulation and blood flow in the penis may facilitate the return of
natural erectile function and resumption of medically unassisted
sexual activity. **There is an interest in using oral PDE5 inhibitors
for this purpose, since this therapy is noninvasive, convenient, and
highly tolerable. However, while the early, regular use of PDE5
inhibitors or other currently available, "on-demand" therapies is
widely touted after surgery for purposes of erection rehabilitation,
such therapy is mainly empiric. Evidence for its success remains
limited."

I am not against anybody taking Viagra after surgery.  I would do the
same.  The only point I was really trying to make is that if you end
up in the subset of men who have sustained serious nerve damage, I
don't think Viagra will do anything for you, either to get you an
erection or to restore long-term natural EF.  And you don't really
know which category you'll end up in, in spite of what the doctor has
told you about nerve sparing. That's why some people consider it
playing it safe to try early injections or VED, which I think have
been found to be somewhat effective (not by everybody).

I am just trying to promote good clinical practice offered by such
hospitals as Sloan-Kettering and Columbia Presb. in my area.  As Tom
R. wrote here, after he had surgery w/Dr. Eastham st MSK, he was
immediately scheduled for a 6-week follow-up to examine his sexual
function.  Both hospitals I mentioned have experts in "sexual
medicine" on board who deal w/sexual function and "penile rehab".  So
I suggest, that if a man does not regain EF after 2 mos, he should see
an ED specialist because it's always better to intervene earlier than
later.

There's also evidence that a lot of men who do not respond to Viagra
at first will respond later when their nerves have had a chance to
heal (for example, at 15 mos.)   (Dr. Samadi mentions 9 mos. as a
ballpark)   I suggested to my own husband that we should add Cialis to
his regimen of injections for ED about a year post-RP because there
wasn't really anything to lose (unless you have a heart problem, I
think).  We tried it and I don't know if it has worked -- always hard
to distinguish a placebo effect.  But, as I have told everybody here,
my husband seems to have miraculously regained his erectile function
at 14 mos-post op (and now I can attest that it was "replicated").  It
seems like the wires are starting to function.

Anyway, I already have a stack of updated articles on sexual rehab
sitting right by me, so I will try to summarize them quickly to see if
anything is new.  (This is just a quickie.)

1) There is a study ongoing on JH to test the effectiveness of  a
nightly dose of Vit. V on men who've had nerve-sparing laparscopic RP.

2) Study by Donatucci, et al, Duke U., 11/06.  "Recovery of Sexual
Function after PC Treatmnent".  Bottom line: they believe "No standard
treatment or prophylaxis exists for post-tx ED.  **Neuroprotective and
regenerative therapies, including the immunophilin ligands, hold
promise to reduce morbidity of localized pca therapy".  Amen.

3) "Update on EF in PCa Patients", Current Opinion in Urology, 16(3);
186-195, May 'O6.  Summary: data shows that pharm. rehab programs
provide a higher rate of EF following RP.  "Both intracavernosal and
intraurethral approaches are thought to provide integral roles for the
maintenance of sexual function in men undeergoing PC therapy".  Notice
the absence of PDE5's.  It says that they, injections and VED's have
all been reported "in a positive light".  That's all.

4) Article from Cleveland Clinic, "Early Combination Therapy:
intracavernosal injections and sildenafil following RP increases
sexual activity and the return of natural Erections"  Int. Journ. of
Impotence Research, Feb. '06.  Combo of injections and Viagra seemed
to work.

5) "Can an erectogenic pharm. regimen after RP improve post-op
EF?" (Nature Clinical practice Urology (2006) 3, 72-73, Eardley, I.)
Recovery of EF may take 18 mos or even longer, even in men who've had
bilateral NS.  ** In those men who do develop Ed, a number of factors
have been implicated, including "unrecognized nerve injury, arterial
injury, and veno-occlusive dysfunction caused by structural
alterations in the cavernosal smooth muscle."  **These can be
discovered by Doppler Ultrasound, done 6 mos. after surgery.

6) Dr. Mulhall (of MSK and NY Hosp.) wrote a summary for the Sexual
Med. Soc. of N.A., 2005 Fall meeting.  He concludes that "there is
accumulating evidence that the presence of blood flow abnormalities in
the penis after RP is a predictor of long-term ED after RP".

Also from above:  animal studies have shown that certain compounds can
help in *"erection nerve protection".  A group of rats who had
undergone "nerve crush Injury" were given a combination of sildenafil
and FK506 (an immunosuppressant) after cavernosal nerve injury had the
"maximum protective effect on erectile function recovery."

And Eureka!

"Sildenafil alone also appeared to exert a protective effect on EF".
(In rats, of course.)

Hope this helps.

Leah

Even way late in this sorry game, there's always time to read a PC book
or 6. The PC learning curve is much like some contrarian roller coaster
that starts with the downhill part and climbs the big, clackety hill
*after* the rush. You'll learn *so* much in that first intense week of
full-time reading that you'll almost feel like you actually *know*
something about PC when you finish, and your PC isn't going anywhere in
a week.

I.P.