RP and Nerve Removal

[BundyBear]

Well, I never thought I'd be in this place in my life. My entire life I've had healthy erections up until about a year ago. Started having very minor ED and got some cialis. All was fine until my PSA's jumped to 10. Long story short, due to my relatively young age (47), I went with RP. Last thing I need is to undergo a RP after radiation, or to possibly get other cancers due to radiation.

While 'in there' the urologist removed one of the nerves due to possible incursion. There wasn't any but its better to be safe than sorry and the good news is - looks like everything is out - Prostate removed with no spread beyond, not even in the lymph nodes.

So I'm dealing with the slowly worsening depression. I am happily married (to a man) and we had lot of discussions prior to and post surgery about ramifications. However...I've had zero erections since the surgery. Not even morning wood. I was warned this was a possibility, and even with one nerve removed I only stand about a 40% chance of getting any kind of erection back, but...being warned and facing reality are two different things.

This absolutely sucks. I still have sexual urges and needs, but...I don't have a physical response. I'm abit nervous to try to reach orgasm yet. Also...and this may seem to be a bit personal, but I was not 'averaged' sized. Well above average really (7.5x6.25 non-bone pressed). And well, I can definitely tell I've lost length - which is a bit of a kick in the teeth too.

I don't know just felt like venting here is all. I certainly didn't ask for this in life and I get it life can throw you curveballs, but man. This sucks.

I was diagnosed with grade 4 prostate cancer in January 2023/ I am 60 years old so my urologist recommended I undergo RARP. The surgery went ahead 7th March 2023, but he had to cut into some nerves as the cancer was very close to them. The surgery went well and I mostly have been given the all clear as my PSA is not quite as low as he would like. I to am married to a man. my husband has been a pillar of strength for me. I had full bladder control at the eight week mark. I started using a Vacurect as soon as the catheter was removed 7 days later. I have lost a little bit of length due to the surgery but have not lost any girth, I use the VED device daily to help restore and maintain the length I have got till surgery. I as well have had no erections what so ever since the surgery. They put me on trimix but the dosage was increasing and the mixture felt like a like a kick in the nuts. So after a lot of research and stumbling onto this terrific website I have decided to go bionic, the surgery is schedule for 13 September 2023. When I asked my husband what does he think of me getting an implant he replied "Its your dick" with a smirk on his face.

My approach to life and always has been is this, yep. life likes to throw you curve balls, but don't like back at the past, that is behind you a road already travelled, keep looking forward and keep pushing ahead, where there is a will there is a way.

[still_crazy]

@equusAz:
Welcome to the forum. Sorry to hear that you are now in the same boat as many of us here, but there is hope, and there are ways and solutions. Yes, daily VED exercises are a must. Go easy at first, because you don't want to cause damage where the surgery occurred. After a couple of months you can experiment with using constriction rings with the VED to produce/maintain an erection for up to 30 mins at a time. Then also look at Trimix or straight Alprostadil injections. Sounds frightening, I know, but once you get used to injecting it works great for many of us. Since you've had one nerve bundle spared, it's possible you will get natural erections back in a year or two, but if not, there's the methods mentioned above. Finally, after a few years, if nature doesn't resume its magic, many will choose to get an implant and "go bionic" as they say.

I'm not a medical professional, just relating my experience so far. I had a non-nerve sparing prostatectomy about 8 months ago. So I know exactly where you're at.

[JetAirliner]

Equzz
Your situation is almost identical to mine ... RP a couple of years ago with a 10 PSA - all found out through an annual physical ... Given your age, you did the right procedure (RP) because if you had gone the radiation route and it didn't work out, my surgeon told me that it is very hard to do a future RP because the tissues surrounding the prostate are compromised during the radiation

FWIW - I officially became Bionic with my new implant this past week ... I tried pills, VD's, and injections but nothing worked because none of my nerves were spared during RP .... I didn't even know that implants were an option until I spoke with my surgeon at one of my follow up visits and I "stumbled" on to Frank Talk - a little over a year ago

Here is what I did: Talk to your RP surgeon about implants and when they would recommend looking at an implant. I am assuming that you have had a follow-up visit with your surgeon and you will do blood work every 3 months. Start researching your potential implant surgeon options based on case numbers, successes, proximity, infection prevention etc. My parameters were that I wanted a top notch surgeon that was close in of case any issues. Remember - You are the buyer and they are they seller - so do your research based on your needs

Also - contact your insurance company regarding coverage and if covered - work on getting a pre-certification from your insurance company .. In my case - I was denied twice and with the help from my surgeon and myself - fought like a mother to get it approved

Hope that this is helpful ... Best, Jet

[BabyBarney]

Happy holiday! I had a RP 25 years ago at Johns Hopkins and here I am at 86 still very much alive. 13 years ago had an implant and still working fine. Missing my wife but doing solo at times to keep my dick somewhat active. There is always a better tomorrow so try and deal with depression, etc. I also believe in God and depend on his comfort as well.

[Lost Sheep]

Well, I never thought I'd be in this place in my life. My entire life I've had healthy erections up until about a year ago. Started having very minor ED and got some cialis. All was fine until my PSA's jumped to 10. Long story short, due to my relatively young age (47), I went with RP. Last thing I need is to undergo a RP after radiation, or to possibly get other cancers due to radiation.

While 'in there' the urologist removed one of the nerves due to possible incursion. There wasn't any but its better to be safe than sorry and the good news is - looks like everything is out - Prostate removed with no spread beyond, not even in the lymph nodes.

So I'm dealing with the slowly worsening depression. I am happily married (to a man) and we had lot of discussions prior to and post surgery about ramifications. However...I've had zero erections since the surgery. Not even morning wood. I was warned this was a possibility, and even with one nerve removed I only stand about a 40% chance of getting any kind of erection back, but...being warned and facing reality are two different things.

This absolutely sucks. I still have sexual urges and needs, but...I don't have a physical response. I'm abit nervous to try to reach orgasm yet. Also...and this may seem to be a bit personal, but I was not 'averaged' sized. Well above average really (7.5x6.25 non-bone pressed). And well, I can definitely tell I've lost length - which is a bit of a kick in the teeth too.

I don't know just felt like venting here is all. I certainly didn't ask for this in life and I get it life can throw you curveballs, but man. This sucks.

I second bldoink's advice about using a vacuum erection device (VED) to maintain penis size and tissue health. Pump up to draw blood into your penis and let it go flaccid "cycling" that way repetitively for about 30 minutes twice a day is a protocol I used. Keep those tissues elastic. Remember also it is possible to orgasm with a flaccid penis (inside someone's mouth or an appropriate masturbation device). Keep in mind that while it sucks, it is treatable. As far a lost length is concerned, if you use a VED to keep size, you should not have any loss. But if you let your penis shrink for any appreciable length of time, you might lose size permanently (or at least have a lot of work to do to get it back.)

Remember that recovering erectile function and urinary continence takes time. Weeks or months or even years rather than days and it varies WIDELY among patients. So, be patient and diligent with your recovery efforts. Take physical therapy (kegel exercises, mostly), which may be covered by medical insurance. Not many practitioners are good with kegels for men, but they are out there.

[vajim1]

I had about the same issues myself, Had prostate removed afterthe doc wanting me to wait and see, after removal two months psa started climbing so I went for 37 radiation treatments.
Zero erections with ppills and a floppy dick with the strongest dosage of trimix. I tried ved with injections and it would work but would have to stop and pump up agin several times before getting to the end.

[equusAz]

Hey all! Thanks for the kind words and support - a little update is due I guess.

I did have my follow-up with my urologist. Undetectable PSA - so thats good. I have a second follow up coming in a couple of weeks. He did put me on Tadilafil and Slidinafil and told me to 'give it a shot. The Tadilafil is once a day low dose, and Slidinafil is 25mg. I did get a VED and have been trying that.

With the VED - of course it works while I'm in the device - and from what I can see, no real lost length / girth. So I'm happy about that (if I did loose any I had enough to start with that I'm not really going to notice ). However immediate deflation when pulled out.

I did try the tadilafil - I'm one month in with zero result. I also coupled it (a couple of times) with the Slidinafil - for those of you that are curious do NOT do this without doctors consent / advise. My doc advised me that since my heart is tip top (had a bunch of tests done a few years ago) to give it a try. Well...the most that happened was that after using the VED I could maintain a floppy erection for about 30 seconds post VED. So...I would NOT call that any kind of success. Not really. Granted I'm 2 months out but with that much medication I figured I should have something going on other than very floppy erections for 30 seconds.

I'm lucky in that my husband loves me for who I am and not just what I have / had. We're flexable so - there is that too (not going into too much detail).

I'll see what he says about injections in my next visit. Not excited about that but....if its something to try - I'm willing.