Hello, new here and looking for feedback. I'm 53 and had RP 1 year ago for Gleason 3+4 =7 prostate cancer with nerves spared bilaterally, no adverse pathology. PSAs have been <.01 post-op. I've been fully continent since about 3 weeks post-op so I've had a great result on urinary function. No spontaneous erections at all since RP, but I do get some fullness in the mornings and with stimulation. I was started on cialis a few months before surgery - erections were usable pre-op, but were better with cialis. Since RP, I don't have any response to cialis or viagra. I'm on daily cialis 5mg since the catheter was pulled post-op and have tried up to 20mg w/o a response. I started with trimix at 5 months post-op with the "standard" strength (30/1/0.01mg/ml) and was not able to get a usable erection for intercourse, only got to about 60% on max. dose. The trimix strength was changed to 30/2/0.02mg/ml and I'm still not getting a usable erection. Getting to about 60% with 45 units and it only lasts for a short time and is not usable for intercourse.
I'm going to get in touch with the NP that is prescribing the trimix to ask, "what's next." The NP is with the urology practice where I had my RP, which is at an academic medical center/cancer center of excellence. They have a high volume of prostate cancer patients and my surgeon has done around 5k RP surgeries. Feeling very disappointed and frustrated that it's not working.
For those of you that have increased the strength of the trimix, how much room is there to increase from what I'm on now? My wife thinks I have venous leak and wants me to talk to them about getting an ultrasound. Worst part about all of this is insurance doesn't cover any ED treatment and won't cover an implant, if it gets to that.
Trimix Strength
Re: Trimix Strength
Welcome to the forum.
I edited the crap out of the original post!
I'm not a medical professional of any kind. Anything I post is at best based on my own experiences and at worst on hallucinations and/or delusions. Internet forum advice is likely worth what you paid for it, or worse. Always ask your doctor and follow his/her advice.
I'm a little confused on the mixes you listed. It's either just too early for my brain or you're listing them in an odd way. Mixes are generally written with the first 2 ingredients written in mg/ml and the last, the alprostadil (PGE1) as mcg/ml. Then you would state how many "units" you're using of the mix or a few will list dose volume by ml/ If listed in units keep in mind there are 100 units per ml.
OK, your 30/1/.01 and 30/2/.02 would be more commonly written as 30/1/10 and 30/2/20 with the first two ingredients in milligrams (mg) and the last ingredient in micrograms (mcg). Yours was written with all ingredients in mg.
I'll come back and finish this later as I have to run out and get zapped. (edited) But just note that when I first started injecting after my RP, 40mcg of alprostadil, in the form of Edex, wasn't doing a good job. Now about 12 mcg of compounded alprostadil mono-mix works fine. That's in combination with Viagra and novelty/sex shop cock rings.
Are you also using a VED (vacuum erection device)? If not you should be. You can try it with medical grade constriction rings for sex if you like but you really need to be using one for therapy. Your doctor can give you a script for one if your insurance will cover it. Use it for therapy along with the pills.
As I referenced earlier, after my RP and for months, up to a year or so after, neither pills or injections did much for me. But I continued trying along with the VED. Initially the VED with constriction rings was the only way I could get and maintain an erection. Not ideal but it's what I could do.
After awhile I gradually got more response from the injections at 40mcg alprostadil, combined with the pills (100mg Viagra). Eventually my dick came back to life to the degree I had to reduce the injection dose. I'm now at the point where I use 12 mcg alprostadil and get a good long lasting erection. I very often fortify that with 50mg of Viagra. I also have found that the proper size of silicone novelty/sex shop cock ring gives me a nice boost. Actually without the Viagra and sex shop cock ring I do need to boost my alprostadil dose a bit more. I can boost the injection to the point that nothing else is needed but then that's a 4 hour erection with reduced sensitivity. I like the combination treatment much better.
I still get no natural erections. Sometimes, when mentally aroused, I can feel like I'm getting some beginnings of an erection but when I actually check there's nothing. Now with Viagra, with mental arousal and stimulation I can get some noticeable thickening and if I add a cock ring I can get a pathetic unusable stiffie. It's still nice to see some life down there. But happily the alprostadil injections work wonders.
It can take a good while to get maximum recovery from ED, whatever that may be. Try some combination strategies. Definitely use a VED for therapy. Try experimenting with the novelty/sex shop cock rings added to the mix. They can even help with a mild venous leak, which it sounds like you may have. The right ring for you might boost that 60% erection into good usable territory. See the "Cock Ring" thread in the "Members Only" sub-forum: https://www.franktalk.org/phpBB3/viewtopic.php?f=16&t=21302
I edited the crap out of the original post!
I'm not a medical professional of any kind. Anything I post is at best based on my own experiences and at worst on hallucinations and/or delusions. Internet forum advice is likely worth what you paid for it, or worse. Always ask your doctor and follow his/her advice.
I'm a little confused on the mixes you listed. It's either just too early for my brain or you're listing them in an odd way. Mixes are generally written with the first 2 ingredients written in mg/ml and the last, the alprostadil (PGE1) as mcg/ml. Then you would state how many "units" you're using of the mix or a few will list dose volume by ml/ If listed in units keep in mind there are 100 units per ml.
OK, your 30/1/.01 and 30/2/.02 would be more commonly written as 30/1/10 and 30/2/20 with the first two ingredients in milligrams (mg) and the last ingredient in micrograms (mcg). Yours was written with all ingredients in mg.
I'll come back and finish this later as I have to run out and get zapped. (edited) But just note that when I first started injecting after my RP, 40mcg of alprostadil, in the form of Edex, wasn't doing a good job. Now about 12 mcg of compounded alprostadil mono-mix works fine. That's in combination with Viagra and novelty/sex shop cock rings.
Are you also using a VED (vacuum erection device)? If not you should be. You can try it with medical grade constriction rings for sex if you like but you really need to be using one for therapy. Your doctor can give you a script for one if your insurance will cover it. Use it for therapy along with the pills.
As I referenced earlier, after my RP and for months, up to a year or so after, neither pills or injections did much for me. But I continued trying along with the VED. Initially the VED with constriction rings was the only way I could get and maintain an erection. Not ideal but it's what I could do.
After awhile I gradually got more response from the injections at 40mcg alprostadil, combined with the pills (100mg Viagra). Eventually my dick came back to life to the degree I had to reduce the injection dose. I'm now at the point where I use 12 mcg alprostadil and get a good long lasting erection. I very often fortify that with 50mg of Viagra. I also have found that the proper size of silicone novelty/sex shop cock ring gives me a nice boost. Actually without the Viagra and sex shop cock ring I do need to boost my alprostadil dose a bit more. I can boost the injection to the point that nothing else is needed but then that's a 4 hour erection with reduced sensitivity. I like the combination treatment much better.
I still get no natural erections. Sometimes, when mentally aroused, I can feel like I'm getting some beginnings of an erection but when I actually check there's nothing. Now with Viagra, with mental arousal and stimulation I can get some noticeable thickening and if I add a cock ring I can get a pathetic unusable stiffie. It's still nice to see some life down there. But happily the alprostadil injections work wonders.
It can take a good while to get maximum recovery from ED, whatever that may be. Try some combination strategies. Definitely use a VED for therapy. Try experimenting with the novelty/sex shop cock rings added to the mix. They can even help with a mild venous leak, which it sounds like you may have. The right ring for you might boost that 60% erection into good usable territory. See the "Cock Ring" thread in the "Members Only" sub-forum: https://www.franktalk.org/phpBB3/viewtopic.php?f=16&t=21302
R.R.P 2011 Mayo Jacksonville, Dr. M. Wehle. Nerve sparing - damaged. C in margin. Radiation 2023, V.E.D, Viagra and PGE-1 (80mcg/ml) injections @ ~ 14 units. Originally Edex20, then compounded PGE-1 - cost. Inject. 12 yrs. It works. Treasure coast of FL.
Re: Trimix Strength
Thanks for your reply. I made an appointment with the NP - appt. is in early December. I'll talk to him about changing the strength of the trimix. Any suggestions on a specific pump? I have a bathmate hydromax pump but using a ring with it doesn't work well due to the design of the pump.
Re: Trimix Strength
I have an Osbon ErecAid Manual System. I've had it since my RP. I like it. There is no gauge with it. It did come in a travel bag with assorted constriction rings and a ring loader and some lube. I'm not going to tell you it's the best pump. It is the one I have experience with and has held up well. However, their constriction rings are usually considered the best. You can check out the "Pumps (Vacuum Erection Device)" sub-forum for other suggestions.
R.R.P 2011 Mayo Jacksonville, Dr. M. Wehle. Nerve sparing - damaged. C in margin. Radiation 2023, V.E.D, Viagra and PGE-1 (80mcg/ml) injections @ ~ 14 units. Originally Edex20, then compounded PGE-1 - cost. Inject. 12 yrs. It works. Treasure coast of FL.
Re: Trimix Strength
Thanks for the recommendation. I'll head over to the pump forum and check it out. It seems like the men that recover good erectile function post-RP, seem to recover it early on after surgery. Not feeling so good about a functional recovery with the lack of success with the trimix so far..
Re: Trimix Strength
I suspect your chances of recovering to the point of achieving natural erections unaided are not good. Actually I think the guys that recover full function after an RP are the rare exceptions, but I can't back that up with any hard evidence. The number of guys that can recover to the point of pills alone is also probably a minority. A sexual life can continue through one of the several options available. You'll just have to figure out what works for you, but don't get discouraged too soon. You recovered full continence quickly so I'd find that encouraging.
R.R.P 2011 Mayo Jacksonville, Dr. M. Wehle. Nerve sparing - damaged. C in margin. Radiation 2023, V.E.D, Viagra and PGE-1 (80mcg/ml) injections @ ~ 14 units. Originally Edex20, then compounded PGE-1 - cost. Inject. 12 yrs. It works. Treasure coast of FL.
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