My partner wanted me to ask this as he is becoming a bit despondent. He had a radical prostatectomy 6 weeks ago. He had almost no issues with urinary incontinence straight after the catheter was removed. BUT now he is worried about erections. How long does this take to come back, if ever
He is 56 and super fit. Goes to the gym 5-6 times a week and was back in the gym 3 weeks after surgery. Urologist has put him on Cialis 5mg (as this may help??).
Any advice or suggestions. Or is he becoming too impatient and it will happen.
Thanks in anticipation.
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Filotimo62
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6 weeks is nothing. He should get started on penile rehab ASAP. Yes, daily Cialis can help, but also daily pumping, and trimix injections two or 3 times a week. He needs to re-establish blood flow ASAP. Here's a good book by the expert on the subject:
It is my understanding that improvements remain possible for up to two years after prostatectomy. There are also a hierarchy of treatments starting with Viagra and going up through pumps, injections and penile implants - something that some men swear by and others won't have anything to do with (I'm not interested in them myself.)
One important point to always remember is that sex does not depend on erections. A man can satisfy a woman or another man without having an erection and can achieve orgasms of his own without an erection. I think that a man should not withdraw from sex or feel in any way less of a man because his erections are no longer forthcoming.
There's a lot to say about all of this. It's a complicated problem involving emotions and psychology as much as physiology. I suggest that you give him all of the support that you can and try to work out a new and interesting sex life with him.
Filotimo, I did Cialis for 60 days after my RALP & used the pump regularly for 6 months or so. While it took about a year for me to get back to maybe 90 % of pre-surgery erections, they did return. Everyone's mileage will vary, but just as with incontinence, being pro-active in doing all you can to help recover each function is essential for best results. Be Well - cujoe
RALP in 2013 was "nerve sparing". Non-organ confined, extra-cap involvement, + rt seminal vesicle inv, so I did 8 weeks IMRT about 3 months post-surgery. (6 mos is usual wait time for RT to allow incontinence to improved. Due to poor pathology, I pushed for the IMRT ASAP.) While the radiation treatment might have delayed the return of erections, I felt very fortunate to get back to 90% at the age of 66. (I'm now 71+.)
No ADT until PSA rise 3 years after surgery. ED was not an issue at that time, but the effects of ADT did impact sexual function and libido in a major way. I only did 3 mo of ADT and have been off treatment for 15 months now with testosterone in the age-adjusted normal range for all that time. The effects of ADT had dissipated after 3 mo off ADT. (labs at that time had T = 586!) Blockage of the male hormone will definitely challenge all aspects of sexual function. If you partner is not on ADT, his prospects for return of sexual function(s) in the near-term is obviously greater. If he is on ADT (or expects to be), you might want to post that info and ask for the experience of long-term ADT forum members.
Bottomline is that the long-term impacts of RP on sexual function vary even with very experienced surgeons. Patience Is A Virtue. Be Well - cujoe
Thanks for that - I told my partner all of this and he needs to be patient and do his exercises. He tells me he is doing some and it seems to be helping bit by bit. I think he thought he would be 100% post surgery as he had no problems with urinary incontinence. He started to think he was superman.... All great positive thinking but also needs to be a little patience.
He is happy with all the information - thank you everyone
Other than TAJohnston, everyone on this site has been plagued with ED following RRP surgery, including me. I have read the book recommended by Tall_Allen (very informative, but offers no magic bullets). My prostate was removed in Oct 2018, and my goal of achieving an erection capable of penetration has been elusive. 20mg sildenafil daily, perform regular manual penile exercises to get blood flow, do the kegels (more for incontinence, which thankfully is not an issue), and yes bought a vacuum pump which does not help much for me. I am considering injecting myself, will discuss with URO in a couple weeks. IMO, this whole "nerve-sparing" component must be the holy grail. Were mine really spared as my surgeon's report states? Do they really take 12-24 months to re-wire? I pray that the answer to both questions is yes.
Good luck Guys. No nerve sparing for me as all neural and veinous bundles out of prostate area were found to have gleason 9/10 pca. Nerves were already useless acct cancer. Nothing has worked with no nerves in area that weren't cut or killed by chemo. Dr says it implant or nothing for me.
Six weeks is, like Tall Allen said, nothing. I continued to have improvement for a long time, somewhere between one and two years. Also, some guys respond better to Viagra than Cialis (I do). He should keep working and keep experimenting!
100mg of sildenafil works better for me than Cialis, and it costs much less than Viagra. I take it at night because it helps with nocturnal erections and avoids day time drops in blood pressure. Penile health is like muscle health - "use it or lose it" is not a myth. Alcohol will kill erections.
I get my ED pills from India. Paying retail in the US is absurd. I would also suggest the 'poor man's viagra': L-Arginine. Throw in some L-Acetyl-Carnitine for good measure. Slam that water too -- doesn't work too well if you are dehydrated.
Great video. Lots of info and lots of questions for us to ask the Urologist next week. My partner is going to get his PSA levels checked this week as he is now 6 weeks post surgery. I suspect they will still want all treatment (radio, chem and ADT) even if it's low as he had Gleeson 8. He is going to ask for the injections after seeing the video. Many thanks again for this.
It has taken me longer than normal but I had radiation after my RP just to be safe. I had to settle with the Trimix shots but that made a world of difference. A little strange at first but now it's no big deal. A very understanding partner is key. This is much better than nothing. I still feel i am making progress naturally but the Trimix gives me a sex life while i am waiting for it to come back naturally. I am 53.
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