For post-prostatectomy ED, the initial question for men is most often "how long until recovery" (naturally, seems obvious as to why). Doctors give advice that ranges considerably; in my case, the initial range quoted was 6-18 months. Around month 12, upon seeing my consternation that I was already at 12 months with a lot of recovery yet to go, they started quoting the more traditional "2 years", and even fudged that with "2-3 years".
I'm now at 28 months with, still, more recovery needed for reasonable usability. The good news is that, apparently, recovery is still occurring, at least it seems so. I realize healing rates vary widely among men, due to variations in age, fitness, health, etc. (e.g., personally I think prostate size can have a significant impact: for me, my enormous 104cc prostate meant that I was on the operating table 5+ hours, allowing that much more time for potential nerve damage to occur as even a highly skilled surgeon is bound to get tired by then).
My question: at what point should a man give up and admit he'll never recover? I've heard anecdotal stories from different sources of post-RP men having improvements beyond 3 years, even at 5 years. But it would seem at some point, one must "accept his fate". Is that 7 years? 8? 10? The underlying question is, how do you know when the nerve healing has "completed its course"?
For men who want to consider the penile implant, this would seem a critical question, since that point of realizing you are not going to recover by yourself might be the point at which you finally decide to have this irrevocable surgical procedure. (My wife and I have decided the implant won't be an option for us, for other reasons. But I'd still like to know what others think.)
My approach at this time is just "never give up, keep trying" but I suspect at some point that might change. (Or of course, I could die before then too.)
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I'm curious as to why an implant is not an option. I have an implant and it was the best decision of my life. The key is to only go with one of the best surgeons in the country that specialize in implants.
Since you asked: there are two reasons, one just me, and one for both of us:
(1) I've tried the injections - they create a very solid and long-lasting (almost too long, sometimes) erection. But there's an accompanying numbness, lack of sensation, "swollen" feeling that makes it absolutely impossible for me to orgasm during penetration (not enough nerve stimulation possible). For me, that's the primary reason for doing it and that's not possible. (And I've learned how to help my wife "ring the bell" without penetration, so she doesn't need it for that either.) I'm picturing the implant to have the same problem, but unlike the injections where I can just decide to stop using them, if you get the implant, you're stuck with it for life - no reversing it.
(2) For both of us, a critical part of the lovemaking experience is observing each other's body physically respond to the other's presence. That forms a wonderful "feedback loop", where the visible reaction of one in turn excites a response from the other, and that builds to a finality. We're both convinced the implant would break that feedback loop for us: "my" visible excitement wouldn't be generated by my own mind, it would merely be the results of physics (hydraulics) triggered by me "pushing the button". We feel that would so severely limit the satisfaction level for both of us. My wife has joked she'd feel like she was having sex with a robot, and frankly, I would feel a bit like a robot.
Everyone's different. Congratulations, I'm very happy that it has worked for you (and partner).
Nerve damage is hard to avoid even when nerve sparing is the goal. While nerves regenerate, they may never come back enough to facilitate erections. After a year, it is doubtful you’ll recover to former self. That can possibly be mitigated with pills, injections, vacuum erection devices, or implants. Pills didn’t work for me, but Trimix injections do… remarkably so. I would explore your options if you are not sold on an implant. Injections are painless and very effective.
I've done injections, as mentioned above. In my experience, they're not exactly completely painless. My description to the NP who prescribed them was that they are somewhere between a mosquito bite and a bee sting: if you do them optimally, more like the mosquito bite, but if you don't quite get the needle action correct, more towards a bee sting.
And like I said above: yes they are effective in terms of producing a long-duration erection, but not effective (for me) in enabling an orgasm-capable erection, since there's so much loss of sensation/feeling from the accompanying "swollenness/soreness/achiness" feeling, and not enough distraction-free stimulation can be achieved to complete the orgasm.
You may need to titrate down. You want to be just hard enough for penetration. Trimix is also used to prevent those that ejaculate prematurely. Oh, the irony. It is a matter of dosage in most cases. The harder the erection, the more difficult to orgasm. You also may wish to explore Bi-mixes.
When I was "titrating upward" during initial attempts, I was trying to match my pre-surgery level of hardness, which I naively thought would be my best approach. Very early, I had a level that was perhaps barely enough for an initial penetration - but then the "normal" interaction (in the world of erectile function) with the mind seemed to kick in, where a man's mental input (in terms of self-confidence or lack thereof) begins to produce that adrenaline or whatever from anxiety, and it quickly subsided. So it felt I needed to generate that same level of hardness in order to allow my mind to engage without stress.
What I hear you saying is that instead, I need to scale down the titration to decrease the firmness, and somehow retrain my mind to still believe in itself, to not be fearful that this diminished level will be "good enough" to get the job done?
I wish someone would tell me how to do that, since all my mind knew prior to surgery was that level of hardness.
It sounds like your dose is excessive. I have had absolutely perfect success using tri-mix. Completely natural sensations and wildly explosive ejaculations. Try a smaller dose. Good luck!
If you're having ejaculations, then clearly you didn't have a prostatectomy ("nerve-sparing" RP, like me). I theorize the characteristics of trimix responses can be significantly different for the RP patient. In my case, the nerves that control orgasm-triggering, in the penis (head) itself, were apparently also disturbed just like the internal nerves that control blood flow for erection-triggering. (BTW, my doctors didn't really inform me about this prior to RP.) So these nerves need to recover also.
Using trimix to generate a penetration-capable erection may be effective, but if those orgasm-triggering nerves have been "damaged" then they seem very susceptible to any distractions. Previously, I had similar erections which were likewise firm but the "fullness feeling" didn't subtract from the capability of the orgasm-triggering nerves to get enough stimulation for success - in fact, it seemed those orgasm-triggering nerves fed off that "fullness". Now it feels like the reverse, sadly.
The ultimate irony, for the man's world of "sexual function": a very common reported that men face is PE or premature ejaculation, which can spoil the enjoyment factor for that man and even more so, for his wife. Now I face delayed (indeed, virtually impossibly delayed) orgasm, which is never discussed because among men it's mostly nonexistent.
I definitely caught a break! If the intern had not destroyed my urinary spinchter I would be pretty good overall condition. I didn't have both choice but to have the RP because I was a Gleason nine. I had 42 radiation treatments after the surgery and my PSA has been undetectable for the seven years since the operation.
Alas, I was Gleason 10 (in one core) from my biopsy, so RP seemed the right choice (especially because it would also solve my second problem of dangerous bladder retention caused by an enormous prostate.
Although once the prostate was removed, it was graded overall "only" as a 9 (as if that makes much difference at those levels 🙄)
I’m at 36 months recovery with nerve sparing and have seen encouraging results each year. Advice that was given to me early on was to take Cialis daily (5mg). Not to simulate an erection, but to “encourage” nerve activation at the point of arousal. I’ve taken it daily for 2.5 years but do not rely on it for sexual activity. Like you, pills alone are not effective so I rely on Quad Mix or a pump/ring set-up for penetration. I will say that my wife has noticed a difference in my arousal during foreplay over the three year period and it is encouraging to see her reaction as things have improved.
While I’m not suggesting Cialis is responsible for improvement, it may have been a factor in enhancing my arousal response.
My suggestion is to stay positive and continue exploring options. While I will likely never get to full strength on my own, each year brings improvements which keep me hopeful.
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PE to ED, wife still dealing with me, she's not waiting any longer, she's now having great sex with other men. 
