Do Easy Erections Ever Return After Prostate Removal?

markinphoenix · Regular Joined: 04 Jun 2008 Posts: 24

Many men have reported on this forum that they can achieve an erection after prostate removal, but most say it takes more visual, mental, and manual stimulation to achieve and maintain an erection. Does anyone know if the nerves will eventually regenerate making achieving an erection easier, like it was before the surgery? If it will get better how long might this take?Any personal experience or input from doctors, books, research, etc?

Thanks for any information you can provide. Very Happy

Hawk · Experienced user Joined: 22 Nov 2006 Posts: 90

Mark,

All men and all surgeries are unique. For instance men have varying degrees of erectile functioning before surgery. Age and other factors can impact healing. During surgery, nerves can be totally destroyed, largely spared, or any degree in between. The way those factors pair up mean no one can predict your progression. Certainly patients on a forum could never predict your outcome. However there are some important points.

RP damages or traumatize nerves (some are traumatized even during surgical healing right AFTER RP,). Of course some nerves are actually removed. Your surgeon should be able to qualitatively tell you the degree of nerve removal for the right and left nerve bundle.

In any event, if nerves were spared, you will continue to get some improved nerve pathways for at least 12 months after surgery and possibly for 24 months. The chances are that it will never be exactly like it was but rarely, miracles happen.

Sometimes intimacy and sex even improves as you and your spouse explore the possibilities.

There are many things you can do to have a positive impact on the process and outcome.

Improve healing and preserve penile health by increasing blood flow to penile tissue (including the large part of penile tissue inside of your body). Do this with a 1/4 Viagra nightly. Challenge yourself at least weekly with attempts at sexual activity (use it or lose it). You may want to take an entire Viagra at these times. A half of a 50 mg Trazadone tablet at night (prescription) also encourages nocturnal erections which maintain penile health.

I would encourage any man that has a RP to strongly consider a Vacuum Erection Device (VED) to encourage blood flow. Penile tissue that is deprived of blood flow from erections or VED tends to lose elasticity. This can contribute to the seldom discussed loss of penile size that Urologists all know about. Here again, blood flow and oxygenation are thought to help prevent Peyronies Disease.

Be careful with injuring a borderline erect penis during sex. Injuries can lead to Peyronies Disease which is much more prevalent in prostatectomy patients than the general male population. Lots of lubrication and controlled positions are important in the beginning.

Things that help erections:
Supplements L-Arginine 2- 4 grams per day. (recommended by many urologists)
Horney Goat Weed
Acetyl L-Carnatine & propionyl-l-carnitine http://www.peyroniesforum.net/index.php/topic,649.0.html
Things that reduce erection
Smoking, caffeine, antihistamines like Sudafed etc, adrenalin which can not only be triggered by sudden fear but also by performance anxiety.

Here is a link that may help. The most recent posts are on top so start at the bottom. There are 5 pages on ED issues. http://www.peyroniesforum.net/index.php/topic,23.400.html
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2 - 8.1 - 8.7 Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06 - May .09 - Jun .10 - Aug .10 - Nov .15 SRT

markinphoenix · Regular Joined: 04 Jun 2008 Posts: 24

Thanks so much for all the detailed information. Where did you get all this knowledge? Are you a doctor, nurse, or other medical professional?

I asked my surgeons nurse if the erections would return to near normal and how long it might take. She said I was already ahead of the curve, and that nerve regeneration might go on for up to two years. I interpreted that to mean be happy with what you've got, and be patient things might get better.

My surgeon, Dr. Tewari, started me on 20 mg of Cialis the night BEFORE surgery. And I'm to continue the 20mg every other day for at least 3 months, possibly longer. The doctor says this improves the blood flow to aid healing and prevent damage to the penis. A local urologist that worked with my surgeon for years told me they believe the Cialis may prevent the damage to the penis that causes the reduction in penis size. So far it seems to be working for me as I haven't noticed any change in penis size.

Thanks again for all the good information. Very Happy

Hawk · Experienced user Joined: 22 Nov 2006 Posts: 90

Mark,

I am glad you asked. NO, I am NOT a doctor or a medical professional. I should have stated that but my post was already turning into a novel. I wish I had learned all I know about this topic in the objective studies of medical school. That would have been the easy way.

I founded, and am the administrator of the organization and the forum I linked to. The overlap with this forum is that a chunk of prostate cancer patients end up with ED, Peyronies Disease (PD), or both. Most people with Peyronies Disease or ED however developed those conditions from issues other than prostate cancer.

the Peyronies DIsease Society forum concentrates only on Peyronies Disease and the ED which is often associated with that condition.

When my PSA recently became detectable it drove home the point that as devastating as PD and ED can be. There are things that are worse.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2 - 8.1 - 8.7 Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06 - May .09 - Jun .10 - Aug .10 - Nov .15 SRT

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