Impotence & Incontinency

If the reason that some opt for one procedure over another is to
prevent impotence or incontinency, I suspect that there is a definite
risk of that happening irrespective of the procedure. Shouldn't the
main concern be to get rid of the cancer?

Hi Lon,
The main concern is to rid the body of cancer or minimize its effects on the
body.
In the process of doing either of these the risk of ED and or incontinence
as well as other ailments are present.
You can talk with your Dr. and depending on your staging,age, or prostate
cancer agressivcness choose a therapy that matches your condition.
No Dr. can guarantee either potence or continece although they have a pretty
good idea of what they can do.
Nerve sparing in radical prostatectomy is a factor with ED.
If the Dr. sees the nerves are cancerous he may remove one or both......
If one is spared erectile function is "highly possible"
Radiation, (EBRT) Brachy(seeding) also have effects on ED and continence.
Hormone therapy can /will effect Libido and effect Erectile Function....
There are many ways to combat these effects, and yes the main concern is to
minimize the cancer...
John Loomis
"Lon" <alonzotanner@yahoo.com> wrote in message
news:1171067861.567799.19830@v45g2000cwv.googlegro ups.com...
> If the reason that some opt for one procedure over another is to
> prevent impotence or incontinency, I suspect that there is a definite
> risk of that happening irrespective of the procedure. Shouldn't the
> main concern be to get rid of the cancer?
>

Lon wrote:
> If the reason that some opt for one procedure over another is to
> prevent impotence or incontinency, I suspect that there is a definite
> risk of that happening irrespective of the procedure. Shouldn't the
> main concern be to get rid of the cancer?
>

You are certainly right about what the main concern should be. You are
also right that all methods of treating early prostate cancer in an
attempt to cure it have similar side effects. But they do differ in how
likely a given side effect may be. But other things are also important.
Age, in particular plays an important role. For example, for
relatively young men, a skilled surgeon can do about as well at
preserving erections as can a radiation oncologist, but for men over 70,
the risk of impotence after radiation is much less than the
corresponding risk after surgery. The important thing to know is what
the risks are for you specifically under different treatments.
Generalities about all men may not be relevant to your case.

Lon wrote:
> If the reason that some opt for one procedure over another is to
> prevent impotence or incontinency, I suspect that there is a definite
> risk of that happening irrespective of the procedure. Shouldn't the
> main concern be to get rid of the cancer?

You'd think so, wouldn't you? For most people that's true, but there
really are some men who won't risk their erections for anything.

For the rest of us, treatment choice is mainly about optimizing the
dizzying array of benefits and side effects and their likelihoods
according to our personal priorities. In fact, some leading oncologists
consider some treatments so close in benefits that they advise us to
choose between them based on their side effects or deliberately postpone
treatment until we have symptoms. There are few easy choices in this
field, and the easiest choices often occur in the worst cases.

I.P.

"Lon" <alonzotanner@yahoo.com> wrote in message
news:1171067861.567799.19830@v45g2000cwv.googlegro ups.com...
> If the reason that some opt for one procedure over another is to
> prevent impotence or incontinency, I suspect that there is a definite
> risk of that happening irrespective of the procedure. Shouldn't the
> main concern be to get rid of the cancer?

That's my view. You can love your wife and even have
some kind of sex with no erectile function - but only if
you're still alive.

Alan

John Loomis wrote:


> If one is spared erectile function is "highly possible"

>
>
CU Medical Guide says that 60 to 90% of patients undergoing RP suffer
from ED. It notes that the nerves involved may heal, though very slowly.
Recovery may take up to two years and is unusual before 3 months after
surgery. CU also cites a British study that says regularly doing Kegel
exercises generally helps against ED; that report does not specifically
address ED caused by RP.

http://adam.about.com/reports/000033_10.htm

This source says that sexual impairment (i.e. impotency) risk is only
10% better if both nerves are spared and 7% if one nerve is spared (66%
if no nerve spared, 59% unilateral, 56% bilateral). Medicine is not
supposed to help in case both nerves are not spared for patients over 55.

http://www.henryfordhealth.org/body.cfm?id=46058

Dr. Menon, on the other hand, claims that 82% of his institute's
patients 60 years of age had return of sexual function at six months.
Not sure whether he is much better at sparing nerves than others, but
the Adam numbers suggest that that by itself doesn't make that much of a
difference.


The Adam report puzzles me. Are the nerves not essential? Can you, at
least in theory, recover even if both nerves are not spared?
If so, does doing Kegels (presumambly to stimulate blood flow) speed up
recovery? Is Viagra or Cialis potentially helpful if at least one nerve
is spared, as in my case?

"Lon" <alonzotanner@yahoo.com> wrote in message
news:1171067861.567799.19830@v45g2000cwv.googlegro ups.com...
> If the reason that some opt for one procedure over another is to
> prevent impotence or incontinency, I suspect that there is a definite
> risk of that happening irrespective of the procedure. Shouldn't the
> main concern be to get rid of the cancer?

To you, apparently. To me, yes. And, of the several hundred who have
passed by here in the last few years, almost to a man, their priorities were
1) Death, 2) Incontinence, and 3) Impotence or 1) Death and the other two
reversed.

However, there has been the occasional man who preferred sex over life or
dreaded incontinence more than death. These have been manifested in
statements such as, "I do not want to live another six years if it means..."

I feel sorry for these men. It means, IMO, that they have made decisions in
their lives that have left them with little "life" left to counteract the
terrible effects of losing one's 'manhood'. I think if I started
subtracting some things from my life; my job, my wife, my friends, my
children, my grandchildren, my truck, ..... I could start thinking in those
terms.




--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

Hello Safire,
I had Radical Prostatectomy in 1999.
I was also fearful of the effects that may appear after the prostate and
cancer was removed.
I was greatful that the cancer was taken out and then I needed to try to
regain any salvageable functions.
I was totally incontinent in about 3 weeks......
I also had problems with erectile function since one nerve was spared.
With the help of the "pump", and injection use for a few months, and then
slight success with viagra, and after about 1.5 years to 2 years, I am up
and running.
Now in 2007, a light 1/3 of a 100mgs pill of viagra and 15 minutes
later.....I feel 100% erectile function.
It takes time, and work at it.....
John Loomis
"safire" <safire@telenet.com> wrote in message news:eqk3gv$2cs$1@aioe.org...
> John Loomis wrote:
>
>
>> If one is spared erectile function is "highly possible"
>
>>
>>
> CU Medical Guide says that 60 to 90% of patients undergoing RP suffer from
> ED. It notes that the nerves involved may heal, though very slowly.
> Recovery may take up to two years and is unusual before 3 months after
> surgery. CU also cites a British study that says regularly doing Kegel
> exercises generally helps against ED; that report does not specifically
> address ED caused by RP.
>
> http://adam.about.com/reports/000033_10.htm
>
> This source says that sexual impairment (i.e. impotency) risk is only 10%
> better if both nerves are spared and 7% if one nerve is spared (66% if no
> nerve spared, 59% unilateral, 56% bilateral). Medicine is not supposed to
> help in case both nerves are not spared for patients over 55.
>
> http://www.henryfordhealth.org/body.cfm?id=46058
>
> Dr. Menon, on the other hand, claims that 82% of his institute's patients
> 60 years of age had return of sexual function at six months. Not sure
> whether he is much better at sparing nerves than others, but the Adam
> numbers suggest that that by itself doesn't make that much of a
> difference.
>
>
> The Adam report puzzles me. Are the nerves not essential? Can you, at
> least in theory, recover even if both nerves are not spared?
> If so, does doing Kegels (presumambly to stimulate blood flow) speed up
> recovery? Is Viagra or Cialis potentially helpful if at least one nerve is
> spared, as in my case?

On Fri, 09 Feb 2007 19:22:20 -0800, "I.P. Freely"
<fuhgheddaboutit@noway.nohow> wrote:

>Lon wrote:
>> If the reason that some opt for one procedure over another is to
>> prevent impotence or incontinency, I suspect that there is a definite
>> risk of that happening irrespective of the procedure. Shouldn't the
>> main concern be to get rid of the cancer?
>
>You'd think so, wouldn't you? For most people that's true, but there
>really are some men who won't risk their erections for anything.
>
>For the rest of us, treatment choice is mainly about optimizing the
>dizzying array of benefits and side effects and their likelihoods
>according to our personal priorities. In fact, some leading oncologists
>consider some treatments so close in benefits that they advise us to
>choose between them based on their side effects or deliberately postpone
>treatment until we have symptoms. There are few easy choices in this
>field, and the easiest choices often occur in the worst cases.
>
>I.P.

Ah symptoms. In all of my fervor to read here, I have failed to asked
just what are the symptoms? My only discomfort is a post ejaculation
tightness (sorry, only way to describe it) that doesn't feel normal.

I agree with the guys who gave you great advice...

the cancer, for me, was the primary concern.

The other things will work themselves out.


All the very best,

Ron B.

Chicago

RRP in 3/05

On Feb 9, 7:37 pm, "Lon" <alonzotan...@yahoo.com> wrote:
> If the reason that some opt for one procedure over another is to
> prevent impotence or incontinency, I suspect that there is a definite
> risk of that happening irrespective of the procedure. Shouldn't the
> main concern be to get rid of the cancer?

I was Dx'd at age 61, put on HDT immediately, 6 months later had 5
weeks of external beam and then HDR brachy. SEs played a large part
in my choice. Was never incontinent and never suffered ED (no
ejaculate, of course, but everything else happened in the normal
sequence). Libido is another story - it's very strange: I wasn't
interested in sex at all, but didn't care that I wasn't interested.
Every great once in a while I'd think about engaging in it just to see
if I could. Very strange.

-Gordy

Paul wrote:
> I.P. Freely wrote:

>> treatment choice is mainly about optimizing the
>> dizzying array of benefits and side effects and their likelihoods
>> according to our personal priorities. In fact, some leading oncologists
>> consider some treatments so close in benefits that they advise us to
>> choose between them based on their side effects or deliberately postpone
>> treatment until we have symptoms.
>
> Ah symptoms. In all of my fervor to read here, I have failed to asked
> just what are the symptoms? My only discomfort is a post ejaculation
> tightness (sorry, only way to describe it) that doesn't feel normal.

I was referring to symptoms across the board -- all the lists and
likelihoods of symptoms and side effects that may occur with all the
various treatments and lack thereof. They fill books, and it's unclear
to us what you're asking about. At its most specific, my comment above
referred to one's timing of and selection from the long ADT (hormone
therapy) menu when one's first attempt at curing his cancer has failed,
i.e., it's bAAaaack. What ADT protocol do we want, and do we accept it
right after RP or RT just in case, when a PSA increase indicates
biological failure, when physical symptoms of metastases become
noticeable, or when they get bad enough to demand further treatment?
More generally, some physicians equate RP and RT prognoses closely
enough that they often advise choosing between them based on the
patient's side effect priorities, which include symptoms.

Confused even more? Good; I'd be worried if you thought I had actually
answered anything specific with that necessarily philosophical response.

I.P.

That is (continent) grammar
"John Loomis" <jloomis@mcn.org> wrote in message
news:45ce195f$0$14057$235e9798@corp-news.dsltransport.net...
> Hello Safire,
> I had Radical Prostatectomy in 1999.
> I was also fearful of the effects that may appear after the prostate and
> cancer was removed.
> I was greatful that the cancer was taken out and then I needed to try to
> regain any salvageable functions.
> I was totally
continent..........

in about 3 weeks......
> I also had problems with erectile function since one nerve was spared.
> With the help of the "pump", and injection use for a few months, and then
> slight success with viagra, and after about 1.5 years to 2 years, I am up
> and running.
> Now in 2007, a light 1/3 of a 100mgs pill of viagra and 15 minutes
> later.....I feel 100% erectile function.
> It takes time, and work at it.....
> John Loomis
> "safire" <safire@telenet.com> wrote in message
> news:eqk3gv$2cs$1@aioe.org...
>> John Loomis wrote:
>>
>>
>>> If one is spared erectile function is "highly possible"
>>
>>>
>>>
>> CU Medical Guide says that 60 to 90% of patients undergoing RP suffer
>> from ED. It notes that the nerves involved may heal, though very slowly.
>> Recovery may take up to two years and is unusual before 3 months after
>> surgery. CU also cites a British study that says regularly doing Kegel
>> exercises generally helps against ED; that report does not specifically
>> address ED caused by RP.
>>
>> http://adam.about.com/reports/000033_10.htm
>>
>> This source says that sexual impairment (i.e. impotency) risk is only 10%
>> better if both nerves are spared and 7% if one nerve is spared (66% if no
>> nerve spared, 59% unilateral, 56% bilateral). Medicine is not supposed to
>> help in case both nerves are not spared for patients over 55.
>>
>> http://www.henryfordhealth.org/body.cfm?id=46058
>>
>> Dr. Menon, on the other hand, claims that 82% of his institute's patients
>> 60 years of age had return of sexual function at six months. Not sure
>> whether he is much better at sparing nerves than others, but the Adam
>> numbers suggest that that by itself doesn't make that much of a
>> difference.
>>
>>
>> The Adam report puzzles me. Are the nerves not essential? Can you, at
>> least in theory, recover even if both nerves are not spared?
>> If so, does doing Kegels (presumambly to stimulate blood flow) speed up
>> recovery? Is Viagra or Cialis potentially helpful if at least one nerve
>> is spared, as in my case?
>
>

On Sat, 10 Feb 2007 14:06:33 -0800, "I.P. Freely"
<fuhgheddaboutit@noway.nohow> wrote:

>Paul wrote:
>> I.P. Freely wrote:
>
>>> treatment choice is mainly about optimizing the
>>> dizzying array of benefits and side effects and their likelihoods
>>> according to our personal priorities. In fact, some leading oncologists
>>> consider some treatments so close in benefits that they advise us to
>>> choose between them based on their side effects or deliberately postpone
>>> treatment until we have symptoms.
>>
>> Ah symptoms. In all of my fervor to read here, I have failed to asked
>> just what are the symptoms? My only discomfort is a post ejaculation
>> tightness (sorry, only way to describe it) that doesn't feel normal.
>
>I was referring to symptoms across the board -- all the lists and
>likelihoods of symptoms and side effects that may occur with all the
>various treatments and lack thereof. They fill books, and it's unclear
>to us what you're asking about. At its most specific, my comment above
>referred to one's timing of and selection from the long ADT (hormone
>therapy) menu when one's first attempt at curing his cancer has failed,
>i.e., it's bAAaaack. What ADT protocol do we want, and do we accept it
>right after RP or RT just in case, when a PSA increase indicates
>biological failure, when physical symptoms of metastases become
>noticeable, or when they get bad enough to demand further treatment?
>More generally, some physicians equate RP and RT prognoses closely
>enough that they often advise choosing between them based on the
>patient's side effect priorities, which include symptoms.
>
>Confused even more? Good; I'd be worried if you thought I had actually
>answered anything specific with that necessarily philosophical response.
>
>I.P.

Cofused? Very, and easily done at this point. I've got a lot to learn
and maybe in a very short period of time....

Dear Safire,

[Any relation to the writer?]

Welcome to the club. Hope I could be of some use.

CU Medical Guide says that 60 to 90% of patients undergoing RP suffer
> from ED. It notes that the nerves involved may heal, though very slowly.
> Recovery may take up to two years and is unusual before 3 months after
> surgery. CU also cites a British study that says regularly doing Kegel
> exercises generally helps against ED; that report does not specifically
> address ED caused by RP.

What exactly is the CU Guide? Consumer Reports? Columbia U? Please
explain. (BTW, Consumer Reports does rate treatments, medicines and
"supplements". It might be worthwhile. Am going to revisit it)

Yes, it takes time, but the nerves do heal. My husband is 15-mos post-
op and his erectile function has improved noticeably in the last few
mos. And the numbers you cite for men suffering from ED look credible
to me. If you have ED after RP, know that you are not alone and
you're perfectly normal.

Do the Kegels. Never hurt anybody. But I'm pretty sure they are not
very helpful in the erectile-function improvement.

> http://adam.about.com/reports/000033_10.htm
>
> This source says that sexual impairment (i.e. impotency) risk is only
> 10% better if both nerves are spared and 7% if one nerve is spared (66%
> if no nerve spared, 59% unilateral, 56% bilateral). Medicine is not
> supposed to help in case both nerves are not spared for patients over 55.

First of all, who is the authority for the ADAM medical encyclopedia?
I like "about.com", but they are not a teaching hospital. You have to
be careful in whom you trust. About nerve sparing, it is a
complicated affair. One doctor who does this told me it depends not
only on whether the nerve was spared, but *how* the nerve was spared,
whether it was cauterized, etc. My husband had his nerves spared and
it didn't seem to help much.

Medicine -- if you mean Viagra & Co., they will not work if the
erectile nerves are too badly damaged. This happens in many cases,
but there are still ways to have a good sex life and an erection, if
that's what you want. And they are working on a gene therapy which
has gotten a lot of publicity. It might help men whose nerves are
damaged in the sense that they would have to go to the doctor once or
twice a year to get a shot. After that, their EF whould be normal.
(No further shots needed until the next 6 mos-1 yr.) However, this is
still *in progress*, we don't know what will happen!

> The Adam report puzzles me. Are the nerves not essential? Can you, at
> least in theory, recover even if both nerves are not spared?
> If so, does doing Kegels (presumambly to stimulate blood flow) speed up
> recovery? Is Viagra or Cialis potentially helpful if at least one nerve
> is spared, as in my case?

Of course I am no expert, but I don't think you can have natural
erections in you have no nerve function at all in that area. Viagra
can help a person who has some erectile nerve function have sex,,
i.e., get an erection, but **it does not help "rehabilitate" the
person's own natural erectile function. I don't think it's a bad idea
to take one of these meds (of course, with your doc's approval). My
husband has been on Cialis for a couple of months and I think it might
have helped. But we had to ask for it. And, I think the PDE5's work
better once the nerves have healed somewhat.

I don't think doing Kegels helps in increasing blood flow to the
genitals, which is important. I read that a lot of men use pumps, or
vacuum erection devices, to "exercise" their penis. Or, get some
injections.

I don't know why you are asking all of us this. Where is your doctor
in this picture?

It sounds to me like you are post-op and concerned about your future
sex life, naturally.

**The first thing you should do is go to "penile rehab". Find a
doctor who specializes in ED! Although there's not a whole lot of
evidence out there, penile injections for ED have been shown to boost
a man's natural erectile function if started early**. And, you can
have a sex life in the meantime.

Run, don't walk.

If you need a referral for an ED doc, try sexhealthmatters.org. They
have the best. Or try the Urology Channel, (urohealth.org?) use
"doctor finder", but click on "practice details" and find a urologist
who's number-one interest is ED.

Good luck to you.

Leah

On Feb 11, 6:27?pm, "callalily" <lfc...@aol.com> wrote:
> Dear Safire,
>
Forgot to tell you the most important thing. If you want up-to-date,
reliable information about Pca, go to "endotext.org". This is like an
encyclopedia for practicing physicians but it is understandable. And
they give you facts, not opinions. I kick myself for not remembering
to go there more often.

[If you go to this site, you have to click on male reproductive
endocrinology and search pca, I think.]

> Good luck to you.
>
> Leah

Paul wrote:
> I've got a lot to learn and maybe in a very short period of time....

Even way late in this sorry game, there's always time to read a PC book
or 6. The PC learning curve is much like some contrarian roller coaster
that starts with the downhill part and climbs the big, clackety hill
*after* the rush. You'll learn *so* much in that first intense week of
full-time reading that you'll almost feel like you actually *know*
something about PC when you finish, and your PC isn't going anywhere in
a week.

I.P.

On 11 Feb 2007 15:27:54 -0800, "callalily" <lfcjjk@aol.com> wrote:

"Viagra..., but **it does not help "rehabilitate" the
person's own natural erectile function. "


Please point us to research which supports the above contention.

Many docs are providing daily or every other day Viagra for 2 week
periods after RP, for this exact reason.


RML

On Sat, 10 Feb 2007 06:50:59 -0500, "Steve Kramer"
<skramer@cinci.rr.com> wrote:
>
>I feel sorry for these men. It means, IMO, that they have made decisions in
>their lives that have left them with little "life" left to counteract the
>terrible effects of losing one's 'manhood'. I think if I started
>subtracting some things from my life; my job, my wife, my friends, my
>children, my grandchildren, my truck, ..... I could start thinking in those
>terms.

I'm one of those guys, and I feel sorry for people who can't accept
their mortality. Everybody dies. If you haven't figured that out yet,
best you get moving on it, because it will bite you in the ass, just
around the corner.

I have my own thoughts about people who choose life at any cost over
quality of life. For once I'll be circumspect and hold my tongue,
inasmuch as that is THE most personal decision any human has, and to
each, his or her own.

I will point out, having lived through the spectre of grandparent who
spent that last 10 years of his life in constant pain (not from PCa),
addicted to painkillers, and a misery to himself AND his loved ones,
there are worse things in life than going when it is your time, at
peace with yourself, with a decent quality of life. Such as
prolonging the inevitable at any cost, including your own comfort and
those whom you love.

Tough choice. Always personal. So keep your value judgments to
yourself, or you'll just start ANOTEHR flame war. And we all are, or
should be, sick of them by now.

"Doug Taylor" <dtaylor@dreamscape.com> wrote in message
news:rvs0t21dfprho0tp8vfumunrqcr338l2b6@4ax.com...
> I'm one of those guys, and I feel sorry for people who can't accept
> their mortality. Everybody dies. If you haven't figured that out yet,
> best you get moving on it, because it will bite you in the ass, just
> around the corner.
>
> I have my own thoughts about people who choose life at any cost over
> quality of life. For once I'll be circumspect and hold my tongue,
> inasmuch as that is THE most personal decision any human has, and to
> each, his or her own.
>
> I will point out, having lived through the spectre of grandparent who
> spent that last 10 years of his life in constant pain (not from PCa),
> addicted to painkillers, and a misery to himself AND his loved ones,
> there are worse things in life than going when it is your time, at
> peace with yourself, with a decent quality of life. Such as
> prolonging the inevitable at any cost, including your own comfort and
> those whom you love.
>
> Tough choice. Always personal. So keep your value judgments to
> yourself, or you'll just start ANOTEHR flame war. And we all are, or
> should be, sick of them by now.

Well put. My wife and I are both cancer survivors. We also have our one
and only 2 1/2 year old grandson that bring new joy to our lives.

Dear RML,

On Feb 12, 5:13 am, RML <r...@rml.net> wrote:
> On 11 Feb 2007 15:27:54 -0800, "callalily" <lfc...@aol.com> wrote:
>
> "Viagra..., but **it does not help "rehabilitate" the
> person's own natural erectile function. "
>
> Please point us to research which supports the above contention.
>
> Many docs are providing daily or every other day Viagra for 2 week
> periods after RP, for this exact reason.
>
> RML

I had done a lot of research on this subject and written a whole lot
about "penile rehab" starting last November. (See "Sex After
Surgery", (11/11/06) and "Sex After Surgery - Update" (11/13/06). In
the latter msg, I presented some evidence in response to a question
which was basically the same as yours. I always rely on credible
sources, be they hospitals, people, journals, etc.

Apparently, people found the above posts useful, because I got a lot
of good feedback about them. So, I would like to provide an update on
this subject, very briefly.

"Penile rehab" is a nascent field -- there's not a whole lot known
about it. However, when I did my research back in the fall, I did not
come across a single article that said Viagra and other PDE5's worked
to restore natural erections. There was one report based on a study
done by the mfr which I discounted, and another study which scientists
found to be flawed. There was (almost) no positive info relating to
Viagra and "penile rehab". (It was shown to help preserve smooth
muscle tissue.)

You can't prove a negative, so the burden would be on you and whoever
believes Viagra to be effective for restoring EF to present some
evidence of this. As a matter of fact, I have posted this msg or
variations of it everywhere and invited people to submit contrary info
and I haven't gotten anything.

However, things do change quickly in this arena, and so I did an
updated search of this topic yesterday and came up with certain
promising, and maybe even probative, articles. I still have to digest
them. I can't really do any heavy thinking right now because my
husband's being in medical limbo is making me tired, depressed and
muddled. So for the moment, I will have to think "lite".

But here is a summary from the Johns Hopkins website:

"A relatively new strategy in clinical management after radical
prostatectomy has arisen from the idea that *early induced sexual
stimulation and blood flow in the penis may facilitate the return of
natural erectile function and resumption of medically unassisted
sexual activity. **There is an interest in using oral PDE5 inhibitors
for this purpose, since this therapy is noninvasive, convenient, and
highly tolerable. However, while the early, regular use of PDE5
inhibitors or other currently available, "on-demand" therapies is
widely touted after surgery for purposes of erection rehabilitation,
such therapy is mainly empiric. Evidence for its success remains
limited."

I am not against anybody taking Viagra after surgery. I would do the
same. The only point I was really trying to make is that if you end
up in the subset of men who have sustained serious nerve damage, I
don't think Viagra will do anything for you, either to get you an
erection or to restore long-term natural EF. And you don't really
know which category you'll end up in, in spite of what the doctor has
told you about nerve sparing. That's why some people consider it
playing it safe to try early injections or VED, which I think have
been found to be somewhat effective (not by everybody).

I am just trying to promote good clinical practice offered by such
hospitals as Sloan-Kettering and Columbia Presb. in my area. As Tom
R. wrote here, after he had surgery w/Dr. Eastham st MSK, he was
immediately scheduled for a 6-week follow-up to examine his sexual
function. Both hospitals I mentioned have experts in "sexual
medicine" on board who deal w/sexual function and "penile rehab". So
I suggest, that if a man does not regain EF after 2 mos, he should see
an ED specialist because it's always better to intervene earlier than
later.

There's also evidence that a lot of men who do not respond to Viagra
at first will respond later when their nerves have had a chance to
heal (for example, at 15 mos.) (Dr. Samadi mentions 9 mos. as a
ballpark) I suggested to my own husband that we should add Cialis to
his regimen of injections for ED about a year post-RP because there
wasn't really anything to lose (unless you have a heart problem, I
think). We tried it and I don't know if it has worked -- always hard
to distinguish a placebo effect. But, as I have told everybody here,
my husband seems to have miraculously regained his erectile function
at 14 mos-post op (and now I can attest that it was "replicated"). It
seems like the wires are starting to function.

Anyway, I already have a stack of updated articles on sexual rehab
sitting right by me, so I will try to summarize them quickly to see if
anything is new. (This is just a quickie.)

1) There is a study ongoing on JH to test the effectiveness of a
nightly dose of Vit. V on men who've had nerve-sparing laparscopic RP.

2) Study by Donatucci, et al, Duke U., 11/06. "Recovery of Sexual
Function after PC Treatmnent". Bottom line: they believe "No standard
treatment or prophylaxis exists for post-tx ED. **Neuroprotective and
regenerative therapies, including the immunophilin ligands, hold
promise to reduce morbidity of localized pca therapy". Amen.

3) "Update on EF in PCa Patients", Current Opinion in Urology, 16(3);
186-195, May 'O6. Summary: data shows that pharm. rehab programs
provide a higher rate of EF following RP. "Both intracavernosal and
intraurethral approaches are thought to provide integral roles for the
maintenance of sexual function in men undeergoing PC therapy". Notice
the absence of PDE5's. It says that they, injections and VED's have
all been reported "in a positive light". That's all.

4) Article from Cleveland Clinic, "Early Combination Therapy:
intracavernosal injections and sildenafil following RP increases
sexual activity and the return of natural Erections" Int. Journ. of
Impotence Research, Feb. '06. Combo of injections and Viagra seemed
to work.

5) "Can an erectogenic pharm. regimen after RP improve post-op
EF?" (Nature Clinical practice Urology (2006) 3, 72-73, Eardley, I.)
Recovery of EF may take 18 mos or even longer, even in men who've had
bilateral NS. ** In those men who do develop Ed, a number of factors
have been implicated, including "unrecognized nerve injury, arterial
injury, and veno-occlusive dysfunction caused by structural
alterations in the cavernosal smooth muscle." **These can be
discovered by Doppler Ultrasound, done 6 mos. after surgery.

6) Dr. Mulhall (of MSK and NY Hosp.) wrote a summary for the Sexual
Med. Soc. of N.A., 2005 Fall meeting. He concludes that "there is
accumulating evidence that the presence of blood flow abnormalities in
the penis after RP is a predictor of long-term ED after RP".

Also from above: animal studies have shown that certain compounds can
help in *"erection nerve protection". A group of rats who had
undergone "nerve crush Injury" were given a combination of sildenafil
and FK506 (an immunosuppressant) after cavernosal nerve injury had the
"maximum protective effect on erectile function recovery."

And Eureka!

"Sildenafil alone also appeared to exert a protective effect on EF".
(In rats, of course.)

Hope this helps.

Leah

callalily wrote:

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> Apparently, people found the above posts useful, because I got a lot
> of good feedback about them.

And this will continue, Leah. Your contribution is extremely helpful.
Thank you.

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