HealingWell
Search Close Search
☰

erection problems

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/11/2013 1:56 PM (GMT 0)

Hi having been through the RP two years ago at the age of 68 and very sexually active , and getting clear PSA results every 3 months I am feeling pretty pleased with myself, BUT in regard to the sex side of things they are not so good !VIEW IMAGE I was prescribed one 5mg of Cialis I have taken these daily since 2 months after my Op, my urology nurse has tried me with the pump ,it kinda worked but the results varied such a lot, he then suggested the Muse alprostadil urethral sticks the max dose 1000mg looked like it might have worked but still not enough to obtain penetration, Finally it was suggested that penis injection might be the answer, I am presently using Caverject Dual Chamber  20 mg that being the max dose that they manufacture it in, so far it has been the best , but still not giving a firm enough erection,  recently my Urologist has suggested a system where the patient prepares and mixes himself allowing a max dose of 40 mg .

my question s are has anyone ever tried to increase the dose on the Urethral system by using two sticks ie 1000mg and perhaps a 250 mg ?

And what about two injections with the Caverject perhaps a 20mg and a slightly smaller dose say 5/10 mg ?

And lastly can any one give me any idea on what the mix it yourself system, is it easy to understand? and has it given good results,? is I am not adverse to needles .VIEW IMAGE

Hopefully someone can help

OTTAWA BOY

Posted 7/11/2013 3:09 PM (GMT 0)
I am using straight, compounded 20mcg Alprostadil and injecting with an insulin syringe (have used 5/16" and 1/2" needles). I have a 10ml vial and just draw the amount I want to use each time. Real easy and no mixing. You can vary the volume (titrate) until you dial in on the amount that gives the best results.

I had modest results at .15ml and .20ml but moved up to .22ml this week and was like rock for plenty long enough. I still have some testing to do but think that .22-.25ml will likely continue to work for me. If not, will bump up a little more. Everyone is different, though, and getting the right dosage is an individual effort.

In talking with my uro and the pharmacist, they both noted that results were probably better with the injections than the MUSE due to direct introduction into the blood cavity rather than through absorption but, again, results vary by person.

The Aprostadil is good for me. Other guys on here use a Bimix or Trimix with good results. It sounds like you may benefit from using some kind of variable injection option--whichever chemical or compound that might be.
..
Posted 7/11/2013 3:30 PM (GMT 0)
Ottawa,

You might look into a compounding pharmacy and see if it isn't a cheaper way to get your Alprostadil than the Caverject. I use trimix that contains three drugs, one of which is the same as your MUSE and Caverject (ie. Alprostadil/Prostaglandin). When my doctor writes the scrip for my drugs he doesn't write Trimix, he lists all three drugs and the amount to dispense of each. There are typical mixes but different combinations can be accommodated. You could try one of the usual trimix formulations if you wanted to, the other two drugs do help some guys, or you could have your doc prescribe a mix that's mostly Alprostadil*.

The thing is that all of them come in a bottle that will give you anywhere between ten and forty jabs depending on how much you use and you can titrate looking for an exact dose. You just draw out how much you plan to inject and the dose is up to you and your doctor. It has to be way cheaper than using Caverject two at a time.

Footnote: (yes, I know. Get over it.)

* Alprostadil is effective at tiny little doses compared to the other two drugs in trimix and when I talk about a mix that is "mostly" Alprostadil the amount of that drug will still be tiny compared to the doses of the other drugs typically used in standard trimix formulas.
Posted 7/11/2013 9:59 PM (GMT 0)
Peter mentioned the cost of Alprostadil so let me just add that my compounding pharmacy does not bill insurance for my script...I have to file the claim from home. The cost at the register for a 10ml vial of 20mcg strength was $85.00 and that included a package of insulin syringes and a dozen alcohol wipes. The drug cost was not broken out separately but is about $80 as the other supplies are cheap. My copay is $15 with my insurance plan so I will get the difference back but that can give you perhaps a ballpark idea as to cost.

With a 10ml vial, that provides about 40 injections based on .25ml each. The quirk is that the pharmacy has to give a 30-day expiration date since there has not been clinical testing of a longer shelf life in the fridge and that is the standard dating. The pharmacist said it would likely not lose potency after 30 days but he could not officially state so.

There is no way I will use up 40 shots in a month...maybe not even in two. The max recommendation is no more than three per week. Gee, maybe I could get three months out of it! Of course, a lot depends on your needed dosage and consultation with your doctor.

I have found the disposable insulin syringes easy to use. The ones with the 30-gauge 5/16" needles seem to do fine. I did not have any issues with the larger 28-gauge 1/2" needles. Have not used any of the auto-injection devices as I have a pretty steady hand.

So, there is some info for what it's worth. By way of disclaimer, I am not a doctor. I do not play one on TV. And I have not stayed at a Holiday Inn Express in the past 90 days.

..
Posted 7/12/2013 4:09 AM (GMT 0)
Hello I thought I should say something here about the alprostadil question. I'm actually a pharmacy tech and work at a compounding pharmacy that makes alprostadil/ bupivicaine combo
The second drug helps with the sting and we sell a 5ml vial with syr and alcohol swabs and a really nice instruction sheet for 70.00 out the door.
I speak to lots of paitients because we specialize in sexual medicine for both men and women if you like give me a call and I could explain a little more

(phone number removed - please put an open email in your profile, which is accessible only by members, or put it in one of the other information fields. Since posts are openly readable, personal information of this nature is forbidden - 142)

Post Edited By Moderator (142) : 7/12/2013 6:20:38 AM (GMT-6)

Posted 7/12/2013 6:40 PM (GMT 0)
You might want to start thinking about the penile implant, that is if things don't get better or better enough. They are usually covered by insurance as you are a cancer patient. And they work, of course there is some risk in the operation, like always.
Posted 7/12/2013 10:40 PM (GMT 0)
Hey guys they won't let me put my number here but you could contact me at (contact deleted by moderator Tudpock18)
We specialize in sexual medicine and have good products for both men and women.

Gabe, no advertising please per forum rules.

Post Edited By Moderator (Tudpock18) : 7/13/2013 5:56:20 AM (GMT-6)
Posted 7/13/2013 1:11 PM (GMT 0)
Okay - stupid question but one I haven't seen answered on forum. Exactly WHERE do you inject this? Base, shaft, where?
Posted 7/13/2013 1:19 PM (GMT 0)
Here you go

https://www.dropbox.com/s/wcqnph0wrxqxp8u/Ionia%20Injection%20Instructions.pdf
Posted 7/14/2013 1:32 AM (GMT 0)
Franco, just so you have a reply in words on here...

The injection goes into the Corpera Cavernosa which are on either side of the penile shaft. I inject about an inch up from the base at around the 1:00-2:00 position with "noon" being top dead center. (Probably shouldn't use "dead" in the description.) I think the instructions from the uro said it was okay to go up to halfway but keeping it a bit lower seems to work well here. It is recommended to alternate sides each time to help avoid scarring and to give each side equal opportunity although an injection on either side works for the entire equipment.

There are a number of posts on here that talk about the injection particulars but that is sort of the basic answer to your question.

..
Posted 7/14/2013 1:36 AM (GMT 0)
John good replay also Franco you might want to print out the PDF to the link I posted to refer back to it if needed.

Thanks
Posted 7/14/2013 9:15 PM (GMT 0)
Guys Thanks for all the help I have set up an appointment with my uro later this week.I will have a lot more to ask and discuss with him after all your great comments .

Thanks
✚ New Topic ✚ Reply