HealingWell
Search Close Search
☰

Radical Prostatectomy and Penile Implant at Same Time?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/6/2016 8:24 PM (GMT 0)
Has anybody here heard of prostate surgery and penile implant surgery at the same time? I'm currently using injections for erections but via active surveillance I'm on the clock for possible removal of my prostate. I could need prostate surgery in six months -- or six years -- or never. However, the clock is ticking. Just looking ahead, I am intrigued about the implant and the prostate surgery at the same time.

Am I out to lunch on this?

I did find this answer from PubMed.gov:

http://www.ncbi.nlm.nih.gov/pubmed/16145445

Men who chose simultaneous placement of a penile prosthesis with RP reported greater overall QOL (quality of life), erectile function and more frequent sexual contact than a comparison group of men who underwent RP alone. Placement of penile prosthesis at the time of RP may be a desirable option for men with prostate cancer in whom a nerve sparing procedure may not be ideal. These results underscore the importance of sexual function for men undergoing prostate cancer treatment.

Comments? Thoughts?

Age: 60
Diagnosis: 1-29-16
Last recorded PSA: 8
Highest tested PSA over several years: 11
Gleason: 3 + 3 = 6
Enlarged prostate? Yes
Current strategy: Active surveillance.

My race: African American, important only because I am AA and I want to raise awareness of higher risks for AA men.

Post Edited (Cigar56) : 9/6/2016 4:51:39 PM (GMT-6)

Posted 9/6/2016 8:49 PM (GMT 0)
Wow, I wouldn't have guessed that was a thing...but I guess it is. It looks like it is primarily for men who are unlikely candidates for nerve-sparing techniques. You are on AS now, so if you ever do need treatment it would be likely that yours is also nerve sparing. Non-nerve sparing surgery is generally needed in advanced cases.

So, here's how I see it, through the lens of my own experience. In my case, Cialis works great for me now. I need it post-RP, but it works great. I have very frequent intercourse with my wife and my erection is never an issue. That being said, I know that I have some element of luck--or maybe I should say that some other guys with very similar case characteristics have had some bad luck, and are suffering through enduring ED problems that Cialis doesn't solve for them (nor do other less invasive options). And I realize it is pure luck/bad luck, because it happens to some guys who go to experienced or inexperienced doctors (although the numbers tell us it happens less when you go to an experienced surgeon).

But since I have a nearly normal active sex life (the only abnormal part is taking a 10mg pill every other day), I can't imagine having to deal with an implant. I am certain that if I exhausted other options, I firmly (pardon pun) believe I would be thankful for an implant...as a last resort. But I would have wanted to exhaust the other less invasive options first.

It just doesn't seem like the combo surgery approach would be a thing for anyone who is a candidate for nerve-sparing RP.
Posted 9/6/2016 9:00 PM (GMT 0)
Why eliminating the possibility that natural erections remain after surgery? With a competent surgeon and nerve sparing RALP most patients will have good erections post surgery. If loss of full erection is a major concern you could look at the different radiation treatments instead, if you ever need treatment.
Posted 9/6/2016 9:03 PM (GMT 0)
It sounds like a great idea. I think you will need two different surgeons to do the procedures, which may be challenging to coordinate. I know PDA had both the penile implant and the artificial urinary sphincter done at the same time - he may have some tips. On the downside, there may be loss of length and girth from both the RP and the penile implant. Let us know how it goes, if you decide to go ahead with it.
Posted 9/6/2016 9:22 PM (GMT 0)
You're not out to lunch, but it will be very difficult to have both surgeries performed during one lengthy operation at the high level of surgical skill you'll want. There are relatively few doctors who specialize in IPP surgery. You might want to check out FrankTalk.org for more information. B
Posted 9/6/2016 10:24 PM (GMT 0)
I never experience ED after my daVinci surgery, and I wouldn't want to have that option considering the possibility of not incurring ED.

Now maybe an extension added on for the lose in length would be a viable option?
Posted 9/6/2016 10:29 PM (GMT 0)
Actually, Tall One, I had an implant, an artificial sphincter and a hernia repair all done at the same time -- a threefer. The combination was a bit like being run over by a truck but, to be fair, most of the discomfort was from the hernia repair and it was almost like getting the implant and the AUS for free discomfort-wise, and since any of the three sufficed to hit my out-of-pocket max for my insurance for the year, it was exactly like getting them free financially as well.

Since you are already injecting, Cigar56, and since a man never gets quite everything back after surgery, it seems realistic to write off your chances of regaining natural erections. If you need the injections now you will still need them after RO. Recent advances in nerve-sparing techniques are amazing, and everything, but that doesn't make prostate surgery a cure for ED. If you know that you will be wanting an implant sooner or later and if you need the prostatectomy then it makes great sense to have them both done at the same time.

Chances are the surgeon who does your RP can do the implant, too. Compared to the the prostate surgery the penile implant is a minor detail, and since you are African-American, it won't be fiddly micro-surgery like it is for some of us here.
Posted 9/6/2016 10:31 PM (GMT 0)
I suppose anyone can do anything to stay in the "game"...Why not get the sphincter too...ya know...just in case...a bit of sarcasm...from the illustrated man...just so the colors match...
Posted 9/6/2016 10:34 PM (GMT 0)
When I saw the headline, I thought "why????", but it's clear once I read it. Or, you could do the implant now, and still wait and see if the prostate will need attention.

Best of luck to you...
Posted 9/6/2016 10:55 PM (GMT 0)
Yeah, I missed the part earlier about you doing injections. Those, to me, are a next-to-last resort before implant.
Posted 9/7/2016 12:37 AM (GMT 0)

JackH said...
Yeah, I missed the part earlier about you doing injections. Those, to me, are a next-to-last resort before implant.

And since it is rather large odds that RP surgery will do nothing to improve Ciga's erectile function, and indeed is very likely to decrease however little function he has now, despite some folks getting lucky, and since he could maybe justify the implant before RP ( unless he is thrilled with injections of course), it makes perfect sense to me to go for it from the get go. If he can find some folks to do it. I think ( but I'm not sure ) he would have less chance of losing any length if he came out of the OR fully inflated rather than waiting a year or two for shrinkage before the implant. And just becuse injections work for him now does not mean they will work after RP and he maybe develops some venous leakage or Peyronie's.

Cigar, it seems totally reasonable to me, if you ever have to have surgery(but really, why would you ever absolutely have to have surgery?) to have the implant, or maybe even have an implant even if you never have RP. In fact, it would have been a great idea for me considering my results. If I could have seen the future, as well as could have done anything I wanted ( docs would do it, insurance would pay etc), I should have had an implant and AUS at the time of my RP. Just think, I may well have never had a day without a needed erection, never any wet pads, and never any urination during sex, a never any Cialis with it's SEs and big $, nor all that injection stuff with fear of PD and/or ER trips, none of which was ever worthwhile for me anyway. Implant at time of surgery? Sounds wonderful to me.
Posted 9/7/2016 3:40 AM (GMT 0)
I'd do the implant now. You may never need RP. And I can't imagine recovery from both at the sane time.
Bob
Posted 9/7/2016 8:20 AM (GMT 0)
I was suffering ED at the time of my diagnosis, which I was managing with Caverject injections. That was satisfactory and I have to say my wife and I enjoyed a very good sex life.

My Uro did mention the option of an implant, but not within the context of an RP which was already planned. I assumed that was a future option if we wanted it.

What it did mean was that he could "go wide" with his cuts cos it couldn't make anything worse. As it happened, that didn't help as I still had a + margin.

We have passed on the implant.
✚ New Topic ✚ Reply