ED after RALP

good morning,

I am 4 weeks post RALP. The ED and incontinence stinks! There does seem to be some improvement with the incontinence. The biggest issue is when I have to walk more than 100 yards or so. The question I have for all of you has to do with the ED. No signs of improvement in that area as of yet. I have been able to have a couple of orgasms but no erections. My uro did not prescribe any medications and said he wanted to see how things were going at my 6 week FU which has turned into a 9 week FU. I read that getting blood flow to that area is really important- since my FU has been pushed back and I am not seeing in signs of improvement down there should I be asking for some meds. Has anyone found any other thing that has helped?

Thank you.

raypaul,

There is hope, but it takes time, some more that others.

I had no erections at all, nothing, for 6 months. Then, things started to 'move' about 7.5 months out. I was, and still am, taking 5mg of Cialis daily and 20mg once per weekend per my surgeons advice. I did use the pump, starting about 2 months post-op, a few times per week. Now, don't get me wrong, I still am not near what I was pre-op, but I am getting better and making progress. I feel that I am 60%-70% of what I need to be and I am now 10 months post surgery. I am hoping that by my 1 year follow up in June I will be 80% and will then discuss some other options with my Uro/surgeon. Maybe i'll ask for a change in meds to get me over the last hump (no pun intended).

All I can say, is hang in there. They told me I could be this way for 24 months post-op. I am hopeful that I will get back to my pre-op status one of these days without any meds.

---------------------------------------------------------------------------------------------------------------

Age at Dx: 54
08/31/15 PSA 2.5
01/01/16 Urinary Frequency
02/05/16 DRE +
02/22/16 Biopsy
02/26/16 Dx 7-12 positive; (5) 3+3=6; (1) 3+4=7; (1) 4+3=7; T2B
03/11/16 Bone Scan -
03/23/16 CT Scan -
03/31/16 Surgery Consult UPENN
04/08/16 RT Consult/2nd Op Fox Chase CC upgrade to 4+4
04/14/16 3TMRI "organ confined", EPE-, SV-, LN-
06/01/16 DaVinci @ UPENN (Dr. D. Lee)
06/08/16 Path EPE+, Marg +, SV-, LN-, G7(4+3), T3a
07/01/16 Start 5mg Daily Cialis, 20mg once a week on Friday's
07/06/16 Decipher 0.56
08/31/16 uPSA <.006
12/01/16 uPSA <.014
01/30/17 PORTOS Lower RT Response
03/01/17 uPSA <.006

Tell your Dr. you want to get started on rehab immediately. Those tissues need blood flow in order to regenerate the nerves required for erections. He may prescribe Viagra or Cialis. I began the regiment the day after the catheter was removed.
Good luck.

raypaul - If your ED problems remains:
1. ED pills. Take them on a need basis, not every day as if they were vitamins.
2. Tri-mix injections
3. Vacum pumps (VED)
4. Penile Implant

raypaul,
Hang in there. Your still early in the game. Fortunately I was fully continent 3 days after my catheter came out and I don't consciously think about it any more. I know I am extremely lucky in that regard. I do have ED. As the others said it takes time for nerves to regenerate if they are going to. My doc started me out on Cialis 20 mg x twice a week the day after the catheter was removed. He also said I need to use the pump at least 3 times a week and I have done it about that much. It did make a small difference when trying to get an erection but not like before surgery or even close. I was on that regimen until about a week ago. I was switched to Siledenafil (Viagra) 20 mg/day and 3-5 of them if I wanted to have sex. The Sildenafil helps more than the Cialis for me. I would estimate that I got to about 75% a couple of times and maybe 90% one time. Others have reported different results. I go in next week for a Doppler and I believe he is going to inject me with some form of Trimix so I'm a bit nervous about that. Oh well, what the heck. I plan to give it a try so that way at least I'll have some more data. Good luck to you!

Hang in there. Just like others have said it takes a while. I had surgery one August, and started on Viagra one month out - but it did nothing but make everything very bright. I then started on daily dose of Cialis, but that didn't do much either. Then in November, started on Trimix and that did the trick to get a hard erection. I stayed on that for three months, but kept on the Cialis and the erections gradually started coming back on their own at night. I am one of the lucky ones because now I have erections like before the surgery. I do take Cialis (5 mg) a couple of times a week, but will cut that back to one day a week soon. I also have been lucky that I don't have incontinence except for when I pick up something heavy there might be a small amount.

Best of luck to you, it just takes time. Bit by bit or poco a poco as they say in Spanish.

MK, gather the courage for the trimix.

It is less of a big deal than you might think, and the results are likely to surprise you. You may see the 'missing' 2 inches again.

It has helped me, and my natural function is now also on the improve, but that is not necessary linked to trimix use - just time I think.

D.