Blood flow, venous valve control, nerve bundles and shrinkage

1.  Lack of erections results in the lack of blood flow into the penis, resulting in maybe atrophy and loss of filling capacity within the cavernous cavities of the penis.  Normally, nocturnal erections occur 4 or more times a night, resulting in the filling, flushing and emptying of the penis.  Damage to the erection nerve bundles after surgery results in no getting the trigger for those critical nocturnal erections.

 2.  Good question- one that I am seeking more info on, also.  My understanding is that the same damage to the nerve bundles occurs to a different degree in individual men.  The veinous valve function is an intregal part of the process of erections.  The nerve bundles trigger the response to open the valves up, allowing blood flow into the penis, then closes off when a certain internal pressure inside the penis is attained, resulting in a sustained erection. When sexual orgasm is reached or stimulus is stopped, the nerves tell/allow the valves to open, emptying the penis of blood.  Regrowth and repair of the nerve bundles after surgery is required for the complete erection process to work properly. 

  

3.  Time, rehab efforts and luck are all part of it.  Regrowth/repair of the nerve bundles is slow, some say it takes 8 months or more to complete the process down the length of the bundle.  Using a penis pump and Viagra or other ED drug will help accelerate healing, according to some.  The scale of best results is first injection, then the pump, then Viagra.  Viagra isn't necessarily or used in this case for immediate erection response, but to help trigger those nocturnal erections needed for penile and nerve repair, along with its effect on dilating the veins in the abdomen and penis. 

4.  The jury is still out on this.  Some surgeons and patients swear this happens, others say it doesn't.  In my case, it appears I have lost about 3/4 inch flaccid, and none erect. 

What kind of plumbing screw-up results in semen being replaced by urine during ejaculation?

1. What restricts the blood flow after surgery and what causes it to improve (other than drugs such as Viagra that I assume dilate the vessels)?

2. What causes venous valve control to disappear?  to reappear?

3. Both my left and right nerve bundles were spared, which I know is a good thing....but what will cause these bundles to get back to doing whatever it is they do normally?

4. What causes the penis to shorten in some prostate surgery patients?  Does this improve at all with therapy?  Is it generally more pronounced when flacid or erect?

1.  I was told that there are two basic problems. Firstly, veins have been removed and these provide the blood pressure needed to 'pump' the penis to an erect state.  Then - Nerves have been damaged and these are used to control the valves used to restrict the blood OUTFLOW, and hence cause the erection.  Chemicals like viagra creates the chemical trigers to help muscles restrict the outflow and hence cause the pressure-build-up, and the erection.

2.  As per 1..

3. TIME, and the skill of the original surgeon, but a most disappointing comment comes from the Australian (NSW) Health Dept., that 2/3 of men (having had Nerve-Sparing RP) are effectively Impotent after 3 years, and this is a time when all should have returned to normal or at least as normal as possible.

4.  A deal of the penis mass is composed of the muscles that control blood-outflow.   As with ANY muscle, if you fail to exercise the muscle, then it WILL die and this will show in shrinkage.  Hence the need for the natural nocturnal erections and the exercise that it imparts to the penis muscle.  Failure of the natural exercises MUST be supplemented with artificial exercise via Viagra, Cialis, injestions etc. and regular stretching might help with any issue with shortened ureathra. Once muscle is lost ED is complete.

   .. .  Use it or Lose It

 ""What kind of plumbing screw-up results in semen being replaced by urine during ejaculation?""

Nothing to do with plumbing screw up..  All the usual ejaculation hardware is GONE-GONE, and you are left with a weakened bladder control, and when the signal is given to ejaculate, the only muscles available to respond lie in the bladder, and the weak flow control might have no hope in stopping any flow..

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Post Edited (BuiDoi) : 1/4/2011 4:22:43 AM (GMT-7)

about the reason for shortening, I first thought that some of the uretha is removed thus the shortening. I now doubt that simple explaination. The part of the uretha that is removed is between your external urinary sphincter and the bladder. The external sphincter is the one you are left with after the RP and this sphincter is part of your pelvic floor muscle structure and this remains in its former place. So the uretha lenght between the pelvic floor and the glans of end of your penis should be the same. I think it must the nerve issues sort of like the shrinkage from swimming.

Ron

The best I can describe it is male orgasm is nerves triggering muscle to spasm or convulse. Even though our liquid part of orgasm has been removed, we still have the muscle part intact. At the same time, we , being men, had 2 sets of valves controlling urine flow, just exactly for the purpose of overcoming that powerful muscular contractions of orgasm. After surgery, we lose the main and stronger on the two, and only have one remaining. Hence, when we orgasm now, we still have the same muscle movement and force involving adjacent areas to the bladder, but with only one valve left to control any forceful issue of urine.

Here's a little more descriptive of it. The way I understand it, the main sphincters are on the outlet of the bladder and down into the prostate gland, so when the gland is removed, the sphincters go with it, and the resulting outlying sphincters, below where the bottom of the prostate was, are pulled up and stitched to the bladder opening, hence your weaker muscles/valves post-surgery. I hope I got that right.

Quoting them: Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder into the urethra, the tube that allows urine to pass outside the body.

Here's a link to some general info. about sex, surgery and loss of ejaculate.
www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinMen/SexualityfortheMan/sexuality-for-men-with-cancer-ejaculation-and-treatment

ron, thanks for adding that, I forgot to go far enough with my explanation.

As a side note, I find that I can actively do a strong kegel and keep urine in, but it does detract from the experience and even some of the pleasurable contractions.

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Based on the assumption that the 66% ED figure is correct, and I can only assume it is, (As I don't know one RP friend who is not adversely affected by ED)... Then we all have to take something or inject or pump or whatever prior to 'participation'..

So just make sure you completely void your bladder and the chances of a squirt will be minimised.

re.  the shortening - I am confident that the bladder is pulled down a bit to compensate for the shortened Urethra.

Check your Ureathro-Cysto-Gram (???) and see the conical shape of the bladder

If shortening was an issue, caused by Urethra shortening, then it should have been short Post-Op and possibly regains some length as the Urethra stretches.

BUT - my length was the same post-RRP, and has shortened since, suggesting that it is more to do with the lack of use, and the inability to pump it up to 100%, when you do get the chance.

"Even though our liquid part of orgasm has been removed, we still have the muscle part intact."

I suspect that this is not entirely correct, but close...  Most of the muscular-activity is devoted to squeezing the ejaculate fliuds, so I presume that ALL the Ejac' muscles/nerves/veins are removed with the Prostate. 

I would suggest that it is just the general abdominal contractions that cause the problem..

With the 66% ED figure -- Don't forget that this is AFTER 3 years, when we were told "All should be fine".. 

They make the point that the figure for Post-RP to 12Mths., must be dramatically higher..  probably 99%

I speak to a good few men and NONE of them are claiming Normal function, and most are resigned to "Other Activities"..  with normal activity seeming just too much bother !

I am finding that the (Alternate use) of the nasal-spray..    .. is easily the most natural  ??  ( If anything can again be considered 'Natural' ) --- "Have a squirt, give it a squirt and come out to play "

PS --"3. Both my left and right nerve bundles were spared, which I know is a good thing....but what will cause these bundles to get back to doing whatever it is they do normally?"

One Doctor, critical of the concept of Nerve Sparing and reporting the real and adverse ED at 3 years, commented that nerve sparing was like carefully paring a strip of apple-skin , stem to stern, from the apple and then removing the apple leaving the skin-strips behind.  You must take ALL the prostate material away, just leaving this slice of the outer capsule..

How difficult would that be, when you can't even see the nerve, and can barely see the nerve sheath.  How difficult would it be to not bruise or nick or stretch (and break the inner nerve)

Why do we wonder why things don't work the same?  I NOW wonder, why anything works at all !   .. . It's all quite fascinating.. and frustrating..

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Post Edited (BuiDoi) : 1/4/2011 2:58:27 PM (GMT-7)