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    Recovery of Erectile Function after Radical Prostatectomy
    Basir U Tareen, MD posted:
    Patients will often ask me if there is anything they can do to improve erectile function after radical prostatectomy.

    In general, I tell them that pre-operative function is one of the most important predictors of post-operative function. The old saying, "use it or lose it" actually does apply.

    More recently, there is mounting evidence that prophylactic PDE5 inhibitors (Viagra, Levitra, Cialis, etc.) even in small doses every other day may help increase blood flow to the penile region and hasten recovery of erectile function.

    I would encourage you to ask your surgeon if they or their colleagues have a program of "rehabiliation" for erectile function following surgery.
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    BeegeBeege responded:
    Now they tell us. Thanks a bunch. All prostate cancer surgeons should have the surgery before they do one some poor sap. i.e me!
    steady022 replied to BeegeBeege's response:
    Beege, that was a concern to me as I was trying to determine which way to go - radiation or surgery. The final outcome %'s were just about equal. I spoke to a number of men that had had gone the surgery route and found out that a number of them were having this issue. Seems the Prostate develops the fluid for the ejection and once it is gone, then it is a dry function apparently, that is if you can even get an erection. That is not covered by this Dr since all he is talking about is getting an erection here. After reading all I could find on it and talking to my family doctor, I decided to go the radiation route for what was referred to as a better quality of life. We will see if it makes any difference. So far, things still work - erection and ejaculation. Maybe not as well as before I had all the treatments (43 of them). But since I just finished the radiation treatments it is too early to tell the final outcome.
    RichardA replied to steady022's response:
    Starting radiation in a few weeks. Just had the first of two three-month hormone (Lupron) injections and will undergo a gold seed implant just prior to IMRT. Still worried about the side affects of ED and colon and bowel problems that could occur from the radiation. Any words of wisdom from someone that has undergone the treatment? Has your PSA number reduced?
    I am relying on prayer and the LORD for my healing, but following the advice and treatment plans of my Doctors.
    jasre responded:
    I, age 63, had PSA 6 ,T3b-10 mm penetration margin, SV neg Lymph nodes neg with tumor 30 grams Gleason 3 5 on right side and had Robotic RP July 2012. Started ADT with lupron August and 3D IMRT Oct.--I started Cialis 5 mg daily prior to surgery and started to have "soft" erections prior to Lupron therapy.I have continued Cialis and using VED to keep penis expanded daily. Had Nerve sparing on one side and now with dose Viagra 100 mg am getting improved erection just enough for penetration in the past week. I have been on strict diet and am encouraged that once completion of ADT( 2-3 yrs) that may not need Viagra or VED therapy.Radiation to be completed prior to Christmas.Could not have done this without extremely supportive wife.
    spanz replied to jasre's response:
    I don't think there are that many surgeons out there forgetting to tell us this stuff. I think there are a lot of patients out there that are perhaps overly optimistic about the side effects. They assume things will be rough for a few weeks. When it hits 2 months and you have sexual issues and are dripping like a sieve...that's when you come on these sort of boards and figure out what is really going on!
    olderbutnotbetter responded:
    Let me ask this question: Can a man even have an orgasm after a Prostatectomy? If so, Will it be painful now becasue it will be "Dry"?

    Just wanted to know. I'm facing the surgery within a month, and wanted to know what hapens afterwards when/if sexual function returns.
    billh99 replied to olderbutnotbetter's response:
    I do not have orgasms and not pain.

    I get a small amount of fluid from the cowpepper glad, which is after the prostate.
    billh99 replied to billh99's response:
    Correction I DO have orgasms and no pain.
    olderbutnotbetter replied to billh99's response:
    nccmking replied to olderbutnotbetter's response:
    Dry yes, not painful but much more sensitive. The orgasm comes less often however. Have patience!
    MIKERAPHONE replied to olderbutnotbetter's response:
    Yes , a man can have an orgasm after surgery with no pain and yes dry as the saudi desert ! Your sexual function afterwards depends on the skill of the surgeon and if you were able to raise the flag before surgery ! Pray that everything goes well !
    heller1 replied to MIKERAPHONE's response:
    you just have to go the route you feel comfortable with a dr hospital that you feel comfortable with
    olderbutnotbetter responded:
    Okay, nearing 10 months Post DaVinci, and while finally 'Pad Free', the ability to have erections is basically NIL. It was nerve sparing surgery, and I was told (and I trust as TRUE) both nerves were indeed spared. So I was put on a 1/4 pill regimen of Viagra for 3 months (every other day), and that gave small indications of near-erections (like Goldilocks--Not too hard, not too soft, but NOT JUST RIGHT either). Surgeon is a little perplexed that things haven't progressed as well, so I'm now being put on Cialis for 60 days ( 5 Mg doses). Forget the Pump as the Missus says that ruins any spontaneity, and the thought of having to Pump for Pleasure is not to my liking. The Surgeon also said that after being on Cialis for awhile, I can also take a Viagra on an 'as need' basis, along with Cialis..Does that make sense???? I have to admit, the lack of morning 'reminders' is getting me down a bit, and my libido is slowly becoming an afterthopught.
    An_246614 responded:
    I am fourteen months out since prostatectomy. Davinchi robotic method with a very experienced urologist. Psa essentially zero. Incontinence never huge but wore pads for 9 months. Erections beginning to come back. Tried several sample meds for Ed. Viagra worked the best. Three weeks ago was able to have vaginal penetration for first time. What a wonderful blessing. My advice to all -- be patient. Fortunately ability to have orgasim never gone. Mutual masturbation kept our sexual relationship alive.

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