My husband is 6 weeks post-op and doing great. His test results couldn’t have been better. His doctor started his on ED med’s at 4 weeks with poor to no results. He is very discouraged at this point with the result from the med’s. It’s so early in his recovery; I think his expectations were too high. What is the norm concerning this. His doctor is so vague on this issue and I don’t know where to turn. Meanwhile we’re waiting for pre-approval from his insurance company for a VED. Can anyone help?

Tough subject...

Lots of factors are involved here...

Two initial questions...

How old is he?

Did he have "nerve sparing" RP (nerves on both sides of the prostate are spared)?

:confused:

Tough subject...

Lots of factors are involved here...

Two initial questions...

How old is he?

Did he have "nerve sparing" RP (nerves on both sides of the prostate are spared)?

:confused:

Thanks able5,
My husband is 56 and he had a "nerve sparing" RP (but they were only able the spare the left nerve bundle).
Thanks

Clover,
It is much to early to tell. I think as you keep in touch with this board, you'll find that the return of erectile function varies widely. Some begin to see results in a couple of months, while others have mentioned that it took as long as 2-3 years. Encourage your husband to be patient, check out other health related boards for prostate related issues and he'll find encouragement from others in the same situation. It is discouraging, but there are other options down the road. I waited over 2 years, and finally, upon the advice of my urologist, had an implant. I had both nerves spared, but it just wouldn't work. I also tried the VED, and for some, that is successful. Also, he can get injections, such as Caverject or Edex. I started them at about 10 weeks after the RP. Your urologist should have some suggestions. Good luck as you begin this journey.
doj

clover45;

This procedure is called unilateral nerve sparing technique since the nerves on one side of the prostate are spared.

I'm not saying this is your problem. Only your urologist can determine what's needed regarding further surgery. For those patients who require loss of the penile nerves on one or both sides, there is a nerve reconstruction procedure. It involves a nerve graft. During robotic prostatectomy, a piece of a nerve in the leg called the sural nerve is harvested and transplanted to the pelvis after removal of the prostate. This nerve graft will function as a conduit for regeneration of the penile nerves.

Again, your urologist is the only person who can make a judgement to continue with reconstructive surgery. My suggestion for now is to take time to heal completely. Six weeks is much too soon for any RP patient to expect too much regarding improvements in ED and continence.

:angel:

My husband is 6 weeks post-op and doing great. His test results couldn’t have been better. His doctor started his on ED med’s at 4 weeks with poor to no results. He is very discouraged at this point with the result from the med’s. It’s so early in his recovery; I think his expectations were too high. What is the norm concerning this. His doctor is so vague on this issue and I don’t know where to turn. Meanwhile we’re waiting for pre-approval from his insurance company for a VED. Can anyone help?

Clover,

I understand totally! I'm right there too.

My husband is now at 13 weeks. Some of the meds did nothing. Viagra, however worked well. Tell the doctor, and try different ones. They do not work the same! Also, my husband has now used the VED. That has helped a lot. Strange though, one time, the viagra didn't work. So, don't give up on each situation.

Mu husband is seeing an ED specialist (our urologist's team of care post surgery) on Thursday. Maybe that will offer other info. We'll see.

I do understand how tough this can be. On both people. If you want, I can email you. Let me know.

Debbie

Clover45 -
All good advise and i echo searching this board for other answers to questions and concerns you have.

I am 43, and 7 months post-op. Both nerves spared and still waiting for him to wake up. Everyone is different which may be why your MD seems a bit vague in his answers. My biggest mistake was expecting to bounce right back into bed due to my level of health, young age, pre-op sexual activity level, and decorated surgeon. Not so. I have never been more challenged to learn patience in my life.

Stay connected with your husband. Talk to him. Listen. Support. And dont watch the clock.

It is much too soon to expect much in the way of erection recovery. The healing itself takes longer and the loss of one side's nerve will make it more problematic but far from impossible.
Best adjust to more realistic expectations. Its a very gradual process for the nerve bundle which was severely traumatized to heal and it can takes many months two several years for maximum recovery.A nerve graft is probably no longer an option since its almost always performed simultaneously. Use the meds and have him learn to first practice and then attempt to use the VED if possible. Restarting sexual activity as soon as possible is very important for recovery even if it cannot be completed successfully at first. You both must avoid discouragement and despair when it doesn't work as you hope. It will get better with time.
In my opinion injections and especially surgical implants should only be a last resort after giving the E.D meds and the VED the necessary time to work as the body heals itself. Several weeks is unrealistic after this kind of surgery.

Thanks everyone,
I want to thank everyone who took the time to post a response to my questions. It certainly is true that there is comfort in numbers. Tonight I showed my husband this message board and your replies and he seemed encouraged. I'm hoping that he will start posting messages himself very soon. Thanks again to all of you.

clover45;

This procedure is called unilateral nerve sparing technique since the nerves on one side of the prostate are spared.

I'm not saying this is your problem. Only your urologist can determine what's needed regarding further surgery. For those patients who require loss of the penile nerves on one or both sides, there is a nerve reconstruction procedure. It involves a nerve graft. During robotic prostatectomy, a piece of a nerve in the leg called the sural nerve is harvested and transplanted to the pelvis after removal of the prostate. This nerve graft will function as a conduit for regeneration of the penile nerves.

Again, your urologist is the only person who can make a judgement to continue with reconstructive surgery. My suggestion for now is to take time to heal completely. Six weeks is much too soon for any RP patient to expect too much regarding improvements in ED and continence.

:angel:

Able, a nerve graft is performed the same for any of the procedures. Robotic is not better or unique. Also, we inquired prior to surgery about nerve grafts if it was needed and the surgeon stated that it was not a new procedure and not a very successful procedure. That it could cause further damage and the donor site is greatly affected. That's what we heard....

Nerve grafts are highly specialized and delicate procedures. Most prostate surgeons are not skilled or experienced with them. At Sloan-Kettering they are performed during an open prostectomy by a neuro or plastic surgeon who collaborates with the prostate surgeon and is on call when it may be called for. Not sure if it can be performed with robotic surgery due to the smaller surgical field available. Dr. Scardino of Sloan reports in his book a 50% successful recovery rate when one nerve is resected and replaced by a graft. With bilateral nerve grafts 75% of the first group of 12 patients in 1999 operated on by Dr Scardino and Dr. Rath who pioneered the procedure recovered partial to full erections with the aid of Sildenafil.

No answers needed yet Clover. All function can return with one nerve spared and 4 weeks is way too soon to know where things stand.

Don't jump the gun with guessing on that. Proceed the normal course as anyone with both spared. Odds aren't much worse for one nerve than two. Many with both spared wonder what happen and have issues. Many here will tell you that. Its not all about sparing. Have faith! It is early.

Try different ED drugs, they all work differently. B6 works well to recover nerve trauma. VED's work well to regain size and can help sexually. Injections are options. Implants are a last resort. Don't jump the gun. Enjoy each other. Intimacy helps. Worked well for us and we are at 13 weeks. A lot of ED issues are mental trauma as well - cancer, worry about side effects, worry about death, worry about spouse, etc. Work on those issues disappearing and it is amazing how much better things go.

All function can return with one nerve spared...

Interesting...

Can you provide any references?

:confused:

Able5,

A personal reference....me. I've posted many times that I lost the left bundle but the right one (took over a year) eventually began working again. At the initiation of an erection it starts off a little crooked (leans to the left) but eventually looks pretty much as it did (a bit shorter) than before open RRP. Debbie35010 is correct and it can't be stated often enough, IT TAKES TIME TO HEAL!

Only a small pun intended when I tell the "newbies" to the post-RRP world to "get a grip on it" and calm your expectations. I know from personal experience how difficult it is to have these problems. I also know that each man (and concerned partner) must find it within themselves to deal with the issue and no amount of reading posts like this will create that internal fix. But, they can build some appreciation for the wide variation in other's experiences.

I can only say that we all have the capacity to prioritize these kinds of issues, but only if we have a personal base to work from. When the MD asks "how much does this hurt," one can only give a subjective answer based on prior pain experiences. Reading message boards such as this can provide some measure of relative mental or physical pain that other's have experienced, allowing us individually to build some level of patience/tolerance of our own...but only if we will it to.

Right now I have two sterile patches on my backside from the bone marrow tests yesterday for my lymphoma staging. Several people have asked me if it hurts? On a 1 to 10, it's about a 3. Before RRP, hernia, hemorrhoid, knee, kidney stone, bladder blockage, going thru a windshield face first, etc. operations I'd have put the bone thing a lot higher at a 5 or 6.

Not being able to "get it up" is about a 3 on the mental scale from my perspective, because it is ultimately fixable. Orgasms and erections are not indivisible and to quote some ancient sage "the worst sex I ever had was still great" is a good one to remember. This too will pass.

Regretfully, I think we managed to scare off clover45 with all of our long winded expert testimony.

Hate when I do that...

Speaking for myself, me thinks I should read more and post less...

Bye and good luck!

;)

able,

No you haven’t scared me away. I’ve been checking daily to see if there are any new posts. I guess I just process things slowly and sometimes I need some time to digest them before I comment. Now I’m really getting off the subject. Anyway my husband and I really appreciate everyone’s help. We need all the advice and support we can get.

We just found out yesterday that his insurance company won’t cover the cost of a VED. The lady who called my husband to give him the news said to try and find a durable medical equipment company that would accept his insurance. She said there was no guarantee that this would work but it was forth a try. (We’ve talked to her several times about numerous problems we’re having with his insurance and she’s the only one who has even tried to be helpful.) Today we did find a company that accepts his insurance and sells the Osbon Erecaid. Now we get to wait again to see if the insurance will approve it or not.

Oh, by the way is the Osbon Erecaid the best choice? It’s what the doctor recommitted. Should we get the manual or the battery powered? What’s the verdict? Please let us hear from you all. We value your opinion.

Thanks,
Clover

able,

No you haven’t scared me away. I’ve been checking daily to see if there are any new posts. I guess I just process things slowly and sometimes I need some time to digest them before I comment. Now I’m really getting off the subject. Anyway my husband and I really appreciate everyone’s help. We need all the advice and support we can get.

We just found out yesterday that his insurance company won’t cover the cost of a VED. The lady who called my husband to give him the news said to try and find a durable medical equipment company that would accept his insurance. She said there was no guarantee that this would work but it was forth a try. (We’ve talked to her several times about numerous problems we’re having with his insurance and she’s the only one who has even tried to be helpful.) Today we did find a company that accepts his insurance and sells the Osbon Erecaid. Now we get to wait again to see if the insurance will approve it or not.

Oh, by the way is the Osbon Erecaid the best choice? It’s what the doctor recommitted. Should we get the manual or the battery powered? What’s the verdict? Please let us hear from you all. We value your opinion.

Thanks,
Clover

Hi Clover,

My husband has the Osbon Erecaid, Esteem. The manual version is the one that most recommended and we went with. My husband is very pleased with it.

If you call Osbon directly, their rep will help regarding insurance as well. He'll ask who the coverage is with, what durable medical equipment providers they have, etc. They are very helpful.

I will tell you, my husband saw an ED specialist. His surgeon goes this route for PC patients, which is nice. He thought the VED was a good way to go early on. Even with the luck we've had - and not all the time - this guy told us that at 13 weeks, things are still very early....... So don't fret. I do understand the frustration and the fear. We're young also, 49 and 50 and it's been a dramatic change for us as well.

Good luck.
Debbie

Hello clover45;

I found some great posts over on the "Sexual Health - Men" forum that may interest you. Really good information about ED and the various ways to treat that disorder.

Best wishes...

:angel: