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Erectile Dysfunction

The question is often asked as to how long it might take to recover erectile function after surgery: what steps should be taken to improve the chances of this happening and so on. Thom Forbes recently posted a good piece on erectile dysfunction after surgery and he has given me permission to reproduce it here:

He started with an except from an interview titled "Rehab is key to restoring post-RP erectile dysfunction." conducted with the ED specialist he uses, Dr. John Mulhall of Memorial Sloan Kettering Cancer Center in New York, and was published in Urology Times (11/01/06) – the PDE-5 inhibitors referred to in this article are drugs such as Viagra, Cialis, Levitra.

SNIP We tell our nurses that when the catheter comes out, whether after an open or laparoscopic prostatectomy, the man should be challenged with a PDE-5 inhibitor. We want the patient over the ensuing 4 to 6 weeks to use a PDE-5 inhibitor at maximum dose on at least four occasions. When they come back to see me, they're going to be asked: Did you get an erection with the PDE-5 inhibitor? Did you get a 6/10 on the hardness scale (penetration hardness)? If so, I tell them they are oxygenating their penis well enough and can use pill-based rehabilitation.

If the patient comes back to see me and has not responded to medication, we move him directly to penile injection therapy. Like many others, I believe the cornerstone of rehabilitation is erection and oxygenation, and that the regular use of PDE-5 inhibitors is a useful adjunct. A clinical trial by Pfizer, which is not yet published, has shown that a man has an increased chance of preserving his preoperative erectile function by using regular sildenafil. That's bolstered by strong animal data. If you expose animals to nerve injury and you give them PDE-5 inhibitors regularly after surgery, you can actually improve erectile function by reducing apoptosis and improving endothelial factor preservation.

We encourage men to get three erections a week with whatever works (pills or injections) and then on non-erection days, to take a low- dose PDE-5 inhibitor before going to bed at night. SNIP

Thom says he saw Dr. Mulhall six weeks before his laparoscopic surgery in January 2007, and he started Thom on 25 mg. doses of Viagra six nights a week at bedtime prior to the operation (stopping a week before). Some of Thom’s left nerves were removed as his margins were positive. “I've been told that I'm doing well (using 11 units of bi-mix - penile injection therapy - six months out), and should not expect to reach my full potential (whatever that may be) for 12 to 18 months.,” he writes.

Thom asked Dr. Mulhall, who is a research consultant to Pfizer, why he recommended Viagra over Cialis and Levitra for "non-erection days." He responded that any of them work but that Viagra tabs were bigger and it was easier - and more cost effective - to split a 100 mg. tablet into four 25 mg. doses. Fair enough, and I've found this to be true. The purpose of the 25 mg. dosage is to increase blood flow to the penis while you sleep, so the longer life of Cialis does not come into play unless you are anticipating intercourse sometime over a longer period than four hours.

Thom moderates the Prostate Cancer and Sexulity discussion group at http://health.groups.yahoo.com/group/prostatecancerandsex/ and writes the Prostate Cancer and Sex blog at http://blog.prostatecancerandsex.com/

Re: Erectile Dysfunction

Unfortunately the vast majority of insurance view PDE-5 inhibitors as "party drugs" and offer no coverage. This would lead me to believe that many are not getting the rehab that they need. - p Alaska, USA

Re: Erectile Dysfunction

Terry,

Thanks for posting this piece. I'm now 6 months post surgery at Sloan Kettering and have been taking (although not always very religiously) my Viagra as perscribed by my surgeon - he gave me 100mg Viagra to be split into 4 for exactly the reason given by Dr Mulhall. My 6 month appt with my surgeon is next week, followed that afternoon by one with Dr Mulhall to discuss whether he feels I'm on track and whether there are other options.

Dan

Re: Re: Erectile Dysfunction

I started taking 50 mg of Viagara nightly the day of my surgery. The surgeon told me that the data from his patients showed that recovery of erectile function takes between 3 and 24 months. However, only 70% of his patients do get erections, and I suspect that has a lot to do with age, because we all lose some of that virility as we get older.

I was given the option of joining a research project where I would be assigned to penile injections or Viagara therapy. It required keeping diaries of all sexual attempts and returning to the doctor's office with my diary regularly. That regimen was not for me.

Six weeks after surgery, I am still waiting for the first erection, as is my wife. Fortunately, the nerves for orgasm are still working fine. In fact for some unknown reason better than before surgery. Why doesn't the literature tell men that the joy of sex is not forfeited after RP? I have not read musch discussin of this topic on the YANA site.

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Replying to:

Terry,

Thanks for posting this piece. I'm now 6 months post surgery at Sloan Kettering and have been taking (although not always very religiously) my Viagra as perscribed by my surgeon - he gave me 100mg Viagra to be split into 4 for exactly the reason given by Dr Mulhall. My 6 month appt with my surgeon is next week, followed that afternoon by one with Dr Mulhall to discuss whether he feels I'm on track and whether there are other options.

Dan

Re: Re: Re: Erectile Dysfunction

Dan,
I just had a Da Vinci robotic prostatectomy and my urologist prescribed viagra 100 mg for penile rehabilitation. My insurance company allows only 6 tablets for 90 days. Do you have any suggestions where I could buy them inexpensively - they cost $10 each at my local drugstore. I saw a website www.coreynahman.com (Internet Drug News .com) that recommends some sites to buy from but I'm not sure if they can be trusted. Any thoughts from you or others who are using viagra will be appreciated.

Ron

Re: Erectile Dysfunction

I just ordered from www.alldaychemist.com.

Viagra 100 are around fifty cents per pill.

They were highly recommended by members of Healingwell.com forum. I have yet to receive them, but take a look at the website. People have been dealing with them for years.

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