LRP Recovery - ED

[James]

In my readings from various surgical web sites (really ads for different

surgical practices) - thre are some practices that mention that they encourage

the use of Viagra (or similar) a few times a week post surgery (as soon at

catheter is out)  to assist with ED recovery.  Others go farther and say if no

impact after a month - encourage weekly use of injections for ED.

 

I looked for studies - and found a little - very little on this.

 

So - Dr K - in the absence of knowledge (i.e. good studies) can you share with

us your opinion and practice in this area.  Do you find that using these modes

early on after nerve sparring surgery helps patients recover potency.

 

Now - I know that preoperative function matters, as does overall health and

issues like diabetes etc.

 

But - that aside - have you found that on average - using something like this

helps men who are healthy and potent presurgery - recover faster or better?

 

Additionally - do you have any stats on your younger prostatitis patients (under

55) as opposed to generally older cancer patients - chances of ED recovery.

 

In reviewing your surgical web site for prostatitis - it seems most men still

refer to erections as "a work in progress" or "improving" - and few refer to

recovery of potency.

 

So - I just want appropriate expectations.  Is it fair to say that even a young

potent man will likely have permenent ED after LRP?  Because - if it is - it

would not necessarily stop me or others - but it would be best to know such

things up front.

 

I know a lot of factors go into this - and you are likely going to say "...the

only thing in the surgeons controll are..."  and I get that.

 

But patients like me really want/need to know what we are in for in reality (are

we signing up for a life of impotence or not).  Again - it is not a deal breaker

for many of us - we just need to know.

 

When I review the prostate cancer blog sites - most of those men who had nerve

sparring robotic LRP are basicly impotent (could be those are the only ones that

post....)."

 

[Arnon Krongrad, MD]

The likelihood of ED varies with many variables including: Age, baseline function, smoking history, illness (diabetes), obesity, mood, partner health, libido, exhaustion, and more. Young men tend to recovery very quickly relative to older men.

[James]

Your reply is understood - and I also understand the range of variables involved. I am really just curious about appropriate expectations for younger (healthy?) prostatitis patients likelyhood of regaining potency.

I have read all of the posts on the prostattiis surgery site - and most all list it as a "work in progress" (the ED) - do you have any numbers on those that have regained potency (either in number or percent).

Its hard (no pun) to set appropriate expectations for a recovery based on the info available -

[Arnon Krongrad, MD]

That's the point. You want to look at each case individually. So for a 35-y old, perfectly healhy non-smoker who is not depressed or suffering marital friction or over-worked, the likelihood of recovering erections approaches 100%. From there the odds diminish. For a 70-y old obese diabetic smoker with poor erections and a lousy home life who is holding down two jobs, the likelihood of good function approaches 0%. You have to look the patient, not just a set of tables.

[James]

Thank you. I appreciate the difficulty you have in being able to give good answers to this question - but - as I assume you know - it is the main stumbling block for men like myself as we plan for our condition.

I appreciate your response and any other info you can provide for us "under 50 prostatitis" patients that want to trade in this disease for a normal life....

[Arnon Krongrad, MD]

Not all men under 50 are created equal. Thus it would be an over-simplification to give a single answer. We need to get beyond reflexive answers and on to custom assessments of the individual before us. So I ask you: Who is this 50-y old man? What can we know besides his year of birth?

[James]

Yes - I understand the overall picture influences the outcome in a major way.

My question was tailored to the following candidate group:
- 35-50 yrs old
- Normal health (no diabetes, no cancer, no marked health issues) except for prostatitis
- Normal erections pre LRP
- weight? This one varies for us all. I am overweight and I know that impacts things, but I am sure others contemplating this are not.

[Arnon Krongrad, MD]

Every variable varies. That's why it's called a variable. So weight is among many variables that vary.

The subgroup you are beginning to define generally does well. I emplasize generally because the definition you provide is still quite vague and open to many modifying variables. Sorry, but there is no simple answer to a complicated equation. We have to look at the individual patient when advising him, not just the group he generally belongs to.

[James]

understood.

Thank you for what you can provide / have provided.

[James]

In the original post I asked a few questions about injections for ED or viagra etc etc.

Have you found that using these right after surgery helps improve ED outcomes or not?

A few (very few) studies have shown that injections may reduce ED post surgery (quicker recovery) - do you find this to be true or do you have any opinion on the use of such things post surgery?

[Arnon Krongrad, MD]

The effect of early Viagra is not well quantified. What patients usually report in early use is side effects: Headache, flushing, and the like. That said, I am not categorically opposed to it and do prescribe it to selected patients.

Injections can induce erections. Do they accelerate spontaneous recovery? I have seen no data to support that.

[imnotcrazy]

injections have worked for me any many others i keep in contact with on a regular basis .
my data is personal contact . to me that is the best way.

[James]

Dr.K. - the study I am refering to is:

http://www.ncbi.nlm.nih.gov/pubmed/19860695
Prophylaxis of erectile function after radical prostatectomy

and for penile injections several "surgical centers" claim:
Injections of medication directly into the penis can also be effective. These injections can result in a normal erection even early after surgery, and they can also facilitate the healing process.

for example: http://www.marincancerinstitute.org/cancer/prostatectomy.html
and many others (now - granted these are not studies - hence the question I posed.....)