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Penile Prosthesis

Willx's picture
Willx
Posts: 41
Joined: Jul 2005

After years of trying different options for the treatment of erectile dysfunction - none of which worked very well - I have decided to have the penile prosthesis. The surgery is scheduled for July 20. On August 3, I will observe the 8 year anniversary of my radical prostatectomy - my PSA results remain stable. The last test was two weeks ago and was 0.1. Other than the surgery n 1998 and
1 1/2 years of 50 mg daily of Casodex, I have had no treatment and feel great. At 66 years of age, I look forward to the future.

There have been previous posts on this board about penile implants, and I greatly and sincerely appreciate the help which those posts have been. The personal experiences which others have shared have meant a lot to me in deciding to proceed with this next chapter in my prostate cancer and life experience.

Should anyone want to know how this goes for me I will be more than happy to share my experience with you.

RLR64
Posts: 23
Joined: Jun 2006

I am encouraged to read about your 8 years of stable PSAs. My husband just had surgery 4 weeks ago and had a positive margin in one focal area. When did you have the Casodex? Was that given along with the surgery at the same time? I am wondering if my husband needs to have it along with the surgery since the margin was not completely clear.

Good for you for looking to the future and living such a full life. Hope everything goes well with your upcoming surgery and may God bless!

Willx's picture
Willx
Posts: 41
Joined: Jul 2005

I made it almost six years without having to do anything, except keep my regular checkup appointments. I did not begin the Casodex until May 1, 2004, and continued it through October 25, 2005. The PSA had risen to 0.30 and that was the trigger point for my doctor to prescribe it. I took one pill a day and while I experienced a few side effects, there was nothing major. The PSA immediately fell back to <0.1 and has remained at that basic level (there was one spike to 0.16 but the last result was 0.1).

In my case, the doctor chose to wait until a PSA pattern developed before starting me on the drug. So far, that seems to have been a good decision. The stable PSA for the last two years has been a major factor in the decision about the implant.

Thank you for your encouragement.

stuart
Posts: 88
Joined: Dec 2001

I would like your imput once you have had the implant...I am in a similar situation...I just completed a year of casodex and my PSA dropped to less than 0.1...During the last year my breast's swelled up and my penis actually got smaller...
Since I am no longer on casodex I wonder if my physical status will reverse or if this is the way it's going to be...In either case I am interseted in a penile implant so I will await your comments...thanks

stan53
Posts: 5
Joined: Apr 2008

I,m 54 and had a RP last March i,ve had 36 rad. tx ending in sept. I,m having problems with incontinence and erections. I am considering penile implant and artificial sphinter. I am not sure which is worst bladder control or erection problems. I really feel like I have lost my manhood. Depression could become a problem real easy. Any thing you can tell me or share with me I am sure will help.

thanks stan

JH32
Posts: 19
Joined: Nov 2008

Stan-
My surgery was a year ago and I had post surgery problems on top of it. My erections started to come back and then the post surgery problems kicked in (they left clamps inside me!). It has really set me back on regaining erections and I totally understand your feelings. I also feel like my manhood took a hit that it may not recover from. On the days I feel that it is gone for good I get very depressed. Never really felt it before and it is devastating to feel like you can't get out from under the dark, wet blanket that covers your mood and attitude. There are times my anger just grows and grows and that is unlike any mood I've ever had.
I am 53 and have fought back the thoughts that life isn't worth much if this doesn't get corrected. I met a month ago with an ED doctor and he told me to be patient. The pills don't do much and he is talking about injections (self) that work in a high percentage of the time. I'll let you know how it works and hang in there. You are definitely not alone.
Jim

harvs
Posts: 54
Joined: Jun 2003

I’ve had both the Penile Implant and Artificial Sphincter for almost two years now.

It was a life altering experience. I now feel like a real person again. Gone from 6-8 pads a day to one, and no leakage at night. Used to need disposable briefs on top of the pads to catch the overflow.

My wife loves the implant. Not as spontaneous as usual, but it’s always there and never lets you down.

al1111
Posts: 4
Joined: Feb 2006

My expereince is the same as harvs, had Penile Implant and Autificial Spincter for 2 years.

It is live changing, gave me back my quality of life. I was using 12 pads a day now only one.

My wife also loves the penile implant.

Life is good!

JH32
Posts: 19
Joined: Nov 2008

Does the implant cause any lack of sensation? and how long was the surgery and recovery?
I'm 1 year post RP and am having little help with the pills. I am going to see about injections, but the implant seems closest to 'normal'. Although I'm not even sure how it works once implanted. Is there a pump?
Glad to hear that you've turned a positive corner.

brookjax's picture
brookjax
Posts: 18
Joined: Apr 2009

I had the robotic three months ago and am almost over the incontenance, or I hope so. I have tried some Cialis from my Doc's prescription, although I had to ask him for it, but they don't help the ED at all. Did you Doc give any reason why that would be so?

And in preparation for my checkup appointment, what injections are you referring to for ED? My Doc doesn't seem to be too knowledgeable about ED, although he does certainly know a lot about the penile implants, but I'd rather try medication first unless I have to wait a year, which someone said they had. A doc who specializes in ED for prostrate patients gave a talk at my local Man to Man group so I know about these from him.

By the way, does more incontenance accompany the penile implant surgery? The doc I heard said that the catheter is removed after one day for that procedure.

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

I would encourage you to find a doctor that is knowledgeable about ED issues following Prostate Surgery. I'm no doctor and am waiting for my surgery. From what I have read though you want to start on a penile rehabilitation plan ASAP. There are other drugs besides Cialis. Some men have better results with the different meds. It takes time for sexual functioning to return. From what I have read on the injections this is a shot with a very small needle that is given directly into the side of the penis. I believe the needle is similar to the needle that diabetics use.

Larry

ismetals's picture
ismetals
Posts: 70
Joined: Feb 2009

the road to normalcy starts the minute you wake up in the recovery room. Always look forward never look back. If nerve's were spared it's important to get things going as soon as possible. A good doctor that know's about ed is in order. No doctor knows all. It is difficult to get them to admit that though.
I'm ten months out of surgery and things are getting better, but I won't stop my rehab until I,m back in the game with only a woman and not a pill

al1111
Posts: 4
Joined: Feb 2006

Docter will want you to wait for over a year before either of the procedures, both are last steps. Once you have to penile implant you can not got back, you will loose the ability to have a normal errection. So be patient, work with a docter that understands ED. Try everything they suggest and if all else fails go with the implant. There seems to be no less sensitivity, recovery was not as bad as the RP. I could not work for 2 weeks, only pick up 10 lb for 6 weeks. And could not use my new toy for 3 months.

brookjax's picture
brookjax
Posts: 18
Joined: Apr 2009

I plan to try the pill and any other drugs before going to either an implant or injections, but if you could generally describe the difference between a 'normal erection' versus one with an implant it would be helpful to me. I have the impression, which may be wrong (I have my first followup postop visit in a week), that my Doc leans toward an implant operation, so I'd like to educate myself beforehand. I still can't visualize how an implant operates, but that is beside the point. I guess if the wives like it, it can't be much less effective than the 'normal', but what is the difference between normal and implant, other than the way it is activated, which is still a major difference, of course.

Are there other drugs besides Cialis or Trimed for ED therapy?

I doubt that I would ever get a sphinxter operation. I feel that I'm at least two-thirds of the way toward ending the incontinence after three months. I may be further; it's hard to know what improvement will come next. My Doc suggested using disposables from the start rather than pads, which was lucky because I needed to change them 5-6 times a day at first, before I started adding pads to them. Now I get by on usually one per day lately, but I use a lot of pads.

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

I believe that the implant is the last method of choice for the Dr's and patient. The way I understand it a surgery is performed where two tube like devices are place into the penis. There is a valve type mechanism that transfers a fluid into the two devices which then inflats the penis. This then allows you to have intercourse. When you are finished you release the valve mechanism and the fluid is then transfered back into a storage device inside of I believe your abdomen. I've read there are several different brands on the market. Perhaps someone else actually has one or has researched more. After my upcoming surgery I will try all the other methods first and see how I do. I believe Dr's don't usually like to perform the implant until two to three years down the road to see how your nerve function returns.

There is Cialis, Viagra and Lavitra in the pill format. For injections there is Caverject and Trimex.

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

Yes, I totally agree when you said "I believe that the implant is the last method of choice for the Dr's and patient." I am three months post DaVinci, so I have some time to recover yet. I was given Cialis and told to take "once in a while" Well, no real results yet. But there are more medications to try.
It's a tough decision.

shubbysr

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Your Dr. Didn't start you on a specific plan on when to take the pills? My surgery is next week and my Dr. all ready gave me a specific plan to follow. Shoot me an email if you like and I'll be glad to forward you the plan that he recommended. I also saw the same plan in a book I read entitled Saving your sex life by John Mulhall. He is at Memorial SLoan Kettering in NYC.

http://www.amazon.com/Saving-Your-Sex-Life-Prostate/dp/0980064961

lewvino@yahoo.com

Larry

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

LArry,

I believe that the doctor made some assumptions. Of course I will ask the questions when I see him or maybe an e-mail. Pre surgery I answered a questionnaire re: sexual realations with my wife. We scored very high, which meant no problems. And he assumed that no problems post surgery.
Thanks for the advice and plan.

Jim (shubbysr)

brookjax's picture
brookjax
Posts: 18
Joined: Apr 2009

I just had my three month checkup today. The PSA reading was 0.1 or less, so that's great.
My doctor did prescribe a second exercise to speed the cure for incontinence, involving ten contractions in quick succession, twice a day, to be increased to 20 and then 30 at a time. This was called an aggressive treatment as opposed to the more passive treatment of 10-20 contractions holding each one for six seconds.
As for ED, the doctor recommended using 10 mg. of Cialis twice a week, but when questioned he did say that some use it daily. I think he wasn't too sure what to recommend,so he referred me to another doctor who specializes in ED, which I was already thinking of.
The cost of Cialis is quite high through insurance; they don't give much of a discount for medical uses. I am wondering if anyone knows if the generic Cialis is as effective and if there are sources for that which are better than others. In the end, money is not a major object to me, but I do hate to waste money when a generic is just as good.

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