Partial nerve sparing

MK1965

Grinder said:

Putting aside the futility of a TURP procedure followed shortly by an RP, the simple but crucial question remains... 

Why was my Davinci surgery a success and yours was not?

Equivocating by your urologist that there is "no rational explanation" does not help us discover why one worked but another did not, therefore the procedure must be condemned in all instances.

I am not trying to be an "advocate" of RP, I am recommending everyone determine which procedure is best for their PC profile. That certainly includes RP in many instances, and was certainly so in my instance. Yes, you should make known your reservations, but there still has to be some explanation that is being avoided. Or did fate simply flip a coin and say "you win but you lose"? 

If anything, due to the massive size of my prostate, reduced down to 197cc during the surgery, my RP was much riskier than a routine surgery. I was warned of the increased risk by my surgeon, but I chose it anyway because of my profile. And I would do it again, and anyone whose profile would better fit RP needs to know why mine was successful but others were not and why, so they can make the best decision possible for their profile.I

A checklist should be itemized for all procedures to determine the best course for any patient. Tips on my list would be:

Experience and expertise of surgeon.

What other factors beside PC are relevant.

In my opinion, maybe not a very good one, it is not enough for the field of urology to say "Some are successful, some are not". With my experience in experimental sciences, variables are everything... It is in the variables that we can make make predictions of the outcomes. So if urology expects to be a science, at least as much as possible, it has to discover which variables affected which outcomes. 

That is the truth. Discovering which variables affected which outcomes will lead to more exact diagnoses and prognoses. This is what scientific inquiry is all about. If RP side effects are occurring frequently without inquiry into the variables that create the unfavorable outcomes, then that is an unfortunate commentary on the entire field of urology. But I find that difficult to believe, and my experience with my urologist/surgeon would suggest otherwise.

Something happened that made our outcomes different, and if we cannot know it, then we cannot make definitive statements that RP should be condemned in all instances. But it certainly should be limited to the best interest of the patient. And it would be in the best interest of future patients if they could know why it worked in some instances but not in others, regardless of "no rational explanation".

Political Science

Thanks Grinder!

You sound like political scientist.

I will take: Fate simply flipped the coin which was not favorable for me.

From now, Fate will be blamed for bad outcomes.

This gives me and others insight that RP is nothing better than 50/50 same like a coin.

IF YOU DONT LOSE, YOU WIN.

MK

Clevelandguy

Help?

Hi MK,

You might want to see a Psychiatrist and talk to them about your ED.  I know when  my "member"starting to come back alive and the time to have sex was at hand, I did get nervous and it did kind of kill the moment(going limp) if you know what I mean.  Later on I got over it and now I'm back to normal(99%).  Might want to give it a try.

Dave 3+4

MK1965

Clevelandguy said:

Help?

Hi MK,

You might want to see a Psychiatrist and talk to them about your ED.  I know when  my "member"starting to come back alive and the time to have sex was at hand, I did get nervous and it did kind of kill the moment(going limp) if you know what I mean.  Later on I got over it and now I'm back to normal(99%).  Might want to give it a try.

Dave 3+4

Clevelandguy,

Clevelandguy,

what psychiatrist has to do with iatrogenic induced ED?

MK

Clevelandguy

MK1965 said:

Clevelandguy,

Clevelandguy,

what psychiatrist has to do with iatrogenic induced ED?

MK

Be open to ideas

It might not be all physical?  Mental health plays a large roll in sexual excitiment and in healing.  Did ya ever hear about people with depression that have had ED issues, I have heard that many times in the past.

Dave 3+4

hopeful and optimistic

.

MK is having a physical problem due to the side effects of surgery.

There are psychologists that specialize in intimacy. There are things other than penetration that can give satifaction to couples. 

There are also alternative ED physical treatments, to include but not limited to PDE5 inhibitors, injections to the penis for erection, pumps, penile implants There are urologists who are experts and specialize. Dr. john Mulhall comes to mind. He also wrote a book that you can read. ......

https://www.google.com/search?authuser=0&source=hp&ei=YqwgWreiHKf_0gLvs42gBA&q=dr.+john+mulhall&oq=Dr.+John+mul&gs_l=psy-ab.1.2.0l10.1567.24188.0.29618.23.18.4.0.0.0.227.1937.7j9j1.18.0....0...1.1.64.psy-ab..1.22.2085.6..46j35i39k1j0i131k1j0i131i46k1j46i131k1j0i67k1j0i20i264k1j0i46k1j0i131i20i264k1.97.Szqtuw4-cp0

 

 

MK1965

Grinder & C-guy,

Grinder & C-guy,

Iatrogenic ED is not equal to emotional issue especially for someone who never had EDi issues prior to RP.

ED is sequel of RP. Last week exchanged emails with the surgeon who performed my TURP and RP about ED issues which he could not believe responding to add 5 units of TRIMIX to what I already use. For loss of length, he did not accept it to be related to procedure.

I am wondering if it is possible to get recorded RP to be reviewed by independent experienced surgeon?

MK

Grinder

??

"You sound like a political scientist".

No I don't. And I was trying to point out the absurdity of assuming fate is the determining factor. Deny it all you want, something is different in the case of failed RP and successful RP. 

And I agree with C-guy. If Trimix works but nothing else does, there may be an emotional issue.

Equivocate all you want, but there is still a reason one RP succeeds and another does not.

When we investigate car accidents, we don't just throw up our hands and declare "There's no rational reason for this car to wreck, but the other 1000 cars on the same road did not!" Instead we look at the variables that caused the accident...wet roads, slick tires, faulty brakes, drunkeness, etc. We don't just stop driving cars because we figure there is "no rational reason" for that 1 in a thousandth car to wreck.

If urology as a science refuses to consider the variables that distinguish one outcome from another, and resigns itself to the "flip of a coin" fatalism, then it FAILS as a science. And as I said before, judging from my own experience, most urologists would want to take a scientific approach. My own surgeon/urologist was very much concerned about outcomes and risks and the variables that create different outcomes. He is concerned about future patients and the success of their outcomes, not to mention the LIABILITY issues as well. I was warned of the risk variable of a massively enlarged prostate... I could have opted for other procedures but did not because RP fit my profile. 

This is not about Poly sci, this is about science period. 

Grinder

2ND opinions are always good

I didn't want to come out and say it, but I personally would have been getting 2ND and third opinions all along. I am not trying to insult your urologist, but, like all goods and services in a free enterprise system, you have the right to the best available.

I hope someone more knowledgeable will chime in here.

As far as emotional issues, all we are saying is that the stress of "failure to launch" is affecting the launch itself. You would not have had those emotional issues prior to the RP, so you would not have had ED in the first place. We are not saying it is the only cause, but may be a contributing factor.

I am not suggesting a psychiatrist necessarily, because treating your anxiety with medication will only bring on more side effects. Clearly you are stressed about this, and you have good reason to be. But stress only makes matters much worse in all of our physical funtioning. You must get a handle on the stress ED is causing or there will be worse effects than just ED.

We've had several conversations in here about stress reduction. We have discussed such wide topics as prayer, meditation, hobbies, your relationships with family and friends, your relationship with God, yoga, etc. 

Clevelandguy

Good luck on your journey

MK,

Good luck on your journey, I wish you the best.  Sounds like you have had a bad RP procedure, look to the future and don't dwell on the past.  Remember when life gives you lemons you can make lemonade or eat the lemons raw, your choice.  Based on your posts I feel (and I'm not a doctor) that you do have some heavy mental issues dealing with this whole thing, pros can help you sort them out.  Most if not all of us that have an an RP have had some sort of leakage or ED issue, for most of us it got better so the physical does effect the emotional, I know it did in my case.  There are many many cases where people have had major physical trauma and have recovered when their docs told them you will never walk or ski or play tennis again but over came the physical problems due to a postive I will not give in attitude.  So again the mental can effect the physical, once you accept that premise you can start moving forward.

Dave 3+4

hopeful and optimistic

.

I sent another post last night that is being reviewed.

To add the side effects from surgery can be severe, and is age related. Having ED among patients is NOT rare, and unfortunately happens all too much. So does incontinence. That is why I do not support this procedure, and advise other forms of treatments.

I believe that your reaction to the side effects of this procedure is appropriate.

If my previous comments are posted, I briefly spoke about resources for adjustment and  improvement

1005tanner

lewvino said:

Nev,
My Doc spared all
Nev,
My Doc spared all nerves on the one side and estimated sparing 60% on the other side. I've had good results with Levitra. Not like before but happy. There are so many factors so don't give up hope! Surgeon skill along with other things such as your age, pre surgery ability, etc, etc.

Larry (age 55)

Did Dr Joseph Smith do your

Did Dr Joseph Smith do your surgery? How are you doing now?I hope all is well. I have talked to him for second opinion.