Vacum Pump use after prostatecomy?

Max Former Hodgkins Stage 3 said:

ED

Nash,

Good luck as you move toward surgery. I had my prostectomy in January of this year, or coming up on a year now. My experience is current.

You do not mention your age, general health, or the staging of your cancer, all of which will affect how well a man recovers from post-surgical ED.  I was 58 at the time of my surgery (59 today). If you are younger, healthier, and early stage, things are usually easier than otherwise. Also, guys with ED issues prior to surgery are not going to emerge from surgery potent.  BPH, pain, and the other issues associated with PCa ordinarily have men somewhat impaired before the operation.  It is just common sense.

I have read many comments here regarding ED, as well as in book and professional Journal articles online.  While some guys claim to be fully functional a month after surgery, such is astronomically far from average; virtually unheard of statistically. God bless them, and may they be proud and thankul.  Some men NEVER recover potency. Therefore, the average guy ranges somewhere between those two extremes.

What you can be certain of is probably all of the following:  You will have total ED following surgery. Radiation also usually causes ED as well, but there is reportedly a delay following radiation and ED onset, but radiation-induced ED seems to be less severe, or even very much less severe, than from surgery.  I have read claims that some radiation patients had NO ED.  Bless them also.  But surgery will leave you impotent.

Statistically (form journals, books) total lack of spontaneous erections (i.e., erections not assisted by drugs, pump) last several months, minimum. A year is not uncommon. Eighteen months to two years sometimes occurs. Beginning as soon as a month or two, my urologist had me begin drug recovery. He offered me "the pump," but I declined, for personal reasons.  I do understand that the pump is overall effective in maintaining penis health, however. 

I chose an alternative that his group offers: Cialias and TRIMIX.  The Cialias, in the first several months (over six months for me) will usually not allow erections by itself, but the doctor said it would be helping my vascular network right away. But TRIMIX yields immediate erections, as soon as you are over surgical pain, and (according to my urologist) has the same benefits as the pump in terms of maintaining healthy blood flow.  Trimix requires a perscription, but can only be filled at a compounding pharmacy; a pharmacy that acturally still grinds and mixes medicines. All larger cites have compounding pharmacies available.

TRIMIX is a compounded set of three drugs which in 80% causes an immediate, full erection, within 15 minutes. It requires that you or your wife give you a shot in the side of the penis. It is not painful (it was not for me) but some men report that they simply cannot do this. The urologist or the urologist's nurse will train you on this, and the first test run is done in the doctor's office, to establish that it iwll work for you.  Placement of the shot is critical for it to work, but I missed once and hit the urethra, which is harmless; it just renders the shot ineffective.  A shot can be administered one every two days (you cannot receive shots two days in a row). I am told the tiny needle is the same size as what diabetics use daily, but I have never seen an insulin needle. I read just today that there is also a Trimix JEL.  My doctor did not mention a jel form, and I am not familiar with it.

I have been on Cialias now for about ten months. I had no problem at all getting it filled on my medical insurance. I guess full prostectomy counts as a valid medical reason for getting the drug. I will say that I fortunately have excellent medical insurance with drug coverage.  The price is not prohibitive for me, but my own family doctor said if it was to get a foreign supplier of the drug, since the price is much lower. I have not checked into this, but reportedly it is fully legal and appropriate. 

Cialias now does the whole job for me; I have not used Trimix now for a few months. And, as I stated, I am only 11 months out from the surgery.

Be sure your surgeon is very experienced, and that he practices NERVE SPARING when possible.  Several decades ago, the nerves were never spared, but today it is always at least attempted.  My surgeon said he was able to spare all of the erectile nerves. This is why I asked your STAGING: If the surgeon finds cancer on the nerves (what they call "perineural escape") he will have to cut out the nerve bundles.  These can usually be grafted back in (using nerve tissue that he gets from somewhere else on your body), but the prognosis for sexual return is delayed a lot in such cases, and there are cases of lifelong impotence. There are also some cases where nerve grafting is not possible.  I believe the first question I asked the surgeon when he came into my room afterward was , "Were you able to do the nerve sparing?"

http://thecompounder.com/triple-mix-injection/

I hope this is useful and not what texters dub "TMI" (too much information).  I wish you luck and success with all of this.

max

Excellent response, Max.  It should be posted to a sticky for a general discussion of ED problems following treatment.  Unfortunately, it's not possible to create a "sticky" the way the CSN forums are set up.  So, I'm going to bookmark this for future reference.

However, you never answered the OP's original question about the use of vacuum pumps to restore erectile function following treatment.  I am one of those who never had ED following his radiation treatment and don't know personally whether using a vacuum pump will help or not.  However, I have used vacuum pumps "recreationally" and can add some info based on this.

The theory behind using vacuum pumps to treat is ED is the notion that it will enhance tissue expansion and blood flow into the penis in order to keep the penile tissue from atrophying while the body is still recoving from treatment -- most often surgery.  I suppose this is true.  Using the vacuum pump will greatly expand and lengthen your penis but this change is temporary.  However, using a vacuum pump will NEVER restore any of the erectile nerves damaged during surgery (or otherwise) and you need these nerves to function in order to regain the ability to achieve an erection (naturally). 

Once those nerves are damaged, erectile function is lost forever and can never be restored (unless someone has come up w/a microsurgical method to do so).  The only alternative in this case is to implant a penis pump (which is kind of a vacuum pump in reverse) that will create an erect penis so that entry can be made.  However, you will NOT be able to orgasm or ejaculate just with a penile impant.  There still needs to be some other nerve functioning to achieve that. So, although the intimacy that occurs with entry would be nice, I'm not sure it would be worth the sense of frustration that would also accompany the act w/o the ability to also orgasm the way men normally do.

So, if the erectile nerves are undamaged, I see no reason not to use a pump theraputically until erectile function returns.  I'm not sure if it really helps to restore erectile function but I don't think it can hurt unless you use excessive pressures while pumping.

BTW, one of the "side effects" of prostate treatment (surgery or radiation) is the loss of the ability to ejaculate because prostate fluid (the transporter of sperm) is no longer available with the destruction/removal of the prostate.  However, you can still orgasm w/o ejaculating.  It takes some getting use to -- at least it did for me -- but you will get use to it eventually,  Afterall, what other choice do you have?  None, as far as I know.