nerve sparing is it worth it?

NHS statistics say 90% of men who have nerve sparing will be able to get an erection at 12 months post op either naturally or with mechanical or chemical assistance. That doesn't necessarily mean that they have enough for penetration. Some surgeons have fantastic success and some lie. Our surgeon says that lots of patients lie to him and claim they have recovered but then their wives / partners say different. Our surgeon also reckons the true figure is that about half of men recover natural erections. What you don't know yet is how the emotional aspect will hit you - John does not have physical ED anymore but his head is all over the place which means he often can't perform.

Nerve sparing definitely increases your chances of recovery and your surgeon won't do it if he gets in there and thinks the nerves need to go.

Hello Nigel.  I'm approaching 12 weeks after a non-nerve sparing robotic procedure, and I recognise the dilemma you're facing. Even if all surgeons have a professional obligation to treat cancer removal as the first priority, they differ in their interpretations of the balance of risk. 'League tables' and other methods of comparing surgeons perhaps don't help.

I am very lucky. I have good functional recovery so far, and from what I understand that's unusual but not completely exceptional. Some estimates suggest up to 15% of men having non-nerve sparing procedures recover some function, though of course the degree of recovery varies. 

Good luck making your choice. It's difficult to be objective, but with good research from reliable sources you can at least participate in the process and make your priorities known.

Hi Brian,
That was my worry. I see you are quite local to me did you have your op at the Churchill in Headington Oxford?
I was also offered the trial that you are on, but I noticed that they weren't keen if you had been on other trials, I did loads when I donated platelets.

Thanks to the others for there replies it is helping me come to a decision.

Good luck (we all need it)
Nigel

Hi Brian,
I recently retired from the Medical School in Oxford, and know Freddy, he is a fantastic chap. I have been under the care of " P S" also a top bloke.
Good luck to all.
Nigel.

Less than 3% of men that have non-nerve sparing surgery can achieve natural erections and the assumption has to be made that some nerves were left behind. They can't regrow if they aren't there but it is true that burned or bruised nerves can sometime repair themselves. Viagra etc do not work for men with no nerves so injections, pessaries and/or the pump are best options.

Robgsr - did you have nerve-sparing or non-nerve-sparing ... it isn't clear from your profile?

Many thanks Lyn and Chris,

I am beginning to think I am over thinking this. I think I will just let the surgeon decide.

I went to my GP and mentioned the pump he had not heard of using it for penile rehab. But he did say that if the hospital would not prescribe one he would, as it was a good idea.

I have a feeling he will use me to plug holes in his prostrate treatment knowledge.

How soon after the catheter comes out can you start using it?

Good luck to all

Nigel

Hi Brian,
I was given the same leaflet, I must have missed that bit.
Did she demonstrate the pump to you? (just on my hand), I found it quite surreal.
After the description of penile atrophy I was quit eager to know more.

Good luck all.
Nigel

Just to add my two penneth. I am now Two and a half years post op.I was supposedly non nerve sparring but still get tumescence of the penis, but sadly no standing to attention. My surgeon said it is possible my network of nerves have made a new connection or were not in the "normal" location.

My on going stricture has meant the use of the pump has been quite rare but when I have used it I can still get a pre op length and girth. There was a suggestion that use of the pump might be aggregating the stricture, so follow the advice of waiting for the joint to heal.

I have been prescribed daily sildenafil and although it does not work as it would with a fully nerved/ complete male it has helped keep my penis healthy, exercise of the penis has probably also helped to maintain the health of the penis.

Finally,You do not need an erection to have intercourse and we have mastered the technique of flacid intercourse.

All the best for your treatment and recovery.

Thanks Chris

Interesting, Rob. I too had non-nerve sparing as did at least one other forum member who has had some return of erectile function.

My urologist said it can happen where  function was strong previously, and I specifically asked if it could mean an incomplete removal of the tissues. He looked offended and showed me the record that included both nerve bundles. It's therfore an incorrect assumption to imagine return of function must equal a botched or incomplete procedure.

It's clear like in lots of neurological physiology that there are gaps in understanding. People recover all sorts of functions after nerve procedures, and add to that we're all slightly anatomically different. And chemicals most definitely help.

Edited by member 18 Nov 2016 at 07:58  | Reason: Not specified

Henry,

It is my understanding that it is not just a question of the assessed Gleason score, which could be undergraded anyway but even more importantly how extensive the spread is. Is there a reason why I am wrong in this?

I had an extra blood vessel that had to be preserved, and an adhesion to the bowl.

Slightly leaky just before and after I have a wee.

I have had six blocks caused by blood clots, but managed to pass them all with out intervention.

But I am still getting lots of abdominal pain. I have had my post op appointment brought forward as the pain is thought to be unusual.

Good luck to all.

Nigel