ED Recovery time after RARP with nerve sparing

Taladafil and Sildenafil (Cialis and Viagra) are PDE5 inhibitors. They have two roles at this stage:

1) They improve blood flow in tissues which helps with nerve healing after surgery. Actually, only Tadalafil has been shown to have any benefit here, Sildenafil hasn't, and it probably doesn't last long enough, whereas Tadalafil lasts a long time so taking it regularly generates continuous dosing. This is usually 5mg daily low dose Tadalafil or 2 x 20mg/week Tadalafil. (You would need to take Sildenafil 3 or more times per day to achieve the same effect.)

2) They amplify the nerve erection signal. This means if there aren't yet enough nerves working to generate an erection, they amplify the signal from those which are working, and generate a better erection than if you hadn't taken them. Consequently, you'll get an erection sooner if you use them than if you don't. In this case, you take them when you want to get an erection. This is sometimes called an "event" dose which if you're recovering from initially having no or very poor erections after surgery, is likely to be the highest dose (20mg Tadalafil or 100mg Sildenafil). As nerves improve, you might find a lower dose works well enough. Often not all the nerves recover, in which case you might always need to use a PDE5 inhibitor to get a good enough erection.

PDE5 inhibitors won't work if all nerves were removed, as there's no nerve signal to amplify. However, it is still worth trying an "event" dose occasionally in this case because sometimes not all nerves were removed when the surgeon thinks they were, because they sometimes take different routes. Very occasionally they can regrow too, but that typically takes 3 years to start showing up. Indeed it's likely all improvement after 3 years is due to nerves regrowing.

Not sure how long I will continue to be prescribed this for, however I have follow up with the clinical nurse in March which may inform me.

Hi Fed69

You are relatively young and there is a good chance that your erectile function will continue to improve further but I don't think any one can say when the improvement will flatten out or whether it will reach 100%. Some consultants tend to be very optimistic about nerve sparing RARP. Recent research (https://www.tandfonline.com/doi/full/10.1080/19317611.2016.1204403) shows that only 16% of men following PCa treatment  achieve erectile function to the pre-treatment level. Hopefully you could be a part of the 16% of men; majority of prostate cancer sufferers are much older than you. Obviously that is very discouraging but that does not mean it is the end of your sex life. You should continue to take any prescribed medication and use a VED regularly to help your nerves to recover and remind your penis and you brain that they all functioned well before  the surgery. In any case there are many ways to overcome any minor or complete ED. Vast majority of men continue to enjoy their intimate life after their treatments. One of the problems some men experience is that whilst their erections are good enough for penetrative sex but do not last long enough. They use 'cock' rings which can be bought from online sex shops. I suffered total ED following my surgery over 12 years ago at the age of 71 but we still have a very enjoyable sex life. I would suggest you continue to enjoy sex be it masturbation, penetrative, oral etc. All you need is determination, imagination, good communication with your wife/partner so that you can satisfy each other. 

Edited by member 04 Feb 2024 at 08:18  | Reason: Not specified

I had a nerve-sparing RARP in December 2022 and was prescribed Sildenafil. This is now starting to show signs of movement which I’ve been told by the specialist nurse is encouraging. To be able to have penetration I rely on a vacuum pump with constriction rings. It’s not romantic in any way but achieves a useable erection. I have an appointment in March to consider injections - again not romantic but it’s worth trying.