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Erections post NNS RARP?

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User
Posted 07 Aug 2023 at 12:36

So I have just been reading a medical paper regarding erection recovery 24 months after a non-nerve sparing (NNS) RARP.
The results showed that for those men who had good erections prior to the NNS RARP, 24% were achieving erections that could be used in intercourse.
I had always assumed that it would not be possible achieve an erection naturally again when they told me that they didn't save the nerves but maybe there is a slight chance something might happen.

Has anyone else had NNS RARP and recovered their natural erections?

User
Posted 07 Aug 2023 at 17:12

Steve, I remember posting on here that I was having some form of erection after non nerve sparing surgery. I was quickly told I couldn't have an erection without any nerves. For a long time I have described myself as s"upposedly" NNS. My surgeon said the nerve network is quite complicated and it was possible that the nerves went a different route or that signals were finding a way through.


I was getting stirrings a few months after surgery and probably achieved a 70 percent swelling but it never stood to attention. I never made a full recovery and did not maintain the 70 percent level for long. 


I am now just over nine years from surgery and just over six years from salvage RT. I recently started six months of bicalutamide and strangely I am getting up with a 50 percent swelling. I did start on sildenafil again recently but it has done nothing for the erections, I did get the blue haze and acid reflux.


We mastered the flaccid insertion technique which I described as out of this world. I frequently say never give up and have fun.


Thanks Chris 


 

User
Posted 12 Oct 2023 at 15:15

I wrote previously about my own erectile recovery after complete non nerve sparing surgery, but it was clear my experience ran counter to the established group view. There being little to be gained debating a point about which I was the only possible reliable arbiter, I withdrew from the debate but I did post a link to a peer-reviewed study by a urologist which showed results very similar to those described in the helpful video posted earlier. My own urologist described erectile recovery after NNS as 'unusual but not rare' , and he made the point that neurological damage and recovery is still imperfectly understood. I guess the message could be 'don't despair' whilst being realsitic about probability.

User
Posted 07 Aug 2023 at 12:36

So I have just been reading a medical paper regarding erection recovery 24 months after a non-nerve sparing (NNS) RARP.
The results showed that for those men who had good erections prior to the NNS RARP, 24% were achieving erections that could be used in intercourse.
I had always assumed that it would not be possible achieve an erection naturally again when they told me that they didn't save the nerves but maybe there is a slight chance something might happen.

Has anyone else had NNS RARP and recovered their natural erections?

User
Posted 11 Oct 2023 at 22:25

Originally Posted by: Online Community Member


For a long time I have described myself as s"upposedly" NNS. My surgeon said the nerve network is quite complicated and it was possible that the nerves went a different route or that signals were finding a way through.



Thanks for helping us see that there isn't a sort of binary - as if you either had nerve sparing or non-nerve sparing surgery. I think it is more like a spectrum and actually my surgeon avoided using the terms NS and NNS. He pointed out that when you are actually inside somebody's body with a RALP machine, the nerves are not marked out with high-contrast coloured lines like in a textbook!


What I came away with was that everybody has some nerve damage, and depending on how aggressive the surgery is (and the skill of our surgeon, and luck) we might have more or less nerves spared. Also as you suggest the nerves have some capacity to regenerate over a period of years. This is not to contradict those who had very aggressive surgery with no chance of nerve generation.

Edited by member 11 Oct 2023 at 22:26  | Reason: Not specified

User
Posted 12 Oct 2023 at 15:38
I just watched that YT video and what a refreshing explanation of prostate surgery and the after effects.
I think the point about loss of erections, even in couples where penetrative sex is but a distant memory, was very well made. My favorite quote was 'if you woke up from your surgery and they said 'hey, we have to take off your arm, but it's OK because you don't play tennis anymore' then you would be quite distressed'.
I was surprised that they didn't mention that a very pleasurable orgasm can still be obtained without an erection however as (for me anyway) it was the orgasm that was enjoyable, not the actual erection.
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User
Posted 07 Aug 2023 at 14:02

In my experience and from what I read about other men's experiences erections after surgery are most likely to be inferior in strength and longevity.  Also in my experience if your surgeon did not save the nerves you should not expect any  improvement. I was in the same situation 12 years after my prostatectomy and we had to find an alternative method which was an NHS prescribed penis vacuum pump which we found and it re-establish our sex life. There are many other methods to help you. Have a look at the following link:


https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life




 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 07 Aug 2023 at 15:29

Thanks - I'm not expecting it but it's nice to think that there 'might' be a possibility as I first thought it was an absolute zero.


And yes, it's not really a problem for us as we have other fun ways of enjoying ourselves.


This is the article I was reading if anyone is interested


https://onlinelibrary.wiley.com/doi/10.1111/andr.282

User
Posted 07 Aug 2023 at 16:41

Thank you for the reference. In a modest way it confirms my observations over the last few years on this site and others that nerve damage is underestimated. Consultants like to be optimistic and the patients tend to read into it more than intended. My consultant was clear and told me that my post-surgery situation will be worse than pre-surgery and he was right.


Like us you have found your way of satisfying each other and that is great. Well done.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 07 Aug 2023 at 17:12

Steve, I remember posting on here that I was having some form of erection after non nerve sparing surgery. I was quickly told I couldn't have an erection without any nerves. For a long time I have described myself as s"upposedly" NNS. My surgeon said the nerve network is quite complicated and it was possible that the nerves went a different route or that signals were finding a way through.


I was getting stirrings a few months after surgery and probably achieved a 70 percent swelling but it never stood to attention. I never made a full recovery and did not maintain the 70 percent level for long. 


I am now just over nine years from surgery and just over six years from salvage RT. I recently started six months of bicalutamide and strangely I am getting up with a 50 percent swelling. I did start on sildenafil again recently but it has done nothing for the erections, I did get the blue haze and acid reflux.


We mastered the flaccid insertion technique which I described as out of this world. I frequently say never give up and have fun.


Thanks Chris 


 

User
Posted 11 Oct 2023 at 10:57

https://www.youtube.com/watch?v=22CLGNTrpJQ&t=173s


interesting discussion regarding nerve sparing/ non nerve sparing

User
Posted 11 Oct 2023 at 11:27

That's a really good video.


The point brought up at the end is something I hear from men a lot - while the couple may not be sexually active and not necessarily missing that, it can still be really important for the chap to have working sexual function himself. Sometimes guys feel guilty about saying that if their partner has said sex isn't important, and it's good the prof recognised that scenario, which I'm sure he will have seen many times too. Obviously applies to single men too.

Edited by member 11 Oct 2023 at 11:29  | Reason: Not specified

User
Posted 11 Oct 2023 at 14:33

I was non nerve sparing.  My consultant made it 100% clear that I would never have a natural erection again and he was right.  He also made it clear that viagara and the likes wouldn't work either.  Ho told me I'd need Injections and probably an Implant.  I now have the implant.

User
Posted 11 Oct 2023 at 22:25

Originally Posted by: Online Community Member


For a long time I have described myself as s"upposedly" NNS. My surgeon said the nerve network is quite complicated and it was possible that the nerves went a different route or that signals were finding a way through.



Thanks for helping us see that there isn't a sort of binary - as if you either had nerve sparing or non-nerve sparing surgery. I think it is more like a spectrum and actually my surgeon avoided using the terms NS and NNS. He pointed out that when you are actually inside somebody's body with a RALP machine, the nerves are not marked out with high-contrast coloured lines like in a textbook!


What I came away with was that everybody has some nerve damage, and depending on how aggressive the surgery is (and the skill of our surgeon, and luck) we might have more or less nerves spared. Also as you suggest the nerves have some capacity to regenerate over a period of years. This is not to contradict those who had very aggressive surgery with no chance of nerve generation.

Edited by member 11 Oct 2023 at 22:26  | Reason: Not specified

User
Posted 12 Oct 2023 at 15:15

I wrote previously about my own erectile recovery after complete non nerve sparing surgery, but it was clear my experience ran counter to the established group view. There being little to be gained debating a point about which I was the only possible reliable arbiter, I withdrew from the debate but I did post a link to a peer-reviewed study by a urologist which showed results very similar to those described in the helpful video posted earlier. My own urologist described erectile recovery after NNS as 'unusual but not rare' , and he made the point that neurological damage and recovery is still imperfectly understood. I guess the message could be 'don't despair' whilst being realsitic about probability.

User
Posted 12 Oct 2023 at 15:38
I just watched that YT video and what a refreshing explanation of prostate surgery and the after effects.
I think the point about loss of erections, even in couples where penetrative sex is but a distant memory, was very well made. My favorite quote was 'if you woke up from your surgery and they said 'hey, we have to take off your arm, but it's OK because you don't play tennis anymore' then you would be quite distressed'.
I was surprised that they didn't mention that a very pleasurable orgasm can still be obtained without an erection however as (for me anyway) it was the orgasm that was enjoyable, not the actual erection.
User
Posted 12 Oct 2023 at 20:30

Originally Posted by: Online Community Member
My surgeon said the nerve network is quite complicated and it was possible that the nerves went a different route or that signals were finding a way through.


I think this is important. Some nerves in the body are very obvious to a surgeon, they form a bundle the size of an electric cable although even they divide into smaller and smaller branches as they approach their target. But the autonomic nerves travelling around the prostate on their way to the penis are not like that, they consist of multiple tiny nerves something like a spider's web - and impossible for the surgeon to see when he or she is doing a prostatectomy. What the surgeon does know is that in general nerves travel alongside blood vessels, so for nerve-sparing prostatectomy the approach is to try to preserve the thin layer (think of an onion skin) around the prostate containing small blood vessels.


In non-nerve-sparing surgery there is no such effort to preserve the thin outer layer, but if some of the nerve fibres take a route less close to the prostate they won't be removed. Even then though there will be an element of luck as to whether the remaining nerves can recover after the operation to the extent of triggering an erection.

 
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