Questions questions and more questions

Hi,

Good questions if surgery is your choice. It might not need to be. 

Answering out of order. 

You could be back on a laptop immediately.  The catheter and bag are your invisible friend. Pads do a great job after the catheter is removed.

On average you could be dry in 2 months, no pads. A very few are never dry but there is help. 

You can have an orgasm and feel excited without an erection.  Most would use tablets, pumps or injections to get an erection.  

 Nothing bothered me about continence or dysfunction as I was glad to have the lesion removed and had decided on surgery. Although that's easy to say when your path isn't difficult. 

That said there are things you miss although I can get an erection when standing so it's not all lost and I've never wanted injections. The pump worked but I didn't like it. Having a dry climax can be plus. Also sometimes I leak when initially aroused and that's not uncommon among surgery cases.  The leak is very subtle and you only realise when you find damp. Such a leak is out of your control but awareness helps management. Kegels reduced it. 

Edited by member 19 Jan 2025 at 16:19  | Reason: Not specified

Hi

1) yes in in some instances they are more intense and longer than pre-op. NeuroSAFE is prudent for surgery as it gives the surgeon unprecedented visibility on how much nerve tissue to take for optimum cancer control. Ie they don’t take too much if not needed which impacts potential ED and conversely helps to ensure no positive margins are left behind and not discovered until final histology. Also remember to empty bladder before sex or you maybe ejuculate urine…it’s fairly simple to mitigate. Nerves in that area can take up to 3yrs to recover which now given I’m year 5 seems like a realistic timeline. Biggest changes I noticed in terms of ED improvement were within months. Incredibly I had a semi day 3 post op and had to push the good lady away 🥶 with a catheter in. Was able to achieve penetration 2 weeks after catheter was removed. I took 2.5mg tadalafil daily which was easy to tolerate and helped. Viagra 20mg was make my erections similar to when I was in my twenties. 

2) fairly quickly but retzius sparing RARP is well regarded for faster continence recovery and avoids disturbing the nerves associated with bladder control below the bladder. It’s a technically more complex procedure so a high volume highly experienced surgeon is key.

3) I had a fairly quick recovery. In fact the day after didn’t feel like I’d had major surgery. When the catheter was removed at two weeks  leaked mainly in the evenings until week 5 when the stitches around the bladder neck start to soften. From that point on things got better. I can honestly say when you’ve had the surgery you look back and wish you had known what you do now and there was absolutely no need to be stressed. I think the biopsy was worse in all honesty and I had the TPM under a GA.

4) should be able to work with a laptop but you don’t want to damage stitches in your abdomen. Sitting was ok but kind of sore after a bit. The optimum was a reclining chair and a hospital type table that can slide in and support the laptop over me while sitting slightly reclined. I was driving after two weeks without issue. The more time you can invest in the early days letting you body recover will pay dividends later.

Edited by member 20 Jan 2025 at 17:42  | Reason: Not specified

In no order,

I went home the same day I had surgery. I was walking 4 blocks the next day, by the end of the first week easily walking a mile with my catheter in. Catheter came out 11th day, was in an extra three days due to a holiday weekend. Driving the next day after it was out. Two weeks after surgery I was driving 1 to 1.5 hours each way to go visit my daughter. Only limitation is not lifting anything that might possibly be heavy. I could return to a white collar desk job after those two weeks, although everyone recommends waiting three weeks if everything is fine. Working from home would have been a breeze. Also no issues needing to immediately run to the bathroom.

I had no incontinence after the catheter came out.

Surgeon told me not to even be concerned about erections or arousal for 30 days. He said you wanted your nerves to heal from the trauma of the surgery and the nerves needed this healing time. He said trying to get yourself aroused to early can have a damaging effect. He prescribed me daily low dose pill of sildenafil (viagra) 20mg to keep a blood flow into the organ. This dose would do nothing, but depending on your nerves you might feel some degree of nocturnal erections. Did feel these, but waited the full 60 days until he told me to go to almost a full dose 4 pills 80mg on a “date night”. A full dose would be 5 pills. My wife and I were extremely surprised with the result. I would say 80% my normal, enough for penetration. I think just waiting was the best thing.  Continuing to improve. 

Remember you are more likely to hear the adverse stories on here as thousands and thousands of people have successfull prostate cancer treatment and you never hear from them again as most are content with their treatment and outcomes. Unfortunately the degree of side effects will vary with people. There are people that get serious side effects from routine operations, vaccinations, taking prescription medicines. Potential side effects should not deter you from following the course of treatment you believe is best for you as all the treatments carry again potential side effects and the purpose is to get rid of your cancer. Even the ones that people are most concerned with ED and incontinence almost always have some improvements over time with the people experiencing them. Now are their people that does not happen for, unfortunately yes, but their are continuing improvements in aids for both if the conditions.

Hi Arthur

One thing that the replies here will show you is that we are all different. Here is my story:

I had nerve sparing prostatectomy 14 years ago. The surgery was difficult and lasted for nearly 6 hours, recovery was tough, catheter had to remain in place for 5 weeks, my erections were weak and effectively I suffer from ED, also suffer from arousal incontinence and ejaculate urine at orgasm. Have I put you off?

Do we regret our choice of treatment? The answer is definitely NO because I am cancer free, so far! Of course hindsight is a great skill!

In our long, loving and a happy marriage sex has always been very passionate and important to us. So the shock of ED and incontinence is difficult to describe. However we have managed to re-establish our sex life with quite a few unexpected benefits. Have a look at the following link:

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

When considering the choice of treatment be aware of treatment-bias on part of the specialists. Prostatectomy, on the face of it, is very attractive but there is research evidence that the vast majority of men undergoing this treatment do suffer from some side effects, temporary or permanent as I do. However your age is in your favour.

I hope you will be able to choose a treatment with confidence and don't look back. Good luck.

Edited by member 20 Jan 2025 at 11:08  | Reason: Not specified