Post surgery, nerve sparring minimally invasive robotic prostatectomy

Hi hopeful, you are very lucky. Most people who have had RARP do not fare as well as you. I am assuming you had both sets of nerves spared? My husband had same surgery, same score as you and was contained within prostate. Unfortunately only one set of nerves were able to be spared. Urinary wise dry at night by week 2. Daytime wore pad for 4 months. Erection wise some life but not good enough for penetration. Had viagra and cialis no good. Now waiting to try injections and is almost 9 months post op. A friend recovered incomtonence wise like you. Had both sets of nerves spared but he is waiting for injs too. Our surgeon had performed many of these ops too. Its great to hear of a great recovery but sadly for a number of men on here it is not the same.

hopeful65,

i am glad you had such wonderful and quick recovery of urinary and erectile functions. Wonderful to hear such great outcome. Your outcome is exception and not a norm for everyone who underwent RARP.

My case was total opposite. I was diagnosed at 51 with PCa 4+3 and underwent RARP on November 2, 2016. I recovered 98-99% of urinary function by the end of 3 months. As of now, almost 10 months post op, recovery of erectile function did not start yet. I am still at the point where I was when awaken from surgery with only difference significant loss of length for 2+ inches and loss of girth. According to my surgeon, he also spared both of my nerves but who really knows that. OR holds lots of secrets which will never see daylight. My cancer was also organ contained with negative margins and negative limphnodes. Fortunately, I was downgraded to 3+4 after surgery.

Before surgery I never had any problems with achieving and maintaining my erections for as long my wife and I wanted. I am healthy 52 years old, not on any medication, non drinker, non smoker, not overweight, very active. 

I tryed Cialis, Viagra, VED and did not have any success with either. Since April, I am using TRIMIX which gives me erections most of the time but my penis looks pathetically small like when I was 10 or 11. I am loosing hope to be normal again and be able to enjoy sex which my wife and I consumed very regularly. My orgasams post surgery are nothing compared to prior to surgery. I was able to experience orgasm only 3 times so far and it felt like switch was turned off just before it started.

To summarize it, I am very disappointed with outcome and I wish I stayed on AS against medical advice.

MK

 

I think you did and are doing the right thing for you.  Godspeed!

Fantastic news.  Thanks for sharing.

I'm 8 years older than you, and setting aside the continuous battle against the bulge, have managed to stay pretty good shape, and was in pretty good shape in all pertinent health and functional ways at the time that I was officially diagnosed with PC (G=7) on 12/02/16.  From your description, it sounds like other than the age difference, my experience at MSKCC has been strikingly similar to yours, except the surgeon who performed my RALRP (03/31/17) was another member of what I have come to refer to as the "Top 3" at MSKCC (Doctors Laudone, Eastham, and Coleman). My surgeon was Dr. Coleman.  The surgeon who performed the RALRP on the gentleman recovering in the private room beside mine (also G=7) at Josie Robertson Surgery Center was one of the other Top 3.  From keeping in touch now and again since then, I would say that his results in terms of healing, continence, and potency have been close to, if not on par with mine.

I'm overwhelmingly thankful and grateful for the path that I firmly believe I was divinely led through that ultimately took me all the way from the heart of Texas to MSKCC in NYC, especially the outcome that I have been amazingly blessed to have experienced.  This so much so that when I read stories from others on this board and others (e.g.), the many that bring tears as well as a few now and again like yours, I become inspired to tell as many men as I can who are currently journeying through this PC travail and those to follow about my life changing journey and amazingly better than hoped for outcome, so that hopefully they too can realize the same.

To try and keep it short (challenging for me), I'll summarize for now as follows:

1.  Perhaps life saving, and part of the divine guidance was having a 2nd biopsy taken by Dr. Ehdaie at MSKCC in early February about 3.5 months after initial diagnoses biopsy and MRI analysis done locally in Texas.  My oh my, what a difference in analysis and results.  Local results where 3-cores positive all in left rear base to mid area with G=(3+4), (3+4), (4+3), no PI, and no ECE found in MRI.  MSKCC results including second opinion on the same MRI were very different in major ways with 3-cores positive all in left to mid, G=(4+3) in all three,  PI positive in one, and ECE probable (50/50 chance).  Yikes, much worse than the initial!

2.  Post surgery MSKCC pathology was pretty much in line with the pre.  ECE was present in lower rear left base (stage raised to pT3a) and PI identified, but no lymph involvement, no vascular invasion, no seminal vesicle involvement, no bladder neck involvment, and all surgical margins negative.  Some bad mixed with a fair amount of good.  

3.  Soon after surgery in recovery room, Dr. Coleman informed me that nerves were 100% spared on both sides. Further good news.

4.  Ultra sensitive PSA taken on 06/05 < 0.02 (9+ weeks post RALRP), and again on 08/16 < 0.02.  Hooray!  Next PSA check is planned for late November.

5.  100% dry since time catheter removed on day-7 post RALRP.  No leaks, not even when sneezing, coughing, lifting, straining, etc. So happy about this one!

6.  Lost a noticeable amount of upper body muscle (shoulders, chest, arms) very soon after RALRP and persisted through the prescribed 6-week no 10+ pound lifting period, but this can be brought back by restarting some resistance exercise/training as soon as able post 6-weeks.  Probably would be the case as with any major surgery. Never expect that just because it's laparoscopic, RALP is not a major surgery.  It is.  For me, the first week was the worst, 2nd week got a good bit better, and after 4-weeks things really started looking up. I recommend long walk, walk, and more walk (with kegels continued) as much as possible during this no-lifting time period.

7.  Started having inklings now and again of slight erection (50 - 60% full) about 2-weeks post RALRP. Woke to full erection on day 27, and things have been working pretty well since then.  Takes a bit more time and touch to get things going, but hey that could be a benefit depending on how you look at it.  Remain on Sildenafil under Dr. Mulhall's care to help optimize longer term recovery with no relapsing.  Plan to ask to try things without it at next follow-up appointment in early December.  Low-T is also a factor (had this long prior to PC diagnoses), so taking T-Gel supplement daily for that one, and it makes a big difference.

8.  Today (08/31) marks exactly 5-months post RALRP. Recently (within last couple of months) have noticed that climax during sex, although a bit different, is different in a better way, meaningfully more intense, and lasts 1.5 to 2x times longer.  I've of late been wondering if perhaps it was the case that the diseased state of the gland was actually acting as detractor and inhibitor in that regard?  After all, it is clear now that the little booger was badly messed up, and likely had been getting evermore so over time.  Hard to put my finger on it, but I had noticed from time-to-time a sometimes dissappointing level of degradation in this aspect over the years past.  Plan to ask doctor about this at next follow-up.

9.  Although I can definitely dance to it, sort of sadly I can no longer emulate the jewelry related lyrical content included in the long ago released popular ZZ-Tops tune.  However, all things considered, in the grand scheme, a minor concern and trade-off.  

Factors that I think positively affected my overall outcome where as follows:

1.  First and foremost, the surgeon & surgical team

2.  My overall urological, potency, and general physical condition going in.

3.  Focused kegel regime while taking 4-5 mile walks 3-4 times per week, as well as often when standing and sitting with feet pointed outward at a 45 degree angle.

4.  Prescribed regime of Sildenafil starting 1-month pre-RALRP, and resumed after day-7 catheter removal.  Cialis is  maybe better if you can stand the much higher cost.

5.  Prayer, faith, and best effort at keeping a positive attitude. Constant expressions and deep feelings of gratitude, humility, and humor can be the best spirit friends in these times.

6.  Last and far from least, the best life partner one could ever hope for to give care and support both before and during recovery.

Finally, Dr. Mulhall at MSKCC is a well known expert on Men's sexual heath.  Depending on one's own personal assessment, setting up a consultation pre or post surgery (or both) could be very helpful.  I also recommend his book "Saving Your Sex Life A Guide for Men with Prostate Cancer"

There is hope, and IMO MSKCC is probably one of the best, if not the best place to find it.  All the best in all of the viable treatment options, and experts in the field for each are available there (be it RP, all the latest RT methods, focal, and AS), and you'll be able to decide on the one that you come to see as best for you.  

As a final valuable tip, those having treatment at MSKCC can request through their assigned social worker to stay free of charge at the American Cancer Society Hope Lodge located on 32nd St. between 7th and 8th Ave.  It was absolutely wonderful to stay there through catheter removal, and MSKCC provides free shuttle service to/from the Lodge every 30 to 60 minutes depending day and time.  As would be expected, space is limited, so plan on making the request at least 4-weeks in advance to helps ensure fulfillment, and always keep in mind that the ACS and all the great work it does are 100% supported by donations.

May the God of Abraham and Son of Man bless and guide all who read this.  

n-mac.

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Glad you got result.i had prostate seminal vesicles & lymph nodes removed. Non nerv sparing and still get erection not quite as hard but hey that's a miracle considering everything😊