Fagin's presentation talks about how to use nerve mapping equipment during surgery to locate this deep perineal nerve and keep it intact. The injection just initiates the blood flow, but the muscles that squeeze to get the rigid erection can no longer work. I believe that is what happened in my case, and it explains why injections work so poorly. If you are lucky, that nerve is not destroyed if not, you can never get a full rigid erection. Apparently, nobody worries about saving the deep perineal nerve. When surgeons do nerve sparing surgery, they are trying to save the Neurovascular bundle that wraps around the prostate, which is needed to initiate blood flow into the penis. This deep perineal nerve runs near the apex of the prostate, and its position varies from individual to individual. Randy Fagin that describes this process at: You can see a very interesting presentation by Dr. They squeeze the base of the penis which increases the penis blood pressure after the arterial blood has created a partial erection. This nerve is needed to achieve a rigid erection by activating the Bulbospongiosus and Ischiocavernosus muscles that wrap around the internal part of the penis. My opinion is that the "deep" branch of the perineal nerve was severed during surgery. Most urologists blame it on "venous leak". Since a bimix worked extremely well prior to surgery, I have done a lot of research into why injections don't work any more. Adding prostaglandin helps slightly with erection quality, but things are still very soft and pointing mostly down at about 35 to 40 degrees, with the massive pain. Any mix that doesn't have prostaglandin has no pain at all, but even with the maximum possible doses, they only give an extremely poor erection (very soft and pointing almost down at about 25 degrees). Thanks for the suggestions, but I've already tried 6 different mixes, with and without prostaglandin. I'd be perfectly OK for the rest of my life with my sex life exactly as it is now (as would be my partner). But, as I've started to recover some natural erections, and with the excellent results from the Cialis/Trimix combo, I've dropped the thought of an impant. I even met with a doc in this area who does implants. At times over these three years, I've contemplated getting an implant. It took me a while to find the right Trimix dose (I tried bimix too but that didn't work at all). In fact, with the Cialis/Trimix combo, our sexual sessions can last for up to a couple of hours. Mostly, when my partner and I want to have sure fire sex for an extended period, I use a combination of Cialis and Trimix. Occasionally the erection has been good enough for intercourse with my partner, though for a limited amount of time. On the ED front, just over the last three or four months I've begun to have some natural erections with stimulation without drugs. After RP, the prostate GS was found to be 4+3, and the margins negative.) First and foremost, I'm very happy that my PSAs have been undetectable so far. An MRI and bone scan had shown no evidence of extra-capsular extension or spread. On biopsy, a number of the cores were GS 4+3 with one 4+4. (At diagnosis my PSA was rising and had reached 5.4, cancer stage was T2a. I'm 70 and had my nerve-sparing RP in April 2013, so in a couple of months it will be 3 years since my surgery.
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