44 post RALP ED

[u/Humble_Orange7307]

Had RALP 4 months ago and urologist has me on 5mg daily Cialis. Bilateral nerve sparing was performed. Gleason 7 with cribriform pattern unfavorable intermediate was the diagnosis. Pre surgery I had some mild Ed issues and would take cialis only before sex. Now it is very difficult for me to get hard and maintaining an erection is near impossible. Still getting used to the dry orgasm and not sure if I ever will. My doctor says just give it time but I feel like i had some immediate improvement then plateau at a place that is not where I would like. Have not experimented with any other ED/penile recovery methods. Anyone else in a similar age range who has dealt with or is dealing with ED post op?

[u/SLO_Engineer]

You didn’t mention your age!

I’m 69, 3 months post-RALP. Taking 5mg Cialis daily with an additional 20 mg boost dosage when anticipating the need for a boner.

Was able to coax out a boner at week 7 (Without the boost). Not the best quality boner, but a boner nonetheless. The boost dosage does result in a better boner. You may want to try that.

From what I read, ED could take a year or more to resolve, so at a minimum you should consider resetting your expectations and give it more time.

[u/Dosdossqb]

Cialis, pump, vibrating ring. That was my jam. I used the pump from week 6 u til 6 months, then didn’t need it anymore. I’ll be a year post-RALP in a couple weeks.

[u/ExcellentCookie6399]

Ask your doctor for Trimix. It will help in the meantime while you’re waiting for your erections to return. Once you get over the needle, it’s a game changer! Best of luck with your recovery!

[u/jerrygarciesisdead]

Ask your doc about pump.

Also you say you had ED issues before surgery at 44yo. Is there a mental issue that needs to be addressed or just physical? How is your weight , diet , gym habits ? Have you had your T checked in your bloodwork ? 44 seems young to be having ED prior to surgery.

[u/Appropriate-Owl-8449]

I’m 66 and had my RALP one year ago. ED sucks. I didn’t need anything before surgery and now I shoot up Trimix. I have to. I’m certainly getting feeling and my dick is trying to get hard. I forced my surgeon to check my testosterone levels and I’m above average. I’m hoping it comes around. I have heard mixed stuff about implants. Best wishes my man.

[u/Brief-View-9906]

Augusta medical systems - somaerect Stf Plus

[u/Junior_Hold183]

I am 2 months post Ralp and 58. My surgeon said I could go up to 4 pills of cialis daily. I am currently at 2. Hasn’t made a difference yet.
I am looking into Viagra and a pump.

[u/CuliacIsland]

4 months post RALP, is still early.My little guy started showing signs of life around 6 months. Keep on using the pump and masturbating a couple of times per day. I also used Trimix for a short while and I think that heled as well. Do not use Trimix long term.

[u/Tartaruga19]

Leva um tempo para recuperar, em média 1 ano

[u/jkurology]

Everyone with ED regardless of the cause when treated with PDE5 inhibitors should begin with the highest dose-20 mg-not the lowest dose. Titrate down not up. Try 20 mg 3 times a week

[u/sofly47 → u/jkurology]

Why would you not take the lowest possible dose needed to get the desired effect? It’s easy to increase your dose until the desired effect is achieved. Your advice goes against common sense.

[u/jkurology → u/sofly47]

The lowest possible dose is the goal especially with PDE5 inhibitors but most patients don’t respond to the lowest dose. Therefore you can get effectively treated the quickest-and the cheapest-if start out with the highest dose and titrate down

[u/sofly47 → u/jkurology]

If the patient starts with the highest dose and it’s effective, then why would they even consider trying any lower dose to see if it works? Your advice is counterintuitive.

[u/jkurology → u/sofly47]

It’s not counterintuitive. About 40% of patients respond to 10 mg of tadalafil and it’s difficult to predict who that 40% is because there’s no objective test for ED. Also, most patients pay out of pocket and a 20 tablet costs the same as a 10 mg tablet. So if you respond to 20 mg then cut the tablet in half to see if 10 mg is effective. It’s a better approach

[u/truckaxle → u/jkurology]

Why is this?

[u/jkurology → u/truckaxle]

It’s a more appropriate and better way to approach ED. It’s easy for patients to titrate down