Erectile dysfunction after prostate cancer

Dr. Harmon makes a good case for realistic expectation along with a list of factors that correlate with recovery of sexual function. The published recovery rates vary enormously. Related studies demonstrate that different doctors have different recovery rates probably based on their skill and experience. The best published recovery rates run nearly 100% for young men under age 50 with bilateral nerve sparing surgery and no co-morbidities such as hypertension, diabetes, atherosclerosis, multiple sclerosis, and hypercholesterolemia, or other risk factors such as alcohol or tobacco abuse, overweight, enlarged prostate, high blood loss during surgery, etc. My own surgeon told me he had a recovery rate comparable to the best published rates and in another context said he had a much older patient population. I was then at 49. He was trained at a "center of excellence" by a surgeon with some of the highest published sexual recovery rates. Soon after surgery I asked his nurse when I might expect to recover spontaneous erections. He said " Oh, that is very rare. In my 5 years working here, only one or possibly two men recovered spontaneus erections." This nurse conscienciously talked with me about my sexual function each visit and wrote all the prescriptions for PDE5 inhibitors like Viagra and injectibles like Caverject, so I trust the he knew who recovered. It is now 5 years. I never recovered even though I was relatively young, had had very good erection prior to surgery, and had no risk factors. I had started Caverject twice per week soon after the catheter was removed and kept up regular use. Later I tried nightly Viagra as some articles recommended, but perhaps it was too late by that time. Fortunately I have a loving, patient wife. The point of this message is--get a second opinion and some documentation rather than just your surgeon's claims. My surgeon lied to me either about his ability or his intention to perform this surgery giving the care and attention that is necessary to preserve sexual function. Perhaps as galling after what he did to me, he would not even help me to get test to identify the injury and try to correct it. Even when I had evidence that the problem might be vascular rather than nervous and I showed him research indicating that revascularization might correct the problem, he refused to refer me to a vascular surgeon saying it would be a conflict of interest because of his responsibilities to his insurance group. I feel better now, but it took a long time to get over being conned by someone I had expected to act in my best interest. Like a fiduciary responsibility, doctors have a moral obligation to be honest about their abilities even if they could lose business by telling the truth. If he had told me the truth, I would have gone elsewhere. Unfortunately even in medicine, caveat emptor. 

Dr. Harmon makes a good case for realistic expectation along with a list of factors that correlate with recovery of sexual function. The published recovery rates vary enormously. Related studies demonstrate that different doctors have different recovery rates probably based on their skill and experience. The best published recovery rates run nearly 100% for young men under age 50 with bilateral nerve sparing surgery and no co-morbidities such as hypertension, diabetes, atherosclerosis, multiple sclerosis, and hypercholesterolemia, or other risk factors such as alcohol or tobacco abuse, overweight, enlarged prostate, high blood loss during surgery, etc. My own surgeon told me he had a recovery rate comparable to the best published rates and in another context said he had a much older patient population. I was then at 49. He was trained at a "center of excellence" by a surgeon with some of the highest published sexual recovery rates. Soon after surgery I asked his nurse when I might expect to recover spontaneous erections. He said " Oh, that is very rare. In my 5 years working here, only one or possibly two men recovered spontaneus erections." This nurse conscienciously talked with me about my sexual function each visit and wrote all the prescriptions for PDE5 inhibitors like Viagra and injectibles like Caverject, so I trust the he knew who recovered. It is now 5 years. I never recovered even though I was relatively young, had had very good erection prior to surgery, and had no risk factors. I had started Caverject twice per week soon after the catheter was removed and kept up regular use. Later I tried nightly Viagra as some articles recommended, but perhaps it was too late by that time. Fortunately I have a loving, patient wife. The point of this message is--get a second opinion and some documentation rather than just your surgeon's claims. My surgeon lied to me either about his ability or his intention to perform this surgery giving the care and attention that is necessary to preserve sexual function. Perhaps as galling after what he did to me, he would not even help me to get test to identify the injury and try to correct it. Even when I had evidence that the problem might be vascular rather than nervous and I showed him research indicating that revascularization might correct the problem, he refused to refer me to a vascular surgeon saying it would be a conflict of interest because of his responsibilities to his insurance group. I feel better now, but it took a long time to get over being conned by someone I had expected to act in my best interest. Like a fiduciary responsibility, doctors have a moral obligation to be honest about their abilities even if they could lose business by telling the truth. If he had told me the truth, I would have gone elsewhere. Unfortunately even in medicine, caveat emptor.