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I am 37 months post robotic nerve sparing prostate removal. Took low dose 5 mg Viagra for six months. Started using VED at three months and continue. Started Trimix ant18 months and continue with success. Tried Cialis and 100 mg of Viagra. No result from Cialis. Within the past three month have had a slight response to Viagra. Two weeks ago I awoke very early in the morning with a partial erection. First time in three years. Have noticed it nearly every day since. No reaction during the day. I have just gone back to sleep each day without trying to masturbate to fullness. Will see urologist for regular checkup in four weeks. Has anyone else had a delayed response of three years and can I expect continued improvement over time?

boydie wrote:Has anyone else had a delayed response of three years and can I expect continued improvement over time?

Not your degree of success. I've used Viagra to supplement alprostadil injections for years. Viagra had no visible reaction on it's own but did noticeably boost the injections. It also made the VED much easier to use. But again, Viagra did nothing on it's own. I've used it from the beginning for therapy at my doctors direction.

Fairly recently, about an hour after taking the Viagra, when taking a shower and shaving (my routine), I find that with some stroking and sexy thoughts I can get some thickening. It's just a 15% to at the very best a 30% erection. It's very transitory and not useful for anything so it's on to the injection. However, it is kind of an "Oh Wow!" thing to see any non-injection life in the little guy at all. I don't have any idea where this little sign of life came from all these years after post robotic nerve sparing prostatectomy.

I have no idea if you'll see continued improvement. I don't expect I will but at 37 months you very well might. if I was at 37 months I would indeed have a glimmer of hope.

Good luck.

bldoink wrote:

boydie wrote:Has anyone else had a delayed response of three years and can I expect continued improvement over time?

Not your degree of success. I've used Viagra to supplement alprostadil injections for years. Viagra had no visible reaction on it's own but did noticeably boost the injections. It also made the VED much easier to use. But again, Viagra did nothing on it's own. I've used it from the beginning for therapy at my doctors direction.

Fairly recently, about an hour after taking the Viagra, when taking a shower and shaving (my routine), I find that with some stroking and sexy thoughts I can get some thickening. It's just a 15% to at the very best a 30% erection. It's very transitory and not useful for anything so it's on to the injection. However, it is kind of an "Oh Wow!" thing to see any non-injection life in the little guy at all. I don't have any idea where this little sign of life came from all these years after post robotic nerve sparing prostatectomy.

I have no idea if you'll see continued improvement. I don't expect I will but at 37 months you very well might. if I was at 37 months I would indeed have a glimmer of hope.

Good luck.

Thanks for the reply.
You use Viagra and inject? I was told by urologist not to do that. I pump and the inject with pretty good success. I am going to maintain optimism. Previously my body was a quick healer and was disappointed after the surgery.

When I got a new Uro and I mentioned that I was using both injections and Viagra he looked at me quizzically and asked me why. I told him that using the Viagra allows me to use a less injection mix. He just said "OK" and that was the end of the topic. It is my understanding that more doctors are recommending the combination but I can't document that and I'm not a medical professional of any kind. Ask your doctor and then use your best judgement. But if you decide to use the combination you should experiment with a greatly reduced dose of your injection mix before increasing to your normal dose so as to avoid the risk of priapism.

Even when nerves do repair themselves they often take a very long time.

boydie wrote:Has anyone else had a delayed response of three years and can I expect continued improvement over time?

I'm approaching 3.5 years since surgery. 20mg of Sildenafil daily since surgery. 100mg dose doesn't do a lot for me and rarely have gone this route since surgery for intercourse. VED was a wasted investment. Trimix since June 2019 has worked quite well for me.

As far as spontaneous, unassisted erections -- I occasionally get some really strong morning wood (somewhat assisted as I usually take the 20mg in the middle of the night). That said, I can frequently coax a pretty firm erection (maybe even sex-worthy) with erotic thoughts and stroking. Are the nerves continuing to heal? Not sure, may never know. I firmly (pardon the pun) believe if I were much younger I could make a lot more happen "down there".

Bidoink, I'm not sure this applies to using injection and pill together or not, but when I was using Cialis and it was failing, the dr. prescribed injections. But he was very addamate that I get off Cialis one week before first injection. That may have been just not knowing what the two would do. But I think he wouldn't approve of both.
But of course now I have an implant. And that dr said not to come back to him after I had the implant.

Some publications on the topic that I could find. The jury doesn't seem to have made a clear final decision. Most are just abstracts. The last link may be the best:

Combined intracavernous vasoactive drugs and sildenafil citrate in treatment of severe erectile dysfunction not responding to on-demand monotherapy Ahmed M. Al-Adl, Osama Abdel-Wahab, Tarek El-Karamany & Ashraf A. Aal.
Please note this first one is a PDF.
https://www.tandfonline.com/doi/pdf/10.1016/j.aju.2011.06.008

Why a combined intracavernosal injection with trimix and oral sildenafil is reliable therapy in the ultrasonographic evaluation of erectile dysfunction
Jong Kwan Park 1, Jung Sun Park, Sang Bong Jeon, Wan Shou Cui, Sung Zoo Kim, Kyung Koo Kang, Sung Won Lee
https://pubmed.ncbi.nlm.nih.gov/18476965/

TREATMENT OF INTRACORPOREAL INJECTION NONRESPONSE WITH SILDENAFIL ALONE OR IN COMBINATION WITH TRIPLE AGENT INTRACORPOREAL INJECTION THERAPY
Author links open overlay panelCHRIS G. McMAHON, RAMIN SAMALI, HELEN JOHNSON
https://www.sciencedirect.com/science/article/abs/pii/S0022534705680858

Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections
K Nandipati, R Raina, A Agarwal & C D Zippe
https://www.nature.com/articles/3901448

Combination therapy for erectile dysfunction: An update review
Rohit R Dhir, Haocheng Lin, Steven E Canfield, Run Wang
https://www.researchgate.net/publication/50596730_Combination_therapy_for_erectile_dysfunction_An_update_review