Question regarding PDE5 therapy

[sabaone]

The doctor's office has an entire program for post-surgery ED therapy. It starts with bi-weekly ingesting of Cialis (or whatever) starting two weeks after surgery. The regimen then goes to every other day at about the 8th week when you start with the VED. The explanation for starting with the drug, as I remember, is so that it helps blood to start flowing to the penis.

On the surface that sounds good, but it doesn't make sense. The oral drugs only get the blood going to the penis after you start having sexual stimulation, they, themselves, do not do the stimulation. So, how can it help prior to the VED? I can play with it all I want. I can even have an orgasm, but willie doesn't want to rise.

Any ideas.

Thx

[sabaone]

More or less got my answer on www.mskcc.org/mskcc/html/94910.cfm.

[antelope]

Could you provde a brief summary of the "answer"? Thanks.

G

[sabaone]

OK Antelope,

While I would really advise looking at this video, here is a short view, and I hope true to his discussion:

Sloan-Kettering penile rehabilitation

Sexual Problems in the Male Cancer Patient
John P. Mulhall, MD

The importance is for the rehabilitation of the corpus cavernosum and endothelial cells in the penis. He states that the rehabilitation of erection tissue in the penis tissue is time-dependent.[It seems that the important thing is to get blood into the penis and to stimulate the muscle to absorb the blood, and optimally, get erect with that blood.]

Sloan Kettering has a 2-phased approach. Before surgery they recommend taking (and using Viagra (V,C,L) as the example, but not limited to Viagra) ¼ of a full-dose pill daily for 2 weeks prior to surgery and continue whole with the catheter. Stimulation is not part of this period’s regimen.

After surgery take ¼ pill daily with once a week a full pill with stimulation up to the 6th week. At the 6th week S-K makes a determination after interviews, as to who responded with erections. About 15% respond, the balance don’t.

For those that do, they have them take ¼ four nights, and a full pill the other three, with stimulation to erection; orgasm is not an issue at this point. For the 85% they recommend starting with penile injections to get the erections going. They give injection 2-3 times a week for erections, the remaining days you take ¼ dosage of V/C/L.

He explained that for erections we need nitric oxide (NO). NO comes about during arousal and causes the stimulation of the smooth muscle cells of the penis, and produces cyclic GMP which actually creates the erection. An enzyme, PDE5 breaks down the CGMP resulting in a flaccid penis. V, C, & L are PDE5 inhibitors. BUT, for V/C/L to work we need NO, and the predominant source for the NO are the nerves needed for erections. Therefore, the people with the greatest problem in this area are those who had radical prostatectomies, or have diabetes.

He also says, that at this point, there isn't sufficient evidence to show that VEDs do the job as well as injections & V/C/L.

[antelope]

Good stuff. Thanks.