Penile Rehab Protocol

[jpcp01628]

I am 68 and had robot assisted radical prostatectomy in June 2020 (unilateral nerve sparing). After surgery, I was very incontinent for about 3 months, but once I started leaking less, I improved to 95+% continence in just a few weeks. I was taking 20 mg sildalafil 3 times per week for about 4 months after surgery. My penis was about 1.5 inches shorter than pre-surgery and I was 100% erectile dysfunctional.

I began physical therapy in Sep 2020. Sessions were weekly for about a month and then at one month intervals. The first issue was improving pelvic floor strength for continence. Kegel exercise frequency has varied, but I’m currently doing 20 contractions daily holding for 10 seconds and releasing for 10 seconds. My pelvic floor muscles are in really good shape. I experience only rare leaks and these are only a few drops. I do experience more frequent leaks while I’m performing my kegel exercises and other physical therapy.

Also in Sep 2020, I began using a vacuum erection device (Vacurect brand pump) and also using a Hitachi vibrator based on my physical therapist’s recommendations.

About 5 months after surgery, my shortened penis condition changed to experiencing more “frightened turtle” penis. When confined to underwear, I experience “frightened turtle” with increased frequency. With the help of my physical therapist, I began penis pull exercises in Jan 2021. Grabbing just the head of my penis, I stretch out my penis until I feel resistance. Number of pulls and duration have varied since I started doing this exercise. I am currently performing 10 pulls per day at a 90 second duration each. This might seem long, but pulling just to feel resistance creates no discomfort at all and the stretched length increases from pull #1 to pull #10. Penis pulls and penis pumping successfully extends my penis to pre-surgery condition (length, girth and hardness).

After 30 months post surgery, I have no erection response at all. I was talking 5 mg tadalafil. The drug did nothing for me and I found by accident that it elevated my blood pressure about 15 points. It has become apparent my absence of any erection response is permanent.

I have read from many of you on the blog about pills, injections and implants. I’m not saying anything bad about any of these solutions, I’m just telling you my opinion and what I’m comfortable with. Given my condition, my primary goal is keeping my penis tissue healthy.
• I don’t want to risk developing fibrosis or Peyronie’s disease. Daily penis pumping and daily penis pulls are providing exercise to hopefully prevent these two negative results from happening.
• Pills have proven to elevate my blood pressure so that is out.
• Injections create the risk of scar tissue and fibrosis so that is out.
• After all the collateral damage done from prostatectomy, another surgery for implant is a risk I don’t want to take.

With the help of my physical therapist and an incredibly understanding wife, I will continue on my journey of keeping my penis tissue healthy and getting on with life. I get a PSA test every 6 months and these have been near 0.

In my opinion the medical establishment is grossly disingenuous when it comes to being honest with what can happen to a man after prostatectomy surgery. Articles and studies do not tell the whole story or gloss over important side effects. In my own case, my urologist (whom I like and trust), told me about incontinence and erectile dysfunction. He DID NOT tell me about my shortened penis condition.

This discussion board has, without a doubt, been the most informative resource for me as well as A Touchy Subject website run by an Australian physical therapist. For me, finding a Physical Therapist that is knowledgeable and engaged in addressing my post prostatectomy issues has been a critical to me. Unlike most physical therapy, I believe I will need her help long term insuring I’m doing everything I can physically to compensate for lack of erection response.

Good luck to all of you and thanks for listening to my story.

[bldoink]

Welcome to the forum and thanks for sharing.

Your story is similar to mine in a lot of ways. However you seem to have undergone considerably more formal physical therapy than I have. I did discover that long walks without protection worked very well for me, better than kegel exercises. I also did quite a bit of VED therapy the first couple of years. I also used the VED for sex, for which it was better than nothing. Our current status, as far as recovery, seems very similar. I do still use generic Viagra fairly often, although not regularly and for therapy mainly, but for other possible health benefits too. I would use it more if it weren't for the side effects of heart burn and sinus stuffiness. I don't know if it has effected my tinnitus as it was already pretty bad.

Strangely, fairly recently, the Viagra (sildenafil) has begun to produce some effect in the erection department. The effect is not at all useful but when you've had a dead dick as long as I have the slight thickening and stiffening I get, mostly toward the bottom third of my dick, is a very good feeling. This occurs with 50mg of sildenafil, in the shower and having sexy thoughts and some stroking. Sorry if TMI. As I said, useless but but a WOW to someone with a long term dead dick. It's been over 10 years since my RRP I don't expect much more.

Unfortunately no vibrator device has proved useful to me with a flaccid dick, Hitachi magic wand included. I've tried the expensive medical versions too, also with no satisfaction.

I'm a bit confused by your reluctance to try injections, particularly alprostadil (AKA PGE1). I don't see what you have to lose. Even if you do get some fibrosis or scaring the trade off is well worth it. That's unless your making plans for an implant in the very near future. I've been using alprostadil injections for over ten years and I've, we've enjoyed the results a lot.

Although my VED use has been rare and infrequent for a number of years now the injections (assumption) have kept shrinkage fairly well at bay. Depending on dose and arousal I get a bone pressed 6 1/4" to 6 3/4" and maybe a bit more at peak arousal. I'm satisfied with that. With a VED I could get at least 7 1/4 but that's a very artificial result IMHO. I can't compare with a pre-RRP measurement as I never measured pre-RRP. Unfortunately the fat pad hides a good bit but oh well! I'm a bit over 6' and at 215 I could stand to lose a few pounds, like about 25. Many years ago I could tap my wife's cervix going deep but she isn't the skinny hard body she was and neither am I so dick shrinkage probably has nothing to do with it. Besides she didn't like it when I hit bottom. Probably TMI again, sorry.

Well again, welcome to the forum.

[bldoink]

Is there a "real" Hitachi vibrator? I've seen so many copies, I don't know what is real. If you don't mind me asking, how often was the recommendation to use these devices?

My understanding is that Hatachi didn't want their name associated with what became known as a sex toy so they removed their name from it. I believe it's still being sold here as well as other places, minus the name: https://hitachiwand.com/shop/original-hitachi-magic-wand-massager/

It is an excellent body massager (back, neck major mussel groups) although it is best known as a sex toy.

[ftwabeck3533]

In my opinion the medical establishment is grossly disingenuous when it comes to being honest with what can happen to a man after prostatectomy surgery. Articles and studies do not tell the whole story or gloss over important side effects. In my own case, my urologist (whom I like and trust), told me about incontinence and erectile dysfunction. He DID NOT tell me about my shortened penis condition.

This discussion board has, without a doubt, been the most informative resource ....

If you're interested in my post-prostatectomy journey, feel free to PM me.

You are "right on" with the quotes I emphasized above.