Hi
I am new here and have come across from the Healing Well forum.
I was diagnosed with prostate cancer earlier this year and had robotic surgery on 7th June.
My surgeon doesn't believe penile rehabilitation is necessary which has been very stressful to me as I have read widely that to give yourself the best chance of getting erections again you need to preserve the structure of the penis by getting oxygenated blood into the penis with erections from either viagra type pills or if that does not work injections.
At my 6 week appointment, I got the surgeon to prescribe Viagra but he prescribed it at a much lower rate than John Mulhall suggests, so I went to my GP who increased it to half a tablet daily and a full one to try to get an erection once a week. Unfortunately, I still was not able to get any erections, so John Mulhall's advice is to go to injections at 6 weeks.
Its now 5 months since the surgery and I have just started on alprostadil injections at 12ug ( 30 units on the syringe) after visiting an ED clinic. It certainly works but I am getting a good deal of pain while the erection is there. From reading on this forum I see that most patients seem to be treated with Trimix of various proportions, rather than the single chemical that I am getting which is identical to the cavrject chemical. I gather that the Trimix is lower doses of 3 chemicals
Does anyone know if this combo would lead to less pain? A couple of other thought I have had are if I should try the alprostadil at a lower dose to see if the pain would be less. Also might the pain be coming from fibrosis setting in and tissue is just stretching again as I have not had erections for 5 months? If I continue as I am is the pain likely to lessen with each treatment?
I was trained to use a 29 gauge needle 12.5mm long and push all the way in at 10 o'clock or 2 o'clock positions. I see most people on this forum are using a 31 gauge, 8mm long needle.
Any help would be greatly appreciated as I certainly am not getting much from the urologist.
Post RALF penile rehabilitation Injections - pain
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- Joined: Sat Nov 10, 2018 8:02 pm
- Location: South Island, New Zealand
Post RALF penile rehabilitation Injections - pain
Age 60
RALF surgery 7.6.18
Margins clear - No extra treatment required at this stage
PSA'S now <0.1
RALF surgery 7.6.18
Margins clear - No extra treatment required at this stage
PSA'S now <0.1
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- Posts: 239
- Joined: Sat Jun 04, 2016 7:17 pm
- Location: Central California
Re: Post RALF penile rehabilitation Injections - pain
Have you tried Bimix. It works for me and there is no pain like Trimix.
Retired. R.P. 2016. Bilateral nerve sparing surgery. Now use .15cc of Bimix twice weekly & anorgasmia, moderately incontinent. Wife no longer interested so go solo with Electro-stim using Erostek ET-312. Now am Type 2 diabetic.
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Re: Post RALF penile rehabilitation Injections - pain
...
Last edited by bldoink on Tue Jul 22, 2025 2:43 pm, edited 1 time in total.
Re: Post RALF penile rehabilitation Injections - pain
HarryN wrote:Hi
I am new here and have come across from the Healing Well forum.
I was diagnosed with prostate cancer earlier this year and had robotic surgery on 7th June.
My surgeon doesn't believe penile rehabilitation is necessary which has been very stressful to me as I have read widely that to give yourself the best chance of getting erections again you need to preserve the structure of the penis by getting oxygenated blood into the penis with erections from either viagra type pills or if that does not work injections.
At my 6 week appointment, I got the surgeon to prescribe Viagra but he prescribed it at a much lower rate than John Mulhall suggests, so I went to my GP who increased it to half a tablet daily and a full one to try to get an erection once a week. Unfortunately, I still was not able to get any erections, so John Mulhall's advice is to go to injections at 6 weeks.
Its now 5 months since the surgery and I have just started on alprostadil injections at 12ug ( 30 units on the syringe) after visiting an ED clinic. It certainly works but I am getting a good deal of pain while the erection is there. From reading on this forum I see that most patients seem to be treated with Trimix of various proportions, rather than the single chemical that I am getting which is identical to the cavrject chemical. I gather that the Trimix is lower doses of 3 chemicals
Does anyone know if this combo would lead to less pain? A couple of other thought I have had are if I should try the alprostadil at a lower dose to see if the pain would be less. Also might the pain be coming from fibrosis setting in and tissue is just stretching again as I have not had erections for 5 months? If I continue as I am is the pain likely to lessen with each treatment?
I was trained to use a 29 gauge needle 12.5mm long and push all the way in at 10 o'clock or 2 o'clock positions. I see most people on this forum are using a 31 gauge, 8mm long needle.
Any help would be greatly appreciated as I certainly am not getting much from the urologist.
You could also try the VED 5 minutes at a time, 3 to 5 times a day.

Larry
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- Posts: 4036
- Joined: Mon Apr 03, 2017 12:58 am
- Location: Fl.
Re: Post RALF penile rehabilitation Injections - pain
...
Last edited by bldoink on Tue Jul 22, 2025 2:43 pm, edited 1 time in total.
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- Posts: 2
- Joined: Sat Nov 10, 2018 8:02 pm
- Location: South Island, New Zealand
Re: Post RALF penile rehabilitation Injections - pain
Thanks for the advice.
I should have said I have been using a VED from soon after the catheter came out. It was something I could organise myself with out medical input.
I should have said I have been using a VED from soon after the catheter came out. It was something I could organise myself with out medical input.
Age 60
RALF surgery 7.6.18
Margins clear - No extra treatment required at this stage
PSA'S now <0.1
RALF surgery 7.6.18
Margins clear - No extra treatment required at this stage
PSA'S now <0.1
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