Side Effects from Surgery - Stress Incontinence, Cialis, ED & Climacturia

Well bit of a surprise this week. As last weeks entry said i started on the 5mg Cialis each day. In all the white papers and the discussions with medical people I have had it explained to me the impotence side of things and also the fact that any orgasm would be dry - with or without an erection. Bit of a shock therefore this week when during 'penile rehabilitation'  ( see article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751036/ ) a copious amount of fluid was expelled.

Have done some research it seems that during the process the pelvic floor relaxes and this results in fluid release from the bladder into the urethra and that's what is expelled. No one had warned me of this. Apparently its called Climacturia and its quite common after the surgery I have had and also more common when suffering from Stress Incontinence - again something I am coming to terms with - a reason why I am wearing a pad to combat the occasional leakage.  See short article http://www.ncbi.nlm.nih.gov/pubmed/17509325

So it looks like I have something else to think about. Big learning curve . It does make you think is ED actually worth the bother and stress of it all. At least the cancer has gone. Gets you down thinking through it all. Do wish I could wind the clock back but it wouldn't have made any difference I suppose, I would still have been hit with this disease.

Some of the main points from the US paper on penile rehabilitation that are applicable to myself - especially as I have been put on a PD-5 inhibitor, the main article linked above goes into more detail and something that's quite frightening is the inference of cellular degeneration and the fact that the cells do not repair or re-grow. Its a male thing I think, especially when you are still young - people keep telling me I am still young in terms of this disease I contracted - blokes just have a fascination with the size of their manhood and the threat that it will waste away and get even smaller post operation is something to worry about:

Extract ...

The practice of “penile rehabilitation” to improve sexual function after radical prostatectomy continues to generate increasing interest among clinicians. Although the reported incidence of erectile dysfunction after nerve-sparing radical prostatectomy varies in the literature from 30% to 80%, most will agree that post-surgical quality of life is becoming a greater concern for patients seeking treatment for prostate cancer in the era of early detection.

• Patients are typically counseled that it may take up to 2 years for return of maximum sexual funtion after radical prostatectomy.
• Although the relative hypoxia thought to be associated with penile flaccidity may contribute to erectile dysfunction after radical prostatectomy, the etiology of post-prostatectomy erectile dysfunction appears to be multifactorial and is incompletely understood.
• Several studies have been performed to evaluate the effect of artificially induced erection after surgery to prevent permanent damage, with modalities including prostaglandin E1 injection, vacuum constriction devices (VCD), and phosphodiesterase type 5 (PDE-5) inhibitors.
• The limited data regarding intracavernosal injections suggest that an increased percentage of treated patients experience a return of natural erections compared with patients who receive no treatment.
• Although it is not certain that the early use of VCD will improve overall return of erectile function, data suggest that fibrotic changes leading to penile shortening and possible venous leakage might be minimized.
• The global improvement in endothelial cell function observed with chronic sildenafil treatment suggests a possible role for PDE-5 inhibition even during the period of neuropraxia after nerve-sparing radical prostatectomy.