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I had no ED issues before my RP and am a slim, fit, non smoker with lowish blood pressure and not on any medication. Is it just my age or as my wife suggests it may be partly in my mind and if so do you think therapy might help. My husband is 75, and had prostate surgery, due to cancer, in March 2018. He works out of town most of the time, so we have not had a good chance to try the remedies for ED.

He also had open heart surgery sildenafil 50mg price several years ago, and his heart doctor has been reluctant to prescribe Viagra, or some similar drug.

Is there anything that you might suggest that might help him when he is not home?

There is some response, even at this late date after prostate surgery, when he is home, but he needs something to try in the meantime.

Is Viagra safe in low doses, to help stimulate him?

A viberator seems to help some enlargement and maybe some blood flow. I had a radical prostatectomy on October 31st, (for Halloween I was dressed as a hospital patient with nurses, IV’s and real blood), Sorry,…maybe a bit too graphic ?? Question; it is now 4 weeks since I had this procedure, so,…. Is it too soon to start with any kind of ED meds to “wake up” the sleeping giant??? Hello Tom, blog author and urologist Alastair Lamb has posted a reply to another comment sildenafil cream here (by Susan) which may be helpful to you, as he talks about the timing and purpose of taking ED drugs after prostatectomy. Best wishes, Sarah Chapman [Editor] My husband (52, fit, healthy, normal sexual function before surgery) has just had a radical nerve preserving surgery and was told to start on viagra straight away. We tried it 3 days after having the catheter, blood drain and stitches out (open surgery) and it failed. I feel it was too soon to try after having all these tubes removed but the surgeon had stressed the importance of getting things moving again straight away.

How long should we leave it before trying viagra again?

I’m really glad that your husband has got through his surgery well. As you say, it can seem quite early to start taking viagra so soon after a major operation.

However, there is a bit of evidence emerging (not strong as yet) that starting viagra early, or even before surgery, can help.

The message is a little mixed as, from the Cochrane Review we commented on above, the concept of “penile rehabilitation” has essentially been debunked. However, it may be that starting the drug very early catches the vessel and nerve price of sildenafil at cvs changes at just the right time.

It should be emphasised that the purpose of taking viagra this early is not to give immediate erections, but rather to improve future erections in the weeks and months to follow.

Tadalafil is probably the best PDE5 inhibitor to take for this purpose because of it’s longer half-life, but it is still rather expensive and so, as outlined above, I tend to give my patients a quarter dose (25mg) of sildenafil (viagra) daily which, when prescribed “privately”, can be paid for over the pharmacy counter and is almost as cheap as paracetamol. I have not been part of any survey and had my prostate removed one year ago using the Da Vinci robot.

I am still clear with no follow up radiation or hormone treatment.

After not getting on with muse or the cream variant of the same drug I took it upon myself to buy some Viagra over the counter as I had seen some evidence of activity. To cut a long story short the Viagra helped but I didn’t get a full erection. I told my post surgical team and they are now trying me on Cialis. Most recently I have tried the 20mg dose less frequently and results sildenafil citrate 20 mg price within a few hours seem further improved.

Mr Lamb, it’s very impressive that you’ve attended Mani Menon’s recent presentation at AUA19 on 5 May of the Menon best sildenafil prices Precision Prostatectomy technique, aimed at reducing ED. Plainly, one should not just MRI the area of the PZ to be left in situ, but also

biopsy

Yes, there is a risk that the sliver of PZ which is left in situ may generate CaP.

But in any event, even if you did a full RARP, traditional or Retzius-sparing, my understanding is that the patient will still be taking some risk of biochemical reoccurrence in some circumstances, even if there are “clear” margins at the finish of the operation. It seems to me that it is for the patient to choose what level of risk he’d prefer – and whether he’s willing to take some CaP risk to have a better chance of continued normal erectile function, given that he is, as I understand it, already taking at least some risk of biochemical reoccurrence anyway.

So it seems to me that surgeons, in principle, ought to be prepared to have the technical capacity to “do it the patient’s way” provided that the patient understands and signs up to any extra risk, rather than the surgeon saying ab initio that no sliver at all of PZ can be left and imposing a decision on the patient of greater ED risk when the patient might prefer a better chance of erectile function and be willing to tradeoff some CaP risk, at least if it is found that there is negative MRI report AND a negative biopsy in the area.

Someone needs spend a little time with Menon in the USA and bring the learning over the Atlantic because there are lots of men who’d prefer to have this chance if MPPs can be done in a way that makes sense. yes it does work, viagra should be first consulted by the doctor in this case before consumption. Mr Lamb, What do you think of the Menon precision prostatectomy technique described by Dr Mani Menon in the link below: early results on the first 50 patients are said to yield a much higher recovery of erectile function (said to be about 95%) compared to the usual robot assisted radical prostatectomy, whether retzius sparing or traditional?

Of course, one could not apply the MPP technique to every case (eg where cancer has invaded the cap of the prostate); but one would think that there must be a significant subset of patients for whom Dr Menon’s suggested technique may reasonably be considered. Early days yet in relation to proof of this new technique, of course, but looks promising. http://manimenon.com/menon-precision-prostatectomy/ Thank you for your comment Ian.

Mani Menon is a legend in our field and I want to learn everything I can from him! However, I do have reservations about his proposed technique, just as I have reservations about any focal therapy in prostate cancer. We know that approx 70% of prostate cancer occurs in the “peripheral zone” of the prostate – the “cap” you refer to in your comment. And this is precisely the zone that Dr Menon chooses to leave behind. We also know that up to 30% of negative MRI scans/prostate biopsies actually harbour clinically significant prostate cancer.

I am concerned about doing an operation which, by it’s nature, precludes further radical surgery, but which involves the very real possibility of leaving behind prostate tissue harbouring lethal prostate cancer.

Until we can precisely determine the presence or absence of small quantities of lethal prostate cancer cells at diagnosis I will not be offering these treatments to my patients. Instead I think we should put our efforts and fundraising into basic scientific endeavour to identify such “lethal clones” in the prostate (http://www.nds.ox.ac.uk/team/alastair-lamb).

I am also very encouraged by the potential of “retzius-sparing” prostatectomy techniques, using both posterior and anterior approaches, early results of which seem to offer very promising erectile function and continence results without compromising radical treatment (several abstracts to be presented this year at EAU19 and AUA19 https://eaucongress.uroweb.org/scientific-programme/. It’s also available as PRN does of 10mg and 20mg as well as daily doses of 2.5mg and 5mg. The long half-life isn’t the reason it’s given daily!

Erectile dysfunction (ED) is a common problem amongst men who have diabetes affecting 35-75% of male diabetics. Up to 75% of men suffering from diabetes will experience some degree of erectile dysfunction (erection problems) over the course of their lifetime.

Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from the disease.

Over

the

Causes of ED are extremely complex, buy sildenafil tablets online and are based around changes that occur to the body over time affecting nerve, muscle and blood vessel functions. In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex.

Without blood vessels and nerves that control erection, ED can still occur despite a desire to have sex and normal male hormones.

Many other factors bear on erectile dysfunction amongst diabetic men. Being overweight Smoking Taking too little exercise and other lifestyle factors.

Surgery can damage nerves and arteries linked to the penis, as can some injuries.

Many common medications (including antidepressants and blood pressure drugs) can produce ED.

Psychological factors also have an enormous influence.

Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of ED cases.

Erectile dysfunction is diagnosed using several different methods. Patient history often informs the degree and nature of the ED.

Medical and sexual past often has an influence, as does prescription or illegal drug use. ED patients may be physically examined, and bodily features can give clues to the cause.

Laboratory tests can also be key for diagnosing ED.

Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to cancel some causes out. Furthermore, psychological examination can reveal psychological factors.

Are there treatments for men with diabetes and erectile dysfunction? Men who have diabetes and are having trouble achieving or maintaining an erection can take oral medicine The NHS can provide the following medications on prescription for men with diabetes: Brand names include: Viagra Cialis Levitra.

However, these medicines can all affect the heart rate, and detailed consultation with your doctor is necessary to determine the best course of action. Additional treatments include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy and sex therapy. Psychotherapy can have an enormous influence on erectile dysfunction. Further treatment such as surgery and vacuum devices may also have a role to play in some specific cases. Additional treatments include vacuum constriction devices, intraurethral alprostadil suppository or intracavernous injection therapy and sex therapy. Vacuum pumps consist of a plastic tube, in which you place your penis.

The pump, which may be battery or hand pump operated, creates a vacuum that will draw blood into the penis making it erect.

A rubber ring will need to placed around the bottom of the penis to keep it erect.

A vacuum pump is not for use if you have a bleeding disorder or take anticoagulants.

Alprostadil is a form of hormone medication that stimulates blood flow to penis, and may be given by two different methods: Intracavernosal injection – whereby alprostadil is given by injection into the penis Intraurethral application – whereby a pellet (1.6mm diameter and 6mm length) of alprostadil is inserted into the urethra via a urethral stick. Alprostadil may be prescribed if you do not respond to other treatments, or you are unwilling to try oral medications or vacuum pump therapy. Your health team may provide training on how to inject or insert alprostadil. The most suitable treatment will depend on the health of the patient and their own ability to tolerate the treatment.

Specialists such as urologists can work with individual cases and determine the best treatment. What is the future of diabetes and erectile dysfunction? Better medications, implants, vacuum devices and suppositories have all increased options for diabetic men with ED.

Gene therapy is not being tested, and at some point may offer a permanent therapeutic approach to tackling diabetes and erectile dysfunction.

Erectile Dysfunction: Best Options Beyond Medication, Lifestyle Changes. Most men who experience erectile dysfunction (ED) can achieve stimulation through oral medications like Viagra®, Levitra® and Cialis®. Lifestyle changes can also help remedy the problem. They may quit smoking or lose weight, or undergo psychotherapy.

Cleveland Clinic is a non-profit academic medical center. We do not endorse non-Cleveland Clinic products or services.

While these are the most common methods, they may not work for everyone.

For example, male heart patients who take coronary vasodilators (to help open up coronary arteries) should not take medication for ED in the first place because both types of medications lower the blood pressure, and in combination, they lower the blood pressure too much, according to urologist Drogo “Karl” Montague, MD. Fortunately for these men, there are a few other options, each with its own pros and cons.

The choice generally comes down to personal preference, he says.

“We do see an increased percent of ED as men age, but it’s due to age-related disorders, and a lot of those disorders are based on lifestyle,” he says.

“ED may also be the result of a relationship disturbance or death in the family. When you have sudden onset of ED with somebody who has something [emotionally upsetting] going on in his life, it may well be related.” He recommends three other options for ED when medication or lifestyle changes do not solve the problem: 1. Some men use a vacuum device into which they insert their penis: They grease the tube, lower a rubber ring and squeeze a pump that creates a vacuum inside the chamber.

With the rubber ring in place for 30 minutes, men often are then able to have sex, Dr.