Nerve sparing one bundle.

Hi . I wish I had an easy answer for you. We have had men who were able to recover function with one bundle (see: https://prostatecancer.net/stories/nerve-sparing), while others had nerve-sparing surgery, but still struggle with ED (see: https://prostatecancer.net/living/spotlight-dan-franke). I don't know if anyone has mentioned speaking to a pelvic floor therapist, but they may be able to assist with helping to retain or regain function. Our contributor Erin, who is a pelvic floor therapist wrote this article on ED, which includes information on the nerves: https://prostatecancer.net/living/erectile-dysfunction-now-what. Hope this information is helpful and that others chime in with their thoughts. Best, Richard (Team Member)

I had unilateral nerve preservation for the same reason you might. There are so many variables beyond just nerve spare. There is a lot of traction and heat that is used during surgery and everyone's anatomy is different along with different surgical skills/experience. My surgeon was evasive when telling me that he wasn't confident in the quality of the unilateral nerve spare due to the stickiness of my tissues. I am 4 months post surgery and have followed all penile rehab recommendations. I do 50 mg viagra every other day at bedtime. I use the vacuum pump (7 - 1 minute vac holds with 20 seconds break between). I don't use the rings as I the vacuum pump is very uncomfortable and intimacy is the last thing I want after doing this. I am doing about 15 minutes of cardiovascular exercise (rower) about 3 days a week but trying for more frequency. I also do Kegel's as they also play a role in regaining function but that was only recommended to me for urinary continence which has not been an issue at all for me.

All of that said, I am seeing signs of erectile improvement so I don't know that my erections will ever be what they were pre surgery or if they will ever be sufficient for penetrative sex but things seem to be getting progressively better. Nerve function takes a long time to recover from the trauma of surgery. I know that when being taught the kegel exercises, I was asked if I could feel the abdominal muscles involved in the exercises and I couldn't feel a thing. I now can. So my best advice is to be patient during recovery. Physically you will feel better remarkably fast but ED and urinary functionality can take a long time. Take it as it comes and remember the priorities are: 1) cancer; 2) urinary function; and 3) sexual function.

When is your surgery? Would be great to hear how things go and the post surgical pathology report so I hope you stick with us after the surgery. I was gleason 4+4 from the biopsy and was 3+4 from the surgical pathology and clean margins and lymph nodes. My first post surgical PSA was non detect and my second one is low but 0.014. I see my urologist this week to discuss but I know it is continue to monitor and hope it is just due to prostate tissue stuck to the spared nuerovascular bundle.

Best of luck with the surgery. You will be amazed at how fast you recover.

After reviewing a few second opinions from a hospital of excellence with 1 more to go I’m not so sure now on surgery. 65yrs old, Gleason 7 3+4. Met with an Oncologist and he told me I’m made up of mostly 3’s with one 4. A small tumor is near edge of wall contained in Prostate. He said I do not need any meds along with radiation. Radiation will do it alone. I’m borderline of watching it but doing the right thing to tackle it now. Meeting with Radiation Oncologist this week. My Urologist/Surgeon said to remove it. I met with another surgeon and he told me I could go either way by removing it or radiation. I really was not interested in Radiation but what oncologist said was a few good options for me with my numbers. I’ll make my decision after meeting with Radiation. Having PC is one thing. Trying to figure out what’s best for you will drive you crazy.