What is a Prostatectomy Like?

I can squarely disagree that a blanket statement of guaranteed incontinence and ED is accurate. I had RARP almost four weeks, ago, had an erection within hours of leaving the OR and all but a couple nerves were spared, and I've had "wood" multiple times a day since, even on demand. I also have not had a single drop of incontinence.

I realize that dodging both bullets is pretty rare, as 85% of men have some form of incontinence - be it a single day or years on end, and about the same percentage have some form of ED as well - but neither of these are guaranteed.

Everyone's results will vary and the surgeons skill is absolutely a factor in saving the nerves, without any doubt - and saving the nerves gives you the chance to not have or to overcome ED. Incontinence, in many cases, can be corrected via pelvic floor work or even with surgical options such as slings and artificial sphincters.

I'm sorry that your experience was on the bad side of the equation, but it's not the guaranteed outcome for all people.

I have to agree that without nerves, all the pelvic floor exercises and penile rehabilitation exercises are useless. Look, muscles - all of them including the involuntary ones in the heart, intestines, lungs, etc are innervated - they REQUIRE transmission of impulses from nerve fibers for the muscle to function…PERIOD.
No nerves, NO muscular activity. Just think Christopher Reeve and you get it.
You can prep for surgery all you want, doing all kinds of pelvic gymnastics…If those nerves are removed or damaged beyond their ability to recover, you will be impotent, incontinent or both. I’d rather have a very lucky surgeon than a good one, and if you can get both you hit the freakin lottery.

I never implied that having no nerves had a solution for ED, I know that without nerves there's no non-surgical recovery, I was only countering the claim that all radical prostatectomies end in ED and incontinence.

No, survivor, I get what you are saying: all the bad stuff is NOT a given.
And although I applaud your rigorous approach to pelvic floor training before surgery, if your nerves were damaged beyond recovery or your cancer invaded into the bladder neck you would be in pads right now.
But all the stars aligned for you, your surgeon was excellent and you also got lucky. I don’t mean that in a negative way to take away from your efforts and discipline. But in life, luck is that elusive thing we all want and seldom get. You got it!

I'm absolutely aware of all of that. My rigorous approach to pelvic floor training and physical training was multi-fold: it was the only control I had over the outcome so long as the cancer wasn't worse than anticipated, it provided a means for a better recovery - regardless of the outcome, and if I lost my nerves (which was anticipated by the surgeon by the way) then it still could help with incontinence.

I realize I'm a unicorn, but to me that means I have a duty to let others know that it's not a guaranteed crap-sandwich. I searched high and low for good news on this disease and it's nearly impossible to come by.

And while I don't point this at you, I've had some nasty messages just because I did come out the other side of this without negative long-term results and that saddens me because it makes me not want to participate as much on sites like this.

Seriously? Nasty messages about your outcome? If that’s the case, that really sucks.
I, for one, am GLAD that someone finally had the results all the surgeons have promised us since the introduction of the daVinci system. My surgeon actually advertises online that you will have NO ED, NO incontinence and ZERO cancer once he’s done treating you; he’s only batting .333 as far as my case is concerned….
So you were motivated by a dire prognosis and did everything you could to give yourself SOME kind of chance - and in your case, it worked. Others have done the same or more and are spending their lives in Depends. Such is life.
But they shouldn’t be bitter toward you because you had a better outcome; that’s not right…. I think it might have been you who posted that none of the success stories were on this forum because none of those men needed to be here - and that’s probably correct. You decided that your success story SHOULD be here in order to give some hope to men facing surgery, and that can only be a good thing.
But you must remember that a lot of men are very angry, bitter and disappointed in both their outcomes - and their futures; they obviously didn’t have everything go right for them as you did. You really are an exceptional case - I mean it! All the literature I’ve read including Mayo’s on ED after surgery paints a very pessimistic outlook for most cases - even at the best surgeon’s hands. And I think that is the predominant outcome for most of us and even those not on this forum.
Please go back and look at some of your earliest posts….would you say they were grim, pessimistic and full of gloom and doom? Now imagine that all of those fears really came to pass. You’d be out of your F’ing mind by now. That’s what a lot of men are living with and they are probably a little peeved by a guy who says he was wheeled out of the OR sporting an erection! 😂. OK, I exaggerate on purpose because to some, that may be what it sounds like and I think you get that too.
But please don’t stop posting - you have a lot of accumulated knowledge and experience and it is just so important that it be shared.
Best
Phil

Well said phil. I live in a retirement community and am in the lower half of the economic scale here. I don't hate the wealthier folks, but maybe there is a little envy. The same is true for survivor5280. I don't hate your "wealth" of good results, but maybe there is a little envy. To add my two cents, I just had a male sling implanted (two years after my RALP), even though my surgeon said I was continent. Continence, (or success) by the urology profession's definition, is one pad per day. Did anyone's surgeon mention that in their consultation? I was still filling one pad during golf, hikes and pickleball but my surgeon said I was healed. Yes, my cancer is gone, and I may not have changed the decision for removal back in 2023, but the profession needs to be more up front about what they consider continence to mean. I went with a guy who has 90% of his patients achieving continence and I added to his success rate. But I just had sling surgery to fix my incontinence.

Well said phil. I live in a retirement community and am in the lower half of the economic scale here. I don't hate the wealthier folks, but maybe there is a little envy. The same is true for survivor5280. I don't hate your "wealth" of good results, but maybe there is a little envy. To add my two cents, I just had a male sling implanted (two years after my RALP), even though my surgeon said I was continent. Continence, (or success) by the urology profession's definition, is one pad per day. Did anyone's surgeon mention that in their consultation? I was still filling one pad during golf, hikes and pickleball but my surgeon said I was healed. Yes, my cancer is gone, and I may not have changed the decision for removal back in 2023, but the profession needs to be more up front about what they consider continence to mean. I went with a guy who has 90% of his patients achieving continence and I added to his success rate. But I just had sling surgery to fix my incontinence.