For two hours, Ray sat in an exam room wondering what was taking the doctor so long for this simple follow-up appointment. The walls were thin and, one by one, he could hear the urologist visiting with and sending home other patients.

At last, the doctor greeted him and Ray understood why he had been made to wait.

“Ray, I’ve got some bad news. You have prostate cancer,” he heard the doctor say.

Ray didn’t know much about prostate cancer. He just figured doctors would treat the cancer, and he would be back to normal.

He was about to learn that the cancer would affect more than his prostate, a gland about the size of a chestnut that produces fluid for semen. It would impact his relationships, his sexual wellbeing and even his mental health.

Ray was only 45. He wasn’t about to surrender to cancer – which was detected during a routine physical – and he definitely wasn’t ready to say goodbye to his sex life.

“I enjoy intimacy – a lot,” Ray says. “For me, the cancer wasn’t the biggest concern. I knew the cancer could be treated. I was really concerned about quality of life after treatment. I wanted to be able to have sex. I wanted it to be normal like it used to be.”

Run Wang, M.D., assistant professor in the Department of Surgery at The University of Texas Medical School at Houston, has spent his medical career helping men like Ray restore sexual function after prostate surgery.

He offers a sexual rehabilitation program, which includes a variety of non-surgical therapies to help men overcome prostatectomy-related erectile dysfunction. Patients in the program are prescribed high doses of oral erectile dysfunction medications, such as Viagra, or drugs that can be self-injected into the penis when an erection is desired. These drug therapies are often used in combination with external mechanical devices to help achieve and maintain erection.

Wang, chief of urology at Lyndon B. Johnson General Hospital, also is one of the few surgeons in the world who offers penile implants to patients who don’t benefit from non-surgical therapies.

Ray is one of Wang’s patients who began sexual rehabilitation shortly after his prostate surgery. Here, he shares intimate details about his year-long journey to get back into the bedroom. He does this for two reasons:

1. He wants men to understand the importance of annual physicals. “Don’t wait until you have symptoms,” he says.

2. He wants men to know that they can have a fulfilling sex life after prostate cancer treatment.

‘I had no symptoms whatsoever.’

“Everything was cool,” Ray recalls of his health in the summer of 2002. He was going to the doctor for his yearly, routine physical. He had no symptoms or health complaints. Yet during his examination, which included blood work, a Prostate-Specific Antigen (PSA) test revealed elevated levels of a protein which could be an indicator of disease.

“I was told it was probably a little infection or an enlarged prostate, but there was a 30 percent chance I may have prostate cancer,” Ray says.

Ray didn’t worry about it. He figured he had a 70 percent chance of being cancer-free, so he assumed he was indeed cancer-free.

Even when the doctor scheduled a biopsy, Ray never entertained the notion that he could have cancer. He didn’t rush to his computer or the library to read up on prostate cancer. So when the doctor gave him the diagnosis and handed him a stack of papers about the disease, “never did it hit home that they would remove the whole prostate,” Ray says. “I just thought they’d take out a little piece.”

The doctor recommended surgery and told Ray surgeons likely would have to cut a nerve that would affect his ability to achieve an erection. That’s when it sunk in. This was serious. He had cancer, and it was about to change his life.

Ray figured there had to be a better option to surgery, so he researched radiation therapy and even an experimental treatment.

Ultimately and reluctantly, Ray decided surgery was the best option for beating the cancer. Now he needed to figure out a way to defeat the impotence that he was certain would occur after surgery.

‘It wasn’t exactly romantic, until...’

Ray worked with physicians at The University of Texas M. D. Anderson Cancer Center on the course of treatment. He would have the surgery, and at the same time surgeons were removing the cancerous prostate, they also would take nerves from his calf and ankle and perform nerve grafts. Ray hoped these nerve grafts would prevent sexual dysfunction.

The operation took nine hours, Ray recalls. Over the next 16 days, he had a catheter, which caused painful bladder spasms. And for the next nine months, he battled severe to moderate to mild incontinence. “Incontinence is a big problem after prostate surgery,” Ray says. “Don’t let anyone tell you otherwise.”

As his bladder control improved, Ray was anxious to resume sexual activity. About three months after the surgery, he scheduled an appointment with Wang, who also is the director of sexual medicine in the Department of Urology at M. D. Anderson.

Wang initially prescribed Ray a high dose of Viagra and gave him an external pump, which would help facilitate an erection, and rings that fit around the base of the penis to help maintain the erection.

“The goal was to have at least two erections a week for 10 minutes at a time,” Ray says.
The medication caused severe headaches, and the external pump wasn’t exactly romantic, Ray recalls.

At the same time, Ray’s marriage was dissolving. Couples are encouraged to participate in the sexual rehabilitation together, but for Ray, that wasn’t an option. Late at night, after the children had gone to bed, Ray would hide in the bathroom and try to perform these therapeutic tasks on his own.

“It was awful. I tried it for a few months, but it was frustrating,” Ray says. “I could only get a partial erection. I wanted everything to be normal like it used to be, and it was depressing to realize that you are never going to be like you were before surgery.”

A self-injected medication was the next course of treatment. “They did the first one in the office. Five percent of men are supersensitive to it. Guess what. I was one of them,” Ray says. “It was extremely painful, and there was a tremendous amount of swelling. I was erect, but believe me, not in a good way.”

Wang sent Ray home with a different form of medication and instructed him to administer the shots to achieve an erection. “I tried the shots four or five times, and I did not like that. I felt like I wasn’t getting anywhere. This had been going on for almost a year, and nothing was working,” Ray says.

Ray started going to counseling to help him cope with his depression, divorce and the overall devastation that had occurred since the prostate cancer diagnosis. He needed to start a new chapter in his life, and he decided the new chapter should include surgery to permanently correct his erectile dysfunction.

‘The Cadillac of implants’

Like so many, Ray had misconceptions about penile implants. He wasn’t sure how they worked. Was there an external...something you could see, like a lever, a button, a dial? Could women spot it? He had no idea.

Wang says these misconceptions prevail even in the medical community, and as a result, most men with erectile dysfunction don’t even realize that a penile implant could be a viable option. Each year, surgeons perform fewer than 22,000 penile implants worldwide.

“Penile implant cures erectile dysfunction in about 95 percent of patients,” Wang says. “And more than 90 percent of patients report that they are extremely satisfied with their implants.”

Wang explained to Ray the three types of implants. There is a three-piece inflatable device, which includes hollow cylinders, a reservoir and a pump. The two-piece device lacks a reservoir, but operates much the same as the three-piece implant. The third option, which is rarely used in the United States, is a semi-rigid device that includes only two rods.

With the three-piece implant, two hollow cylinders are implanted in the penis. A pump is implanted inside the scrotum, and the reservoir is placed in the pelvis. When a man wants an erection, he simply squeezes the pump a few times. The reservoir, which holds sterile saline, delivers fluid to the hollow cylinders. In a matter of seconds, he can be ready to engage in sexual activity. Afterward, he can push a button on the pump inside the scrotum to deflate the cylinders and become flaccid.

The two-piece implant is ideal for patients who have had pelvic surgery for bladder cancer or other conditions. “You don’t want to put a reservoir in the abdomen, because that can cause complications for these patients,” Wang explains.

While the semi-rigid implant is less expensive, it is not as popular, Wang says, and is typically only used in other countries. With the semi-rigid implant, the penis is always erect and may be difficult to conceal.

Wang says when he shows the implants to prospective patients, they immediately have questions. Like Ray, they all want to know, “How in the world does all the equipment fit inside the body?”

Wang assures his patients that it can all be neatly implanted through a one-inch incision in the scrotum. Their anatomy will look natural, and no one will be able to tell they have an implant. Best of all, this implant will enable them to have sex.

“Six weeks after surgery, patients should have an almost normal sensation,” Wang says. “They are able to have sexual intercourse. They can climax.”

Wang says there have been significant improvements in penile implants since the 1970s.
“The newest thing is antibiotic-coated implants,” Wang says. “This helps prevent infection after surgery, which occurs in about one to three percent of patients.”

Long-term studies show that after 15 years, these implants are still functioning properly in 75-85 percent of patients.

Wang says that since 1996, the re-operation rate, due to mechanical failure, infection or other complications has been only about nine percent.

Penile implants continue to improve, Wang says, and a one-touch pump is in development. “This will be easier for older men,” Wang says. “They’ll be able to deflate the device by pushing a button once, after they finish intercourse.”

Ray chose the three-piece device, which he calls the Cadillac of penile implants. To continue the car comparison, Wang says these implants are so durable they are likely to outlast any Japanese automobile.

A little more than a year after his cancer surgery, Ray underwent surgery for the implant. “I survived cancer, and now I wanted to get my life back. I wanted a good quality of life.”

‘It’s remarkable.’

Ray didn’t tell anyone in his family about the penile implant. A trusted colleague drove him to the hospital for what he described as “one hell of a surgery.” The next day, the same friend drove him home.

“I won’t lie to you. It was a painful recovery,” Ray says. “My testicles were swollen. I had to take some time off from work.”

Ray quickly learned that he needed more support. He’d been a “boxer man” all his life, but now he was switching to briefs.

“Every day it got a little bit better,” Ray says. “You just have to be patient. Follow the doctor’s orders. Take the antibiotics and have support. It’s worth it. It’s abso-freaking-lutely worth it.”

Within two months of the operation, Ray knew it was a success. He re-entered the dating world, and if he didn’t tell anyone about the implant, no one knew his secret.

“It took a while to get use to operating it – learning how to use it,” Ray says. “I don’t think twice about it now, and I am very grateful to Dr. Wang for helping me find this solution. He’s my hero. He really is.”

With the device, Ray says, he is quick to get an erection and maintain it. His girlfriend nods in agreement, smiles and says, “Yes, it is a woman’s best friend.”

Ray says he still has the ability to achieve orgasm – but it’s different – better even. “They’re much more intense. Plus, I can keep going. From a functional standpoint, I’m better than I’ve ever been. It’s wonderful.”

His girlfriend gives an affirmative nod and whispers, “It’s true.”

UPDATED: 6-14-2006

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