A question about incontinence.

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smc64
Regular Member


Date Joined Jan 2009
Total Posts : 40
   Posted 1/15/2009 10:11 AM (GMT -6)   

Please correct me if these statement are wrong.  The sphincter muscles are often damage during an rrp causing incontinence.  This problem is often resolved over time by doing kegel exercises (I realize this is not always the case).   My question is once continence is achieved post surgery do you still have to continue to do kegels forever or does your body adjust and thing work naturally as they did before?  Thanks?


Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 1/15/2009 10:38 AM (GMT -6)   
in surgery, two of the three sets of valves that men use to control urination are removed. We are left with the single large (and in men, usually lazy) sphincter which was below the prostate. It is this set of muscles we need to retrain in order to become continent. If it's any help, women have just this one set of muscles/valves and they do just fine. In male bodies, this sphincter is usually relied upon very little.
And yes, to an extent, the remaining sphincter has been beat up with a catheter stretching it open for a while. Getting it all to come back fully functioning usually takes some time.

It can be confusing for our body as time goes on. During sexual arousal, this sphincter used to open wide to allow seminal fluid to pass while the other valves kept urine in check. Now, we have to keep these muscles tight all the time.
Kegels are usually necessary to regain control. They will certainly always be good to do, but I have not done any kegels in about 9 months and am 100% dry. The only thing you have to get used to is at the end of urination you must be patient to let the last bit drip out. If you rush things, you end up with more than just a drop or two down your trousers! But, yes, for the most part, things return as they were before surgery and you will blessedly think very little about it again.
Paul
46 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6 (Biopsy 3/07 just suspicious)
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at nine months.
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - Took 100mg viagra every night. for several months
Totally usable erections at 10 weeks, which disappeared over the course of a month or two.
ED bounce is what they call it. Now, at one year, ED is fine with viagra.


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 1/15/2009 4:30 PM (GMT -6)   
Just a note that I am almost 8 months out, and although I am almost dry, I continue to have dribble here and there so that I wear a pad. Lately I have found it particularly difficult because I acquired a nasty cold which I have been having a heck of a time kicking. The coughing spasms invariably cause some squirting. I also think the array of decongestants, antihistamines, and mucus pills have some affect on control. If you add a lot of bending, picking up, and exertion on your feet this also adds stress. I can also say that sometimes I leak a little and don't seem to even know it until I check the pad. I have not been doing kegel's but I guess this is a reminder that some of us need to do more than others. Once I get through this cold, I will recrank some kegel effort. The odd thing for me is that I was almost dry at 12 weeks but basically have made little progress since. So I would encourage the kegel's until you are completely zipped up.

Just taking a general trend from all the reading on here it does seem there is some correlation between age and recovery (although that is not absolute). I am not complaining because I am very thankful to be free of the cancer (saying that knowing it can show up again but hoping it will not), but also recognizing that for some of us we will never be exactly the same in the areas of continence, and ED. Regardless, the situation is manageable and we all do what we have to do.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/16/2009 7:12 AM (GMT -6)   
chas, I had read that same report, guess it wouldn't hurt anyone to do them
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/16/2009 9:14 AM (GMT -6)   
Thanks for the question smc64,

And thanks for the great explaination Paul1959,

Being 1 week post-op I can see light at the end of the tunnel. My drips are not bad...yet. But I can tell already that it does not take very much strain to cause a squirt. I'm signing off and going to do some kegels!
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa, but stable
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c / post-op 3+4  7  stage t2c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Catheter removed 1-15-09

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