Total Urinary Incontinence

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New Member

Date Joined Mar 2009
Total Posts : 1
   Posted 3/30/2009 4:23 PM (GMT -6)   
I had a Davinci Robotic Assisted Laproscopic Radical prostatectomy on February 12, 2009 and had the Foley catheter removed on February 20, 2009. My recovery from the surgery has gone well, with one huge problem--total urinary incontinence since the catheter was removed.  By total urinary incontinence, I mean that in the five weeks since removal of the foley, I have not been able to build up any urine in my bladder that would enable me to urinate like I did pre-surgery. I flow 24/7 at the same rate that I did when I had the Foley catheter. 
I have read that while continued urinary incontinence improvement was possible up to one year and even beyond, most patients who achieved continence did so by 18 weeks post-op. Most of the experiences that I read about on this web site describe progressive incremental improvement from week to week with some level of control shortly after removal of the Foley catheter.  I have not been able to urinate since my catheter was removed because there is no build-up of urine in my bladder. 
I would be very interested in hearing from anyone who has experienced the degree of initial incontinence that I have described and then also experienced a turnaround after several months of not being able to build-up enough urine in the bladder to urinate in a pre-op manner. 
I have performed the kegel exercises since the foley was removed on February 20th. 
Since the catheter was removed I have been using depend diapers with Tena male guards. Inasmuch as all the urine I produce goes into the diapers, I need to change at least every two hours around the clock.  I have also used a penile clamp that provides a much appreciated dryness but is difficult on the penis.  I have also purchased an afex Incontinence Management System that is an external catheter with a collection bag.
I would like to hear from anyone who has an experience similar to mine or knows someone who has had such an experience.  Of course, I would like to hear that there have been some amazing turn-arounds after several months of incontinence on the level that I have experienced.  Most important, however, is to get an understanding of the probabilities that I am facing and if I should focus on a surgical correction of my incontinence.
Thanks in advance for any information and/or guidance you can provide. 
Some quick stats:
Age: 69
PSA: 2.3  (5/25/2007)
PSA: 4.2  (4/18/2008)
Biopsy: Gleason 6 (Grades 3 + 3) (5/19/2008)

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 3/30/2009 4:32 PM (GMT -6)   
Alpha-7, Welcome to HW. I don't have that experience but a couple here have, I think, and will chime in if they see this thread.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2457
   Posted 3/30/2009 6:23 PM (GMT -6)   
I had my robotic surgery on Feb. 9th. I'm still incontinent during the day but only when I'm standing up or doing any physical activity. I'm getting therapy doing Kegel exercises every day. What I can tell you is that with the exercises and physical activities I'm seeing progress. I was using 2 to 3 pads a day but now I onlu use one and occasionally 2.
Age: 67
Retired in 2001 and living in Austin TX.
PSA 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean

Veteran Member

Date Joined Jul 2008
Total Posts : 637
   Posted 3/30/2009 6:54 PM (GMT -6)   
Hi Al, Have you asked your doctor about Detrol? It can stop bladder spasms, and may help along with kegels to build up the bladder....If not, you can have the AUS 800 installed. A wondrous device....Although not perfect for my husband there are many who have complete success...My husband went from many many pads to only three in 24 hours.... Good Luck. There are Gene, KW, and Berb, who have had great success with the AUS....They may jump in here...........Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09

Veteran Member

Date Joined Nov 2006
Total Posts : 883
   Posted 3/30/2009 8:50 PM (GMT -6)   
Alpha, Do you have leaking while laying down? Has your doctor done a cyctoscope on you to see what the sphincter is doing? For now, check on that and keep doing your exercises. If things don't "dry up" for you I would highly recomend looking into the AUS.
Good Luck, KW
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.
    April 18, 2008 - Collagen injection.  Back to using 4-6 full pads a day within a week.
    May 14, 2008 - Another collagen injection to try to Band-Aid the leaking for our June cruise.  Will start making conusultation appiontments for AUS after we return.
    July 14th, 2008 - AUS consultation with Dr. Morey at UT Southwestern (Dallas).
    July 30, PSA 0.00.
    Aug. 22nd, 2008 - AUS Surgery by Dr. Morey
    Oct. 6th, 2008 - AUS Activation by Dr. Morey.  Working Great, only light drips and dribbles.
    Jan, 31st, 2009 - PSA 0.00  Next test in July, 2009  

Regular Member

Date Joined Feb 2009
Total Posts : 39
   Posted 4/1/2009 12:26 PM (GMT -6)   
Hello Alpha-7:
Our situations are strikingly similar, but not identical. Currently, I am 15 weeks post-op daVinci RRP, and am totally incontinent. I am physically active, and otherwise in good shape. I resumed playing tennis 5 weeks post-op, and currently play tennis for 2+ hrs. each time.  I also stretch and lift moderate weights each day prior to playing tennis.
I use at least 6 super absorbent diapers (or the equivalent) per day. Insert pads, such as Poise pads, are insufficient. Instead, I insert super absorbent belted shields (w/o the belt) inside my diapers and remove them when full.  After some leakage, I just wear the diapers, and then change back to the combo when the diapers are soaked.
We appear to differ in one regard. My bladder does fill at night, and I awaken from that sensation. However, upon rising I am only able to make it into the bathroom by using my hand to squeeze off the urine flow until I am at the toilet.  During the day, the only time that my bladder collects and retains fluid is when I am seated.  Upon rising, I void immediately, unless I use my hand, as previsouly described.  While standing (or walking or playing tennis), the leakage is constant, w/o any retention in the bladder.
Since surgery, I have done the kegel exercises religiously. Some have suggested that I vary the kegel routine to conform to a weightlifting routine (i.e., rest every other day to allow the pelvic floor muscles to recover).  I also have been undergoing biofeedback, coupled with electrical stimulation.  The theory seems sound.  But, after 5 weeks, I see no discerible benefits.
BTW, others have theorized that the cure will come from the mere passage of time. Maybe they are correct. Nonetheless, I remain open to all suggestions that involve my effort in an attempt to accelerate the healing process, as long as I am not doing any perceived damage.
Good luck in your healing process.
Last PSA prior to biopsy  -  11.9
Biopsy  -  8/7/2008
Cancer findings at left lateral and left medial apex of prostate
Gleason score  -  3+3 = 6
Staging  -  T1c
Prostate size/weight  -  128 cc./ 99 grams
Bone and CT scans  -  9/12/2008  -  both clear
Age at biopsy  -  65         Health  -  Excellent  (Lift weights, play golf & tennis (incl. singles))
da Vinci RP surgery  -  12/15/2008 at Naples Hosp.
Surgeon  -  Dr. Wm. Figlesthaler
Hosp. Stay  -  1 night
Catheter removed  -  12/23/2008
Post-Op blood test  -  2/2/2009     PSA  -  undetectable
Scheduled for 12 weeks biofeedback, starting 3/3/2009

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