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dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 147
   Posted 10/18/2009 9:26 AM (GMT -6)   
Sorry if this has been done before, but being a relative newby to prostate removal, I am trying to find out exactly which muscles are left intact and which are removed/damaged. I realise there are two sphincters controlling flow, inner and outer. The inner at the bladder neck and the outer south of the prostate. Surely both are left after surgery but are likely damaged, hence the incontinence until they heal and control is restored.  Any of the more experienced members comments would be much appreciated. Best wishes to all from England.
Diagnosed February 2009. Gleason 6, Psa 7.2, 12 core biopsy, and then Mri scan, which showed organ specific.
DaVinci at Addenbrookes, Cambridge, England 18th May 2009.  Nerves removed one side.
Catheter in for 8 days, no pain, no post op problems apart from an infection, cleared with antibiotics.
Some aching around the penis, which still occurs.
6 week psa 0.1, post op pathology all good, confirming pre op tests. Ed a problem, no treatment as yet.
Light ladies pad during the day, just to control a slight dampness and a Tena for  men pad at night for occassional leakage.
Awaiting 3 month consultation at the moment.
Sept 09 - still awaiting consultation. 99% dry during the day, tena pad at night just in case.
Sept 18th 09. PSA less than 0.1
Sept 29th follow up consultation at Addenbrookes. All ok at the moment
Virtually dry at the moment.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/18/2009 9:45 AM (GMT -6)   
If I remember correctly, the upper one at the prostate you lose with its removal, and the one at the bladder neck remains.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 10/18/2009 11:06 AM (GMT -6)   
I agree with Purg. When the prostate is removed we lose the upper valve as well as the prostate itself which can have a significant impact on flow. We are left with the lower valve only so we are much closer in function to the female system which, I believe, is controlled with just a single valve. This info came from discussions with my uro (and from looking at the diagrams on the wall while I was in various uncomfortable positions:-)) so my translation may not be 100% correct.

Garth
Vitae:
DOB: Q4'46, HT: 5'9", WT: 180
PCa:
PSA: <2.5, DRE: Slight enlargement, one node
Biopsy: 12/08
Cores: 4 of 12+ positive, Gleason: 3+3
Surgery: RRP on 1/21/09
Catheter: 15 days
Pathology:
Adenocarcinoma occupying 5% of prostatic volume (right posterior aspect)
Gleason: 3+2, No extraprostatic extensions, Perineural invasion within prostate only
No angiolymphatic invasion, No seminal vesicle invasion, Clear margins
AJCC: pT2a
Post-op PSA's
3/10/09 < 0.014 (undetectable by machine)
6/10/09 < 0.014 (undetectable by machine)
9/8/09 < 0.014 (undetectable by machine)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/18/2009 11:51 AM (GMT -6)   
Yeah, Garth, I think that is how I learned the info too ,lol.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 10/18/2009 6:16 PM (GMT -6)   
www.ivy-rose.co.uk/HumanBody/Urinary/Urinary_Bladder_Urethra_Male.php

This website has a great diagram of the whole system. The sphincter at the neck of the bladder is taken with the prostate because in actuality, there is no space between the prostate and the bladder. If you read Patrick Walsh's Prostate Cancer book, there is a whole great series of drawing of what happens in the surgery. The only sphincter left is the External sphincter right at the top of the bulb. If a surgeon is sloppy, this sphincter can be damaged and continence will not come back. In the old surgeries, the whole area was taken out and men ended their lives incontinent and impotent. We've come a long way baby.

Men hardly use the external sphincter. In sexual arousal, this muscle locks open so that semen will readily evacuate. The Internal sphincter and a secondary valve in the prostate shut. Post surgery, our body still tells this muscle to open wide...which is why so many men leak or ejaculate urine. After all the trauma it simply takes a while for this small muscle to take over and learn to compensate for the loss of the other mechanisms. On reflection, it's amazing it happens at all. We're pretty fortunate.
Paul

added html tags to make link clickable
46 at Diagnosis.
Father died of Pca 4/07 at 86.
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
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
One year PSA - undectable!

ED Website: www.FrankTalk.org - frank discussions of Erectile Dysfunction - check it out.

Post Edited (Paul1959) : 10/19/2009 11:33:18 AM (GMT-6)


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 10/19/2009 9:30 AM (GMT -6)   
In my poking around I ran across a film of a prostate surgery. Fascinating to watch. It even would have been interesting if I wasn't so involved with the subject.
The film showed the various bits and pieces as they went along and was obviously geared toward medical professionals. The film and subsequent reading said that the sphincter up next to the prostate can be saved but it is quite common for there to be some damage. My impression is that it comes down to surgical skill, just how we may be put together inside, and a bit of luck.

Of course if we were big believers in luck we wouldn't be here in the first place. rolleyes
Diagnosed at 54
PSA 8.7
Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7
Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09
Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence
Pad free week 5
PSA 6/6/09 <0.1
PSA 9/10/09 <0.1

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