A week has gone by since my catheter removal and I have progressed from 3-4 pads a day to 2 per day. I am able to get to the washroom during the night without leaking and can stand from a sitting position and do the same during the day. This has prevented the majority of leakage during my resting and waking hours. Walking still presents some challenges but I am working on that as well.
I believe that the main reason I am doing so well is due to a partnership of my surgeon, Dr. Pautler of St. Joseph's Healthcare Centre in London Ontario and Bill Landry BScPT, BScH, CAFCI, CWCE, MCPA, of the Family Physiotherapy Centre of London. They have teamed up to provide Da Vinci Surgery patients a new method of regaining continence. They refer to the exercises as the Landry Protocol (they are researching this protocol compared to the kegal protocol).
One of the many reasons I chose Dr. Pautler was his stats on regaining continence in his patients. 86% of his patients are continent within 3 months and 98% within one year. All of his Da Vinci surgery patients are enroled in the Landry Protocol including myself.
The web site can be seen here:
With the permission of Bill Landry, I am going to post this protocol for anyone who wishes to try the exercises. Here is their method:
Basically, prior to surgery, there were three mechanisns that were controlling urine flow. The first is the sphinctor muscle at the connection of the eurethra to the bladder. The second is a series of small muscles in the eurethra inside the prostate that contract to stop urine flow. The third is the pelvic floor muscle that wraps around the eurethra and the bowel to control urine flow and bowel secretion and gas passage. The surgery compromises the bladder neck control which needs time to recover if ever. The muscles inside the prostate are now removed with the prostate and therefore gone forever. The pelvic floor muscles are in need of retraining as they are largely now responsible for controlling the flow.
Pelvic muscles become weak and sag after bladder and prostate surgery. We need to work on increasing tone ( at rest, while sitting, standing and walking). Weak muscles and the eurethral sphincter that is unable to maintain a threshold tone will give you less control of the bladder. With weak muscles and poor control, you may leak urine when you cough, sneeze laugh or exercise. Your brain needs to learn a new method of preventing urinary continence - motor learning.
Studies have shown that there are several types of muscles fibres within the pelvic floor and external urethral sphincter, Slow and Fast twitch skeletal muscles. Each requires a different type of exercising.
The exercises should be done in a quiet place where you can relax. It may take some time to get the right muscles. To locate the muscles, it is best to sit down. Try and squeeze the muscles that prevent you from passing rectal gas. As you continue to tighten you will feel your scrotum lift and your penis retract. At this point you will be contracting your anterior pelvic muscles which contains the external urethral sphincter. Concentrate on contracting this part of the pelvic floor. Try not to tighten your abdominal and buttock muscles. Do not hold your breath. Remember, the pelvic floor is not a large group of muscles.
After you get used to doing these exercises, you can do them any time, any place and any position. The following routine exercises focus on strength, endurance and motor re-patterning of the external sphincter/pelvic floor.
1. Slowly squeeze your pelvic floor muscles 25% for 5 seconds then 50% for 5 seconds then ........
2. Hold at full contraction for a slow count of 5 seconds and.........
3. Relax down to 50% for 5 seconds, then 25% for 5 seconds then.......
4. Relax for 15 seconds. Repeat 20 times. Do 2 times per day. Start sitting on the toilet in case of leakage and when control comes, you can do them anywhere. Do in a standing position after two weeks of repeated daily sitting exercises.
1. Quickly squeeze your pelvic floor muscles 100% for 1 full second....
2. Relax quickly......... DO NOT REST.... Repeat 40 times.
3. Perform twice per day. Monitor for no leakage.
1. Squeeze your pelvic floor 10-25% of maximum. Hold this for 1/2 hour.
2. Try standing reading a book or going for a walk while holding it at this level.
3. Us a facial tissue wrapped around the penis as biofeedback of leakage.
The lower levels of pelvic muscle control ( 10-25% will eventually be taken over by the brain as the new "0" level of relaxation and provide constriction of the eurethra and continence.
Well folks, that is it. I have been doing these exercises for week and am progressing rather well in my opinion. I hope that this may help those who are experiencing difficulty as this is quite different than Kegals.
Age 64. Diagnosed with Pca January 2009.
PSA 5.6, Gleason 3+3=6, T1c
TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear.
Robotic Assisted Laparoscopic Prostatectomy - September 29/09.
Pre-op PSA down to 5.28 which I attribute to visualization techniques and a new vegetarian diet.
Robotic Prostatectomy - 09/29/09, back home 10/02/09.
Pathology - 10/14/09 Gleason Score remained at 3+3 = 6 as it was when originally diagnosed. There were no positive margins. Tumors were found in both lobes and involved 3-5% of the prostate. There was no Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and the bladder neck was also cancer free.
10/16/09 - 3-4 pads a day and working on pelvic floor exercises as prescribed.
10/16/09 - Zip, nada
State of mind:
Excellent - always positive.
Post Edited (Modelshipwright) : 10/20/2009 9:14:01 AM (GMT-6)