Another Willy question

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 1/15/2010 10:30 AM (GMT -6)   
My question regarding whether or not your penis was shorter after surgery leads to another question. It does seem like there is a definite shortening (darn!).
 
Now, does this shortening relate to incontinence? It would seem that if the penis is short enough it might be very difficult to aim correctly when urinating.
 
So, a new question. Can you give:
 
1) How much shorter was your penis post surgery?
 
2) Rate  your incontinence, say shortly after surgery. Let's use a 1-5 scale with 1=totally incontinent; no control whatsoever and 5= pretty much totally continent (maybe a slight loss of a drop or two here and there; let's allow that).
 
I'm wondering if we will see that the greater loss of penile length corrolates with a greater degree of incontenence.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/15/2010 10:42 AM (GMT -6)   
Mel, I don't think you find that as a provable connection. Everyone's incontinence or lack of incontinence is so directly personal to their own bodies.

When thing I didn't see mention on your other thread about penis shortening, was the explanation my own surgeon gave on more than one occassion.

Of course there is the space of the prostate that will no longer be there after surgery, that space depends on the original size and location of the prostate. When the delicate attachment is made of the inner side of your urethra is made to the bladder neck (and this is where you surgeon's skill will really shine if done correctly), the bladder, which has had one of its attachment points by the removal of your prostate, is pulled toward the urethra, and joined together. He said the urethra is not pulled toward the bladder, but the bladder is hinged at this point, and is pulled toward the urethra. The shortening is due to the weight of the bladder acting on gravity, pulling everything inward, thus the appearant shortening of the penis. More of the shaft in its flacid state is pulled inward. I cant say what happens when you use a pump or sex drugs or even injections ,because I never had to use any. But as my penis is filling with blood naturally and becoming errect, its length increases all the way to my pre-surgery length. I am guessing here, but I would imagine similar results when the sex pills work and/or injections work properly.

When you are first coming to terms with incontinence, the "shrunken" penis syndrome can make it more difficult to aim correctly. Especially until you have some kind of real stream again. I would find myself proudly peeing down the front of the outside of a guards, or down the front of my pulled down underwear, because I didn't realize that it was a slow dribble with no force, not even enough force to clear the toilet, lol. I learned fast on that one.

Fortunately, I only had to deal with minor incontinence issues for less than a month, and most of it was in my head, more than my body.

David in SC
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/15/2010 11:23 AM (GMT -6)   

I agree with the previous response that a connection on length & incontinence appears unlikely.

I thought I'd add a comment, however, about your question of "aim."

In the first week or two, in particular, after the catheter was removed (during the period of peak incontinence), the spray was everywhere.  I was constantly wiping up the floor after myself.  I think there were two things going on here.  First, the passage way had just been reamed for a week with a tube...I thought that was a contributor.  Second, during those first couple weeks there was a lot leaking out on it's own, so when I did go to the toilet it was less than a full bladder, and sometimes not much at all.  But I did think it was an important part of the re-training to force myself to try to hold it and then relieve myself.  Those first couple of weeks during re-training, I found myself going to the toilet frequently and not much coming out (but some left in the absorbancy pad), but as I said, the aim/spray was messy.  Slowly improved with time.  Almost everything during this post-catheter phase seems to improve slowly...emphasis on the word "slowly".  Have patience.

By the way, go ahead and buy yourself a package of the men's Depends Guards now.  It's awkward going through the checkout line, but in my case my wife refused.  I remember one trip to the store, the 15-year old bagging (at a grocery store) held the package up and ask (loudly, it seemed), "Do you want me to bag these?"


Post Edited (Casey59) : 1/15/2010 9:30:44 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/15/2010 11:31 AM (GMT -6)   
Casey, you should have said "No need, I am going to put on one right now in your checkout line."
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 1/15/2010 9:12 PM (GMT -6)   
I was not kidding about the loss of length - or lack thereof. I have not noticed a correlation between length an leak. If I use the VED, I have a reasonable piece of flaccid material hanging but it still leaks at my now 300 ml per day. On the other hand, it can be almost fully retracted and leak down my testicles and into my underwear. I have to lean way over the toilet or just do it in the shower. There is now a hand print on the wall over the toilet. I promise to paint it when I'm continent.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next? See Uro 1/20/10
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 1/16/2010 12:06 AM (GMT -6)   
Bronson,

Have you investigated a clamp ? Bard makes a Cunnigham clamp that is effective.

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/16/2010 8:20 AM (GMT -6)   
tatt2man said...
...having a better pee day today - kegels are behaving and able to stand without leaking about 50% today ... now if I could only conquer stairs - instead of leaking on each step - ( I know it will improve in time) - but living in a 3 storey house is a bit of a bother right now.
Bronson,
 
Just a gentle reminder of:
 
(i) The patience needed during this time, keeping in mind that you are still less than 8-weeks post-surgery (definitely not time to start thinking about a clamp; these are for more persistent cases who cannot regain continenance after a year or more).  Time seems to move slowly when you are nearly-constantly experiencing the uncomfortable leaking sensation which you've never experienced before.  I could point you to a study results which show that only about 45% of post-RLRP patients are "pad-free" 3 months after surgery.  Hang in there, you are approaching the time when most patients start to see more dramatic improvements (70% are pad-free at 6-months).  Your comment, "I know this will improve with time" shows your head is in the right place, but maybe you just need this gentle reminder every now and then...
 
(ii) Also a reminder that stairs (or walking or other light exercise) is a great time to work simultaneously on Kegels.  Try very deliberately clamping (Kegel style) while you take one flight of stairs.  You should have initially learned Kegeling correctly while sitting, but by now you should work it into your everyday movements (also while coughing, laughing, etc).  The combination of muscle engagement (especially the core) helps make this a natural reflex, which is your goal.
 
Peace

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 1/16/2010 11:22 AM (GMT -6)   
Bronson,

I do encourage that you take my recommendation about Kegels AND stairs seriously; despite the additional challenge. Don't expect to conquer it in the first day. (BTW, "Kegel" is a proper noun, named after Dr Arnold Kegel who invented the exercise.)

Think of it as levels of education. You start in the sitting position learning the proper technique of Kegels (thoroughly covered in other threads). This is your primary school education; pretty basic, but not necessarily living up to your full potential.

Next, challenge yourself to incorporate Kegels into light exercises like walking up stairs. Stairs are the perfect distance because it's not too long a time. You engage many muscles while you walk up stairs. Distance walking is too far/too long a time to try to hold a Kegel; the stairs are perfect. This is your undergraduate college education.

Finally, if you are so motivated to really push yourself ahead, you combine Kegels with rigorous core exercises, like sit-ups and the many variants of sit-up/core exercises. Relax, clinch, sit-up, down, relax, repeat; combine with various core exercises. Six-pack abs are not the goal, and ANYONE can do this level of exercise when adjusted to their own capability. This is your advanced degree. Not everyone is going to push themselves this far, but the results can be very satisfying.

Achieving each level takes time and effort. At about 8-weeks post-surgery, your surgeon would likely have already released you (if you asked him to do so) to do light core exercises, or he will do so very soon.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/16/2010 11:47 AM (GMT -6)   
Buenos diaz complier (amigo) :-) :-) the questions never end on PCa issues and possible cures....did I ever mention twlight zone...sometimes you have to ask yourself is all this b.s. and wonderful effects in the name of good medicine...for real???? Yeah it is for unreal and forever which sometimes is not totally mentioned to the patient....thus another feature of this jungle of PCa. Got to love our choices and side effects and not to mention some of the variables that go on along with the methods. My uro way back said "pick your poison" as to treatments....atleast I can't sue him on that disclosure...I think that was straight enough to hear.

Well I know you are getting your mindset on "D" day (Dr. Menon), in this case the D means..willie's lenght is lessend and other infractions. It is a pity that men are forced to considered all these wonderful treatments. Anyway I hope you do well and recover quickly.
Youth is wasted on the Young-(W.C. Fields)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/16/2010 11:52 AM (GMT -6)   
zufus,

The poison analogy is a good one. I always equate these tough treatment choices as the classic "do you want to get shot or stabbed". All of the treatment choices come with a price and a catch. One could say the AS is scott free, but not the case, for some men, just knowing there is a cancer in them, and the worry and anixety of waiting around for additional PSA tests and biopsies is a worse form of torture for them.

Perhaps not in our generation, but one day, the whole process won't seem so risky and primative. Right now, its up to each man to make really tough choices, with no certainty or guaranty of sucesss ahead of time.

David in SC
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/16/2010 12:36 PM (GMT -6)   

Casey:

 

I've been meaning to get back to you on the cost of the PCA-3 test.

Apparently no charge. I have not seen it on any of the bills from Umich.

I think they are running trials on this, so maybe there was no charge to me for that reason.

Mel


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/16/2010 3:11 PM (GMT -6)   
Nice...
 
 
I'm guessing the actual cost is somewhere between the relatively cheap PSA, and the relatively more expensive biopsy procedure.  Anyhow, that's where the market is.
 
Thanks for the update.

vespatime
New Member


Date Joined Jan 2010
Total Posts : 9
   Posted 1/16/2010 3:56 PM (GMT -6)   
Casey and others,
It is the humor that you add to these posts that make me laugh, sometimes cry, and always feel reassured that I am not alone and others have the same problems with urinating everywhere other than directly into the urinal.

Penile shrinkage...it was explained that a combination of stretching the urethra to allow it to be resewn to bladder neck, coupled with the hollow left by the prostate, contributes to some penile retraction. It said that the average is 15% shrinkage, and when I did the math realized in my case the difference was not that great :)

BG
Age at DX: 47
PSA: Aug 06: 4.31
Jul 07: 4.78
Jun 08: 4.60
Jul 09: 6.10
DRE: Sept 09: nodule on right side
TRUS BX: 21 Oct 09: 8/12 positive cores, 2 questionable
Prostate Size: 44 cc
Stage: T2a
Gleason: 3+3 = 6
Surgery: Dec 09 Robotic RP
UI: 1 full pad daily, some improvement with control at 4 wks out.
ED: No life yet

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