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gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 360
   Posted 7/4/2010 9:33 AM (GMT -6)   
Hi everyone,I have a questio.Do you think incontinence is due to the surgeon or it depend on the patinet?
M y friend has been incontint for four years,but my brother whom has Laproscopy has been dry from day one.  confused
DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 7/4/2010 1:55 PM (GMT -6)   
It is probably both

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/4/2010 2:27 PM (GMT -6)   
Interesting queston, gold horse. The way I see it is that a surgeon without top skills, experience and judgement, will leave more men incontinent than a surgeon with top sills, experience and judgement will. But, I doubt the difference would be huge. Perhaps two cases in a hundred. By the time you're through med school, qualify for specialty training, and become both a surgeon and a urologist you're in pretty rare company already. Okay, I know there are a few bad apples, but for the most part even the bottom of the barrel is cream of the crop.

Also, I believe that a great surgeon can't keep a leaker dry. By this I mean that some people's urinary tract and muscle control is such that no surgical magic is going to keep them totally dry.

Please readers take into account that the above is the opinon of a total medical ignoramus.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/4/2010 3:44 PM (GMT -6)   
I think it is both, to be honest. A very good surgeon can make a big difference in the incontinene factor, but each body has its uniqueness and its own quirks. I don't believe there is a legit study/survey out, but have read somewhere, that incontinence can be worse with robotic surgeries as opposed to old school open surgery. if i can re-find what i read, will put out a link to it. wasn't that long ago that i read it.

david in sc

p.s. same article said that nerve sparing was better under the magnifiation of robotic surgery as a rule, but on the incontinence part, it was the tactile feel of the surgeons hand when the all too delicate bladder neck to the urethra is made in an open surgery. of course, you would still have to have a skilled surgeon in either scenerio.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/4/2010 4:06 PM (GMT -6)   
I think it also depends on the PC as well. If a patient has a high Gleason, and perhaps an EPE, or the PC os close to the edge, the surgeon is more apt to carve up the nerves a little more to be sure he got all of the PC. Better or more experienced surgeons can leave more nerves. Less experienced just whack the entire nerve bundle out.

I also have to wonder how a guy can be incontinent for 6 months and in 1 day be continent. I certainly wouldn't say that was the skill of the surgeon. It would seem that the patient was somehow able to master the kegaling and sphincter control.

It is certainly a riddle.
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,  9 month PSA < .01
1 year psa (364 days) .01


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/4/2010 4:21 PM (GMT -6)   
true, good life, then you have guys that are dry out of the box, and never do keagals, such is the contrary world of PC we live in
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/4/2010 5:42 PM (GMT -6)   
I was convinced that I could do kegels before surgery and afterwards and I'd have control in 90 days. If I didn't it would take three months. So, being lazy, I took the 'don't do it' route and it worked fine for me.

When the sphincter is ready, the close off will come.

Again, this is totally personal, unscientifically supported, shoot in the dark opinion.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6893
   Posted 7/4/2010 7:55 PM (GMT -6)   
I had a good surgeon, good prep, he had a good morning before surgery, but I had a bad, real bad set of post-op numbers. The guy he did the day before walked away without a drop. I'm 8 months out, and counting pads per day still.

I'd rather not know exactly why, unless it is something I can fix.

Gleason7
Regular Member


Date Joined Feb 2010
Total Posts : 111
   Posted 7/5/2010 6:24 AM (GMT -6)   
Incontinence:
Lets not forget that men, prior to surgical removal of the prostate, have the luxury of TWO sphincter muscles the uppermost being primarily responsible for controlling urine flow is REMOVED with the prostate leaving the remaining muscle at the floor of the abdomen which is intended to remain open when sexual arousal occurs. I personally wonder if the guys who claim to be totally continent are perhaps hedging on us a tad. I gave up on pads as unnecessary about two months post op but do have a surprise leak every once in a while with a sneeze, certain twisting motion, heavy lifting etc. Getting horny is another issue for me, with 50MG Siagra I'm back where I was prior to DiVinci removal but leak like a sieve which is enough to put a damper on the party! Normal activities, while I may feel I need to go more often I CAN make it without leaks.

74 years old - Gleason 3+4=7 - After third biopsy 2 of 12 positive at 30% and 70% - Vatikutti DiVinci @ Henry Ford 2/10/10 - nerves spared - margins, nodes, vesicles all clear. Three month PSA .06 - Six month PSA less then .06. Six month follow-up with Dr. Peabody tomorrow 7/16/10.
Other then "parties" life is very much as before PC. (forgot to mention my prostate was 106 grams or three times normal size), Never had any real issues with recovery except when the nurse removed the pubic catheter and my bladder went into spasm. OUCH!

Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 7/5/2010 2:20 PM (GMT -6)   
I've often wondered the same. I sure do envy you dry guys & guys who still get wood after pc.  I'm thankful for my two implants, but I still envy you.  Oh, how good it would be to unzip, pee, & zip back up like a normal male.  But... again, glad for implants.
Gene214
PC diagnosed 12-06 @ age 63
Radical open removal 2-14-07, Gleason 3+3=6
Post-Surgery psa  -- .011
Removal of stricture 6-07, incontinence continues
01-15-08 psa -- .05
AUS, IPP implanted 07-16-08
AUS, IPP activated on 08-18-08.  They both work!
10-20-08 went back to surgeon for a follow-up.  Both devices work well.
10-20-08 psa -- .05
05-15-09 psa -- .07
 


Gleason7
Regular Member


Date Joined Feb 2010
Total Posts : 111
   Posted 7/5/2010 6:10 PM (GMT -6)   
Posted this link in the other "incontinence" thread but others may come to this one so check this link out:
http://books.google.com/books?id=IZmhwzwGyuMC&pg=PA279&lpg=PA279&dq=prostatectomy+removes+upper+sphincter&source=bl&ots=lbeo1eh0HH&sig=
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