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RCS
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Date Joined Dec 2009
Total Posts : 1247
   Posted 11/22/2010 9:32 AM (GMT -6)   

Pelvic floor exercise versus surgery in the treatment of impotence.

Claes H, Baert L.

Department of Urology, Catholic University, Leuven, Belgium.

Abstract

A group of 150 consecutive male patients with erectile dysfunction and proven venous leakage were randomised either to surgery or to a pelvic floor training programme. The operative procedure consisted of dissection and removal of the deep dorsal vein of the penis and its tributaries or large veins that drain into the internal or external pudendal system. The training programme was given 5 times, in weekly sessions, and the patients were supervised by trained physiotherapists. Surgery was not superior to the pelvic floor training programme either subjectively or objectively. Moreover, a significant improvement was found following the training programme; 42% were satisfied with the outcome and refused surgery. Pelvic floor exercise is a realistic alternative to surgery in patients with mild degrees of venous leakage.


PSA 2007 - 2.8; 11/24/2008 - 7.6; PCa Dx 2/11/09; age at Dx 62; RLP 4/20/09

Biopsy - Invasive moderately differentiated prostatic andenocarconoma; G 3+3=6; PT2C; No evidence of Seminal Vesicle or Extraprostatic Involvement; Margins clear; Tumor identified in sections from prostatic apex. 70 gram prostate. Continent after removal of cath.

ED - Trimix works well; levitra @ 90%
PSA - 7/31/09 <0.06; 12/1/09 <0.06; 3/29/10 <0.06; 8/4/10 <0.06

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/22/2010 9:36 PM (GMT -6)   
I've also seen this in many places...that Kegels helps enhance male sexual performance. It's probably not going to turn a "0" into a "1", but like many of the other factors within our control (diet, exercise, stress relief), it will likely make a noticable differenct in a signficant proportion of men. I have continued to do Kegels (albeit less frequently) even though I became fully "dry" less than 4-months after surgery. I don't know if it's helped make my erections better, but I'm pretty happy with them. On the other hand, you will undoubtedly run across the naysayers who say (despite the studies to the contrary) that you are wasting your time and you are better off doing nothing. To me, if it's essentially a "free" benefit and seems like a smart thing to do anyhow (like diet, exercise, stress relief), then count me in! Hope that you also get some benefit.

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 11/23/2010 4:30 AM (GMT -6)   
RCS,  I can't believe you found this old study.  I've had intractable ED problems for 20 years and ran across this study many years ago.  I started Kegels long before I even knew I had PCa.  They helped a little but the venous leakage was just too much to overcome.  I had a classic symptom of venous leakage: the ability to get an erection but inability to keep it long enough to have any fun.  But, the Kegels paid off with a quick regain of my continence after surgery.  I do them regularly every day.
 
Carlos

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 11/23/2010 4:42 AM (GMT -6)   
I think this study also related to "normal" ED rather than that due to RRP surgery. (I'm not sure surgery to tackle venous leakage can do anything for a PCa guy with ED.)

There is a software/hardware issue with ED (no pun intended)
The nerves (software) have to work (and still be there) to send the messages while the muscles and blood-vessels (hardware) have to work to get and keep the blood in the right places for the right amount of time. (If the nerves aren't sending the messages or can't send them a different approach is needed
Kegels definitely have a role though as it is obvious to me that some of the same muscles used in kegelling are the ones that make my erection "bounce". (Confusingly for me, kegel in Dutch is a bowling pin!)

Anything that reguarly gets blood in the penis is good too.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 11/23/2010 7:27 AM (GMT -6)   
Bottom line - Kegels help with many facets of life. The pelvic floor holds it all together.
Kegels definitely help with ED post PCa surgery. If you kegel with an erection, you can feel the engorgement increase quite a bit. This exercise can even help with venous leaks since the increased engorgement helps put pressure on the veins and can clamp them closed.
During ED therapy, pump everyday and Kegel while in the pump, and even as you remove it. One of the best techniques is to kegel and hold it while removing the pump and see if the draining of blood is slowed down. With most men, there is a noticeable difference.
These old studies are still true!
Paul
www.franktalk.org ED website for PCa guys

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.
Two year PSA - undetectable!

Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 11/26/2010 1:34 PM (GMT -6)   
Interesting. I've never heard or read of the connection beween Kegels and ED. My own Surgeon/Urologist says kegels may not help incontenence, but he recommends them because that's what the literature recommends. He said he hasn't seen many results that back-up those incontenence-relieving statements. If there's no additional studies, other than the one referenced here, then I wouldn't put too much emphasis on the ED-assistance claims. Doing the Kegals probably won't hurt anyone, though, and that's why so many physicians recommend them.
Age: 61 (58 at diagnosis - June, 2008)
April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior
June '08 had biopsy, 2 days later told results positive but in less than 1% of sample (Gleason's 3+3=6)
Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days
Dr. recommended robotic removal using da Vinci; Surgery 9/10/08
Northwestern Memorial Hospital, Chicago, IL; Dr. Robert Nadler, Urologist/Surgeon
Post-Op Gleason's: 3+3, Tertiary 4; Margins: Free ; Bladder & Urethral: Free
Seminal vesicles: Not involved; Lymphatic/Vascular Invasion: Not involved
Tumor: T2c; location: Bilateral; Volume: 20%; Catheter: Removed 12-days after surgery
Incontinent: Yes (1 to 2 light (woman's style) pad per day)
ED: Combination of Cialis and MUSE (alprostadil) once weekly: started 9-27-08
Returned to work 9-29-08 (18-19 days post-op)
PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0; 3/10: 0.0; 9/10: 0.0

Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1404
   Posted 12/2/2010 3:25 AM (GMT -6)   
The training programme was given 5 times, in weekly sessions, and the patients were supervised by trained physiotherapists. Surgery was not superior to the pelvic floor training programme either subjectively or objectively.
 
I have asked this question (about the program) a few times with no response.  I was happy to read this article even though it wasn't directly involved with PCa.  My husband just completed 8 weeks of this training.  It has helped somewhat with his incontenence, but the ED still exists.  We are going to try the Cialis.  The exercises have made him seem stronger in the pelvic area.  Believe me the program involves more than just Kegels.  That's the first two weeks.  He has several pages of exercises to build up the pelvic floor.
 
Paul, I don't know anything about the pump.  My husband isn't interested in it.  In time, he may change his mind.
 
We'll see how this works out.
 
Aimzee


Husband Ron, age 63
4/1/10 PSA 5.5 Prostate size = 50 grams
Biopsy on 4/20/10 12 samples... Adenocarcinoma: 3 positive on right side, one core left base (5% ` 0.5 mm) - two cores of left lateral mid
(20% ~ 2mm, 10%, 10% ~ 1mm) - No Perineural Invasion
Gleason 6 (3+3)
Bone Scan/CT Negative (2 lesions on liver)
8/18/10 - Da Vinci Prostatectomy
Post Op: Gleason 7 (3+4)
Negative surgical margins and lymph nodes
Both nerve bundles spared
Catheter - 13 days
ED / Day time incontinence.
Going to rehab to build up Pelvic floor
Post Surgery PSA 8 weeks - .01

Post Edited (Aimzee) : 12/2/2010 2:30:09 AM (GMT-7)


RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1247
   Posted 12/2/2010 7:19 AM (GMT -6)   
Aimzee,
 
I would like to try exercises (beyond kegels) to strengthen the pelvic floor.  Do you have any references on these exercises?

Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1404
   Posted 12/4/2010 3:03 AM (GMT -6)   
RCS, I am posting a portion of a previous post elsewhere.
 
Ron had his rehab session, and it wasn't quite what he expected.  The medical therapist did a complete and thorough exam on him.  He did some Kegals and she told him he was doing them wrong.  It should be a softer movement, and recommended doing them while laying down.  No, not 100... but 10 Kegals,  three times daily.  More harm can be done if not done properly.  His pelvic floor is very weak and muscle tone is not strong. In addition, Ron received a list of bladder irritant foods; most of what he loves to eat is on that list.  
 
Now, this week she recommended the book Headache in the Pelvis by David Wise, PhD.  It is heavy reading but does show why she does these manipulations. 
 
There are exercises in the book.   He actually checked the book out of the library. The 8 weeks of rehab have helped with the leakage which is none at night and very mild in late afternoon.
 
Now get this... the exercises he does are very similar to the ones that pregnant and post-pregnancy women do!! blush    For example, laying on your back, knees pulled towards your chest, then out a bit, and lift your pelvis off the floor.  Another one he has this huge rubber band thing which he wraps around his knees, then he has to spread the knees apart.
 
Honestly, these exercises are great for both men and women.  Being a bit older, he really needed these and they do work.  Ron is not over- weight, and walks 4 miles, twice daily.  You can also get some ideas from a pregnancy website.  :-)
 
Thank you for bringing the article up because no one seemed to be talking about pelvic floor exercises.   Ron started noticing a difference at around 6 weeks.  He had his last session this week.  He believes this will help with ED some time in the future.
 
Good luck with this, RCS!
 
Aimzee
 
 


Husband Ron, age 63
4/1/10 PSA 5.5 Prostate size = 50 grams
Biopsy on 4/20/10 12 samples... Adenocarcinoma: 3 positive on right side, one core left base (5% ` 0.5 mm) - two cores of left lateral mid
(20% ~ 2mm, 10%, 10% ~ 1mm) - No Perineural Invasion
Gleason 6 (3+3)
Bone Scan/CT Negative (2 lesions on liver)
8/18/10 - Da Vinci Prostatectomy
Post Op: Gleason 7 (3+4)
Negative surgical margins and lymph nodes
Both nerve bundles spared
Catheter - 13 days
ED / Day time incontinence.
Going to rehab to build up Pelvic floor
Post Surgery PSA 8 weeks - .01

Post Edited (Aimzee) : 12/5/2010 3:56:10 AM (GMT-7)


RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1247
   Posted 12/4/2010 6:58 AM (GMT -6)   
Aimzee,
 
Thank you for the information and the reference to Wise's book!  I will be going to the library today.

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 12/4/2010 7:23 AM (GMT -6)   
RCS,  The National Assoc. for Continence has a good article on pelvic floor exercises and illustrates a couple of the ones Aimzee was talking about.  Here is a link to their web site: National Association for Continence 

http://www.nafc.org/uploads/pdf/Pelvic_floor.pdf.  Hope this helps some.

 

Carlos


Diagnosed 2/2008 at age 71, PSA 9.1, G8 (5+3), stage T1c.
Robotic surgery 5/2008, LFPF at 6 wks.,nerves spared, stg. pT2c, N0, MX, R0, G8 (5+3)
PSA .12 at 2.5 years, rechk 2 wks later 0.2. All prior tests <0.1.

maltratado45
Regular Member


Date Joined Jun 2010
Total Posts : 84
   Posted 12/4/2010 7:46 AM (GMT -6)   
It is my opinion that kegels are good for both sexes as we age.  I actually was lucky that I was a working carpenter my whole life before prostate cancer. I never did have a sitting type job.
 
My floor muscles were is good shape and I simply maintained the status quo after surgery.  We both did kegels before surgery.  Sometimes alone but also joined together.  My Urologist said kegels produce noticable improvements in his other patients erectile response and overall sexual life improvement.  He said for those just starting a routine 8 - 12 weeks should begin to show results so be patient.
 
If you don't have a routine, START ONE.  Google "Kegels" and pick from the many resources one that you can live with.
 
Jim

*Age 60 when presented to GP on 3 Aug. 2004 with elevated PSA of 13.8.
*Referred to Urologist. Biopsy and bone scan in Oct 04.
*Pathology report in Nov 04. Initial Results are T2cNoMo carcinoma of prostate gland.
*Had a RPP on 14 Feb 2005. Boy talk about irony look at that date again.
*Dr. called 3 days after surgery. I want you both in my office tomorrow morning, we must talk now.
*"I wish to apologize because I misdiagnosed your condition. Biopsy of your organ says Staging is T3bNoMo. Please accept my apology."
*At that moment I fell in love with my Dr. and have never changed my mind.
*Followup radiation of the prostate bed started early June 05 and ran 42 sessions.
*All PSA checkups to date, 5 1/2 yrs, are undetectable.

Post Edited (maltratado45) : 12/4/2010 6:44:30 PM (GMT-7)


Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1404
   Posted 12/5/2010 5:18 AM (GMT -6)   
Thank you, Carlos for the link!  It is a good resource of information.
 
Yes, Jim the exercises and help both men and women.  This is a good topic for this forum.  My husband plans to continue doing the exercises indefinitely!
 
Best regards,
Aimzee
Husband Ron, age 63
4/1/10 PSA 5.5 Prostate size = 50 grams
Biopsy on 4/20/10 12 samples... Adenocarcinoma: 3 positive on right side, one core left base (5% ` 0.5 mm) - two cores of left lateral mid
(20% ~ 2mm, 10%, 10% ~ 1mm) - No Perineural Invasion
Gleason 6 (3+3)
Bone Scan/CT Negative (2 lesions on liver)
8/18/10 - Da Vinci Prostatectomy
Post Op: Gleason 7 (3+4)
Negative surgical margins and lymph nodes
Both nerve bundles spared
Catheter - 13 days
ED / Day time incontinence.
Going to rehab to build up Pelvic floor
Post Surgery PSA 8 weeks - .01
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