I will try to answer your questions to the extent of how I understand things.
1. the internal sphincter is actually removed as it is encapsulated and/or part the prostate. How these two sphincters work is interesting. The internal sphincter ( the one you are now missing) is an involuntary muscule. It is controlled thru an interaction with the bladder among other things. So, when your bladder gets filled to certain level, your involuntary system
opens the internal sphincter letting urine pressure play on the external sphincter. This causes you to feel like you need to pee, you do not feel that urgency until the involuntary sphincter
opens even though there may be some urine in your bladder. Now you decide to pee and you consciously
open the external sphincter and you pee. The internal sphincter is important for continence but not mandatory as women have only the external sphincter as we do now. As you said, the prostate and maybe some other sensations that you have during an errection tell that involuntary not to
open while you have an errection, so fluid from the prostate can be ejaculated so that you can impregnate, hopefully, your wife.
2. I don't know, I am guessing a little of both. more strenght and retraining?
3. Me too. Now I have a stream like I had in my twenties. Others have reported the same. My stream pre op was low which I contribute to enlarged prostate and it had been for years. Why? some restictions like the whole prostate and at least one sphincter is removed.
4. urodynaics should nail things down for your next move. In my case my Dr. had only one recomendation, AUS. And he saw no point in my waiting whereas he normally likes to wait till 14 months post RP, I was only about
10 at that time. The AUS was installed about
2 months later. It works very well.
Now, this is my take on what I would or did do. I was exactly as you describe and did the PT like you. But in my case my leakage (dripage) was 100% or in other words I never peed one time from my surgery till my AUS it all leaked when I walked. At nite or sitting I did not leak that much. If I was able to pee, even a little I would have felt that I had something to work with. Worried Guy had the sling done about
the same time as my AUS and I think that fact that he did pee probably more than he leaked made him a canidate for the sling. I hope he will fill more on this.
My urodyanmics test revealed stress incontinence and appartently my external sphincter can hold hardly any pressure. Now, also like you I could start and stop urine flow with concious effort but I think it must be and stay closed in its "at rest" state. Mine didn't.
I also was put on Imipramine by my surgeon to see if bladder spasms or contactions were causing my incontinence. I took that stuff for months and it did not make me feel good and was a total waste. I think to get a better feel of where you are, I would only count pads if you are retaining enought urine in your bladder so that you are peeing some. I thought I was getting better at about
6 months out till it dawned on me that maybe I was using less pads but never retaining any urine, then the number of pads don't mean anything other than how you manage your fluid intake and activities. I hope you are not in that or my category. Anyway, I know what you are going through as do a number of others here on this site. I had my RRP on 12/15/09 and had the AUS 1/11/11. The urodynamics testing and implantion was done at Methodist Houston by Dr. Boone who is a well respected incontinence specialist.
06-08 1st biopsy neg psa 4
10-09 psa 5.5 2nd biopsy 1/12 pos. 10%, G(4+3) age 65
12-15-09 RRP Tulane NOLA Dr Lee
Path, 1%, clr marg, no EPE, no SVI, nodes cl, G(4+3)
100% incontinent @ 12 months
ED, pre-op severe, post op total
10/10 Dr Boone, Methodist recomended AUS
AUS/ IPP performed 1/11/11 Methodist Houston
post op psa's 0.04,<0.1,<0.1,<0.01@12 mo.
Post Edited (knotreel) : 4/18/2011 9:15:46 PM (GMT-6)