Prevail SV10 said...
My point is obvious - I firmly believe that if you select your surgeon with care and don't require "mop up" RT you should have a very high chance indeed of not suffering incontinence following surgery.
My surgeon is one of the most highly respected and well experienced with RALP in th U.S, having done over 6000 surgerys. He's told me flat out that incontinence will not be an issue, and to just remember that I may need to be a bit patient, but it will be resolved, in all likelihood.
Though these are good points, and I feel you should definitely research and put the odds in your favor as much as possible, there simply are no guarantees. Which I think you both already know, but just in case you don't.
I chose a guy 4 hours away who had done 4000+ robotics plus several thousand
opens, and is a very widely published nationally known expert on both RRP and prostate cancer in general. He told me he would not be able to spare nerves as he would have to cut quite wide on one side and a little wide on the other side, so no guarantees as to nerve sparing. But, he said his incontinence rate was about
2-3%. Immediately before the surgery he told me(unless I hallucinated it from influence of pre-op drugs) that he did not expect me to ave any trouble with incontinence. In retrospect I suppose what he meant was "after 1 year". When I saw him at the 7 week checkup and reported how incontinent I was, he told me I had a really big prostate(107gms) and that this typically slowed recovery down, but did not really decrease odds of full recovery. Plus, he said the single best guarantee of being continent sooner or later was sleeping dry at night from the beginning, which I have done from day 1. I am in my 11th month, and am mostly dry most of the time. Vastly improved. But I still must be careful when up and around, to be on the alert
for any sudden slight stress so that I can clamp it down before the stress or I will push some out. With a strong sneeze I really need to cross my legs and well as Kegel for any guarantees of holding it all in. So, I still need a pad for security. I will be one year on Feb.19.
Now here is the main point: I was considering a rock star surgeon down in FL who has done over 6000. I have seen his published stats showing Trifecta(continent, potent and BCR free) rates of 86% at 1 year and 91% at 18 months. Even 80% at 6 months! Still, there is a brother here- Big Mac - who used the same world famous guy. ( my local URO said that surgeon is probably the most experienced in the world!) Still, he ended up having an AUS installed for his continued bad incontinence after almost 2 years. I'm not certain, but I think he has had his share of problems with ED also, and had positive margins to boot even though he was only a G6 going in(G7- 3+4- after surgery path report).
Now no doubt this Doc is probably about
as good a surgeon as you could hope for, one of the best in the world. Still, no one is perfect, and when it comes to trying to take out a cancerous gland where it is snuggled in tight with all those nerves and muscles and when you are going to remove one of 2 sphincters, there simply are no guarantees. Good odds yes, guarantees, no.