The degree to which the treatment of the bladder neck during prostate surgery impacts the recovery of continence is a contentious topic right now. On one side of the debate are doctors who try to spare as much of the bladder neck as possible to facilitate recovery of continence. On the other side of the argument are those who promote cutting wide if there is any risk of a positive margin at the bladder neck, claiming that a reconstructed bladder neck causes no more incontinence problems that a spared bladder neck.
If you want to read about
the controversy, here are two reviews of the research:Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate CancerBladder neck sparing in radical prostatectomy
Both of the above reviews complain about
the quality of the evidence but they both come down on the pro-bladder neck sparing side, if somewhat half-heartedly.
On the other hand, here is an abstract for a recent study that finds the opposite:The Null Effect of Bladder Neck Size on Incontinence Outcomes after Radical Prostatectomy.
So, the takeaway for you is... the bladder neck thing might
have something to do with his slow continence recovery but there is no reason for you to care. What's done is done.
63 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd
opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5)
Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015Forum Moderator - Not a medical professional