Incontinence and Surgical Technique

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Age 57  PSA 2.5  Gleason 5   Open Radical Retropubic Prostatectomy/Bilateral Nerve-sparing  6/21/06  Cancer confined to prostate  No further treatment

Hi TimG,   The skill of the surgeon is sooooo important! And your commitment to getting this little guy in shape for his new job is equally important!   An **excerpt from Dr. Walsh’s Guide to Surviving Prostate Cancer has been highlighted in our book!!!!   **Men are equipped with three separate anatomical structures that control urine – a sphincter at the bladder neck, the prostate itself, and the external sphincter.   Radical Prostatectomy knocks out two of these—the sphincter at the bladder neck and, of course, the prostate—leaving only the external sphincter to do the work of three.   **Because of the powerful structures upstream, this (external sphincter) is never tested or even used much in most men….   So you guys better take good care of (him)!!!   This is why the exercises (kegels, walking, stairs) are soooooooo important to strengthen this little muscle before surgery.   So ~ when it’s time for him to kick in and start working…. He will be ready!   The main thing our urologist told us is to “not overwork him”!!!   Nice topic Tim and a very important one J   Take care, Lee & Buddy mama bluebird ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~ Buddy 53 RRP April 3, 2006 PSA 4.6 Gleason 3+3=6 T2a Confined to Prostate June 29th PSA Less than 0.1 Non-detectable 

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Age 57  PSA 2.5  Gleason 5   Open Radical Retropubic Prostatectomy/Bilateral Nerve-sparing  6/21/06  Cancer confined to prostate  No further treatment

Hi Ed NJ…. The most important answer is … What does your doctor tell you to do? Obviously there are different opinions…   I would think this holds true for all… Before surgery get this guy in shape…. Like any type of exercise… you can over do it.   But since he’s never had to work before you better get him learning the ropes J   (I will check my previous postings to make sure they are clearer as to what and when we did them.  I will say that what ever we did prior and post has worked.  Buddy has had wonderful control from day 1 and continues to do so....)   Before surgery: Our urologist said to work the muscle when urinating… the start, stop, hold, start several times during urination.   This strengthens the muscle.   Also, walking stairs is a really good exercise.     After surgery we were to still do the kegels when urinating and stairs during his regular workout.   This is the only time Buddy does them.   EXCERPT:…..On page 247 of Dr. Walsh’s book he states: Exercises you can do :   Every time you urinate, do it standing up.   You can’t practice the following exercises, which strengthen the external sphincter and speed up your recovery of urinary control, while you’re sitting down.   Start your stream, and once it’s in full force, stop the stream by contracting the muscles in your buttocks --- not your abdominal muscles, not the muscle “up in front” around the penis.   Tighten your buttocks: imagine you’re trying to hold a quarter between your cheeks.   Hold the urine back for 5 or 10 seconds, and repeat as many times as you can.   Note: Only perform these exercises when you’re urinating; if you keep contracting these muscles throughout the day, you’ll overdo it—the sphincter tires easily—and you’ll end up wetter than you would otherwise.   Previous paragraphs address… things to speed up your urinary control.   One is not using any artificial devices…… and certain high blood pressure medication relaxes this muscle so you may need to check with your doctor.   Hope this helps!!! J Lee   mama bluebird ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~ Buddy 53 RRP April 3, 2006 PSA 4.6 Gleason 3+3=6 T2a Confined to Prostate June 29th PSA Less than 0.1 Non-detectable 

Tim G
where in the NW is your new doctor.
DWT

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mama bluebird

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mama bluebird

Hello Ed,

If it has been 17 days since your DaVinci procedure, and you have blader control enough to get up to go at night; then you are way ahead of the curve. Don't forget RLP is still a major shock to your body, and it will take a little time to repair itself, and re-regulate all of the diff. functions. I had the same experience, but my recovery was slower. Now everthing is about back to normal.

I found that walking was the best theropy, and going up and down steps was suggested by another member (if you don't have a bad knee like me). You must be doing the right things if you can lose 10 pounds, and keep it off. So I hope you continue to have a speedy recovery, and good luck.

Glen

Hi, Ed. My husb. is post-surg. five weeks now and still urinating much more frequently than before - a LOT in fact and during the night as well. Not drinking huge amounts of liquids, either, other than he's added apple juice to the routine. We are assuming it's going to slow down a bit as the healing completes itself.

Hi All,
It's been 9 weeks to the day since I had my operation and at last I think that things are starting to improve in I heading toward achieving full urinary control. I'm down to using just two pads a day now, and I'm finding that the Fleming Exercises ( you call them Kegels) are starting to pay dividends. I still get the odd bit of leakage every now and then, but that seems to be improving as time goes by.

I went back to my Urologist/Surgeon on 29th August and he told me that my PSA level was 0 and that the cancer had been encapsulated within the Prostate, and then he told me that I was basically cured. I still have to go back and see him at the end of February next year for a check up, but, basically that seems to be that!

As for getting an erection, well, that's taking a bit of time. I do get sensations down in that area every now and then, which hopefully means that things are heading back to normal. I haven't used any medications for it, my Urologist told me that if things weren't getting back to normal after 3 months or so that I should go back and see his specialist treatment nurse. Hopefully, I won't need to!

Regards to you all
Tim

After reading books and pamphlets, I expected that the Bladder Sphincter would be lost and the urethra would be reattached directly to the bladder.

Dear Ed,

Sorry, I copied that post from an earlier posting trying to get some understanding on how different doctors are doing the urinary track hook up. I had the operation on July 27th so it has been 7 1/2 weeks now.

I had the catheter in 7 days. The only problems I have with urinary control is that I must think when I do certain things such as yawning when I am sitting or testing my lower bowel for fullness when I am standing. I will lose a little urine if I am not careful. Honestly, I can go for a week without any leakage. I think what is happening is that I now have a little urine captured between the two sphincters and I relax the external sphincter for an instant. Before the operation the prostate was squeezing the urethera between the two sphincters and there was little urine captured or I learned as a child to drain the system properly.

It took my bowels about 5 weeks to get back to close to normal. I have passed some stringy dried blood and the other day I passed a bit of suture that was decomposing as was planned I guess.

It took me close to 6 weeks to get my energy level strong again. I am 68 and today I spend a full day doing carpentry on a commercial project. I live at 7300 feet and that job was at 5000 feet so that helped. I am tired, but not unusually so. I did a lot of bending, twisting, turning and carrying tools and stuff up to 35 lbs. I can probably lift 50 lbs without straining something for a short interval. I expect to be back at normal capacity of 60 to 75 lbs in two or three more weeks, but I am not pushing it. Pretty amazing really considering all of the work done.

Good healing,

Steve Bradley