Posted 1/8/2007 4:34 PM (GMT -8)
Hi Ben,
I'm new to the website, but have found a lot of support and information here. It is good to share experiences here and know that one is not alone in going through this,and that others may have had similar situations or questions that, as time went on, they got answers to, and could pass along to others.
I am 4 months out from a robotic radical prostatectomy. My final pathology staging was T2c, cancer on both sides but according to the report negative margins, nodes and vesicles, with a final Gleason of 7. My first follow up PSA was undetectable, thank God. One of the nerves had to be cut into, and the doctor did a nerve graft. The sensations and status of the graft's healing are the topic of another thread in this forum.
Therefore, because of the nerve injury, I am not getting any firmness out of even 100mg of Viagra, or even the pump. From what I have been told, it may be 6-12 months before that happens. However, the pump is good for inflating the penis in order to keep the erectile tissues elastic. One can use it in combination with the full dose of Viagra. With this level of enlargement, you can use a condom, and if you use the tension ring over the condom at the base of the penis, you may be able to contain the leakage, and something with enough substance to have an orgasm. Even with the one nerve cut, and without a full erection, I am able to have orgasms, and they are more intense, pleasurable, and last way longer (sometimes like over a minute!) than before the operation.
Everybody is different and has different effects from this surgery, but I wanted to make sure you are doing the Kegels correctly. They are not simple to understand or do. In addition to being a patient, I am also health care provider who used to work with women who had bladder leakage of the type that happened when they laughed, coughed, or exercised. This came from weak pelvic floor muscles that sagged and caused the channel out of the bladder to be pulled open. This is similar to what happens to men after they have their prostates removed and lose a natural barrier that holds in urine. The women patients accomplished the restoration of muscle fitness with the help of biofeedback, which is the use of a signal that indicates the strength of the pelvic floor muscle tension. Dr. Kegel was an OB/GYN who published his exercises in the late 40s. He developed one of the first biofeedback apparatuses which was an elongated rubber bulb that fit into the woman's vagina. When she would do the exercise correctly, air in the bulb would be pressed out through a rubber tube and be registered on an old time mercury blood pressure meter such that the more tension the muscle would produce, the higher the mercury would register. He said in his report that it would be very difficult for anyone to do these exercises without the meter. However, the measurement was cumbersome, and people got out of the practice of using it, until electronic biofeedback was developed thirty years later.
When I initially work with patients, I find that they tense every muscle but the correct ones and I have to show them with the instrument which one they need to isolate and which muscles not to use. Most people tense their abdominal, or thigh, or buttocks muscles, and these are all wrong. Tensing the abdominal muscles are especially bad because when these tense, they press on the bladder, and force more liquid out the bottom. The correct muscles are internal and they are hard to get a feel for. The best way to isolate these is to think back about how you would stop the flow of urine if you were standing and urinating. This is the muscle that you would use; it makes up a hammock-like sling that is the floor of the pelvic cavity. The actual exercise is to try to lift or pull up this muscle, and not try to squeeze it like you were trying to keep gas from passing. That only exercises the ring of muscles around the anus. The lifting exercise one would do with pelvic floor muscles is kind of like weight lifting. If done correctly, it bulks up the pelvic floor muscles so that they don't sag and they close the channel out of the bladder both with increased bulk around the channel and with stronger tension. You can, as someone above said, overdo the exercise and cause the muscle to fatigue so that it doesn't have any strength or holding power at all.
A good website that explains this in more depth is www. incontinet.com, which was established by Dr. John Perry who has done a lot of research in this and developed a lot of the methodology for biofeedback therapy for this condition. He also has a list of biofeedback therapists all over the country, and it may be worth it to go at least for one consultation to see if you are doing the exercises right. If you already have been seen by someone who said you are, then my apology, but for others that are reading this thread that are trying to do them and not getting very far with the results, this might be something for them to consider.
Just a thought.
dj