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grunt
New Member


Date Joined Feb 2007
Total Posts : 10
   Posted 2/13/2007 4:29 PM (GMT -7)   
This sounds crazy but after surgery everyone speaks of leaking. Can't the leaking be restricted by some type of restaint around the penis?

hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 2/13/2007 5:03 PM (GMT -7)   
One of the muscles that control the stoppage of urination is located at the upper end of the prostate.  When the prostate is removed, and the bladder pulled down and reconnected to the urether, then your lower muscle is the sole control.  With Kegal exercises, both before and after surgery, you learn to use this muscle exculsively to control your flow.  I'm just two weeks post catheder, and am pretty much dry, with just an occasional drip - about ready to get rid of pads entirely.  Some take a long time to regain control, and even a very small few get an artificial sphintcer installed.  Trying to just restrict things at the penis level wouldn't help you learn this control, and I don't think it would work anyway.
PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5%
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery scheduled January 19, 2007


djhouston
Regular Member


Date Joined Jan 2007
Total Posts : 68
   Posted 2/13/2007 5:13 PM (GMT -7)   
Hi Grunt,
That isn't crazy. They actually make cushioned clamps that go around the penis. However, this is not a good idea for at least three reasons. One: you can imagine how it would show under one's clothes (a la "Is that a gun in your pocket or are you glad to see me?"); Two: you don't want to put back pressure on the tubes that come out of the kidneys into the bladder when the bladder contracts to start urination and there is nowhere for it to go but back up. You can really mess up your kidneys that way, and that can be a whole other life-threatening problem; Three: all the docs want people to learn to use the muscles on the floor of the pelvis to act as a urinary sphincter to take over for the one removed with the prostate, because this is more "natural."

They also make catheters that have a condom on them, and that have adhesive on the inside of the condom, so that you can put this thing on the outside of the penis and drip into a bag through an attached tube. Most docs hate those, too, because the inside of the tube and condom become breeding grounds for bacteria that can give you a heck of a urinary tract infection, with the possibility of messing up the kidneys, as well.

Good idea in principle but doesn't work that well in practice.
dj
dj's stats:
PSA (10/04): 2.9; PSA (2/06):4.4, on Androgel (serum T about 450) at age 56; negative DRE, no symptoms.
PSA (5/06):5.7 with a free PSA% of 8, OFF Androgel (serum T 163). 
Biopsy (5/06): 4/12 samples positive; postitive samples only on right side; max Gleason 4+3=7 (in 2 of the 4 -from area nearest bladder.
DaVinci robotic-assisted laparoscopic radical prostatectomy + bladder lift + Right nerve plastic surgery (8/23/06).
Catheter out 4 weeks postop, due to internal pinhole leak at bladder-urethra junction.
Final pathology report:T2c-both sides,but in capsule; neg. margins, neg. lymph nodes, neg. seminal vesicles; final max Gleason still 4+3=7.
Follow-up PSA (11/06): <0.008; serum T: 195 OFF Androgel (at present).


grunt
New Member


Date Joined Feb 2007
Total Posts : 10
   Posted 2/13/2007 5:19 PM (GMT -7)   
When the urge comes on to urinate after surgery is it hard to stop till you get to the bathroom? How do you stop from leaking I mean do you constantly need to supress the urge? Bear with me I'm going to have surgery and I'm trying to prepare myself to get back to normal as soon as I can. I just don't know what to expect'
AGE 56
PSA 5.6
GLEASON SCORE-7
T1cNxMx 

Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 2/13/2007 5:24 PM (GMT -7)   

Grunt:

There is such a device - it's called the Cunningham Clamp.   My younger brother has never regained complete control and uses this when he wants to make sure he has no "accidents".  He says it's not perfect, but better than being embarassed. 

Dutch

 


Diagnosed Feb 2001  (Age 65)
PSA 4.8
Gleason 3 + 3 = 6
T2
Completed Proton therapy @ Loma Linda - Aug 2001
5yr PSA   0.17
Have had no side effects.


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 2/13/2007 8:42 PM (GMT -7)   

    Grunt,  If your not doing Kegeals yet start doing them now.  Continue to do the as directed by your Dr. after surgery.  If you look at my Journal you will see I'm one of the  Unlucky few that has had leakage problems longer than most.  I am having a cystoscope on The 20th to see what is going on.  The Dr. may also do a colligen ingection if he thinks it may help.  Will update my Journal when I know more.

    I still use the Depends Underguards for men.  They slip into the front of your underwear.  At work when I'm on my feet all day I have to change almost every hour to make sure I don't have any "break out's"

    Good luck with your Journey.  KW

   

 


    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
    Gleason 7
    Biopsy - 3 of 12 positive (up to 75%) all on left side of prostate
    RRP on Oct. 17, 2006 - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 3 weeks due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00
    Office visit on Jan. 19th due to continued excessive urine leakage.
    Scheduled Feb.20th Cystoscope with possible Cottigen injection into bladder neck to help control leaking.
   


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 2/13/2007 9:10 PM (GMT -7)   
Grunt,

In my case immediately after surgery one of the biggest problems was the lost of the sensation that tells you when you need to go. Therefore, I would just time myself and go on a time basis. I first you begin to consciously tense your pelvic muscles to help stop the leaking or slow it down. My leaking was never continuous but came in spurts. When the spurt would start I could tense the pelvic muscle and it would stop. After about two weeks it became more of a subconscious act and I did not notice I was doing it. At about 5 weeks after I got my sensation back of knowing when I need to go. Today, at three and a half months after I am dry and almost back to the way I was before surgery. It will improve but unless you are one of the lucky ones you will have leakage for a while.

Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
Catheter out on 11/13/06
56 Years Old
Post Op Path
Gleason 3+3
Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 2/13/2007 9:48 PM (GMT -7)   

Hi Grunt,

 

Partial Quote:

This sounds crazy but after surgery everyone speaks of leaking. Can't the leaking be restricted by some type of restaint around the penis?

 

In response to your question above... 

 

Excerpt from Dr. Walsh’s Guide to Surviving Prostate Cancer ~ Page 246

 

Can you do anything to speed things along, and improve your urinary control?

 

First, whatever you do, do not wear an incontinence device with an attached bag, a condom catheter, or clamp!  If you use any artificial device, you will hurt yourself in the long run.  You won’t be able to recover your urinary control, because you won’t develop the muscle control you need.

 

(reference to Dutch’s posting ~ yes there are devices out there but the key wording in his post is  “brother has never regained complete control”…  this is when other options come in to play if you are one of the ones who do not regain control… But….. we think positive!!!  The most important words we can share here is….  It takes time and you best prepare yourself in advance by starting exercising immediately… )

 

Excerpt from Dr. Walsh’s Guide to Surviving Prostate Cancer ~ page 244

 

Why does incontinence happen after radical prostatectomy? 

 

**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….

 

There is so much information in regard to Long-Term Issues: Urinary Continence in his book that I would highly suggest you get at least 1 book….  There are several listed in this forum and eventually I’m going to place them on the Helpful Hints… page…

 

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!

 

In any case…. get the little guy ready before surgery day… !!  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”!!! 

 

You’ve had some wonderful responses now you need to start exercising and getting prepared for whatever treatment you choose.

 

Our thoughts are with you and will remain with you as you search for answers.

In New Friendship ~ Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

Link to our personal journey…>>>     Our Journey ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)


USMC Retired
Regular Member


Date Joined Oct 2006
Total Posts : 29
   Posted 2/14/2007 6:09 AM (GMT -7)   
Grunt,
During my last physical therapy session concerning Kegels before my surgery I asked the therapist is I would have to conscienouly think about stopping the flow. Her comment was by doing the kegels now you are training your body - both that muscle and the mind - to know when the time comes that it must start doing the work the prostrate was doing. I thought OK I should of started sooner because I am a slow learner. Well, I will tell you when that cathetor came out I had leakage one time and after that the durn muscle has been doing it job. And believe me after living with a swollen prostrate for a couple years that restricted urine flow that muscle when it comes to release I am streaming like a teenager again. To bad the rest of the body does not perform like that age again.

Bottom line - do the kegels!
Mac & Donna
 
Age - 59 (barely)
PSA - 4.4
Oct 3, 2006 -> Biopsy - 3 of 8, Gleason - 3 + 3 = 6
Oct 12, 2006 -> CAT & Bone scan - both clear
MRI - Nov 14
Treatment - Da Vinci (Dec 13 2006)
Returned Home Dec 15, 2006.
Dr said it looks successful, save nerves on both sides.
Dec 21, 2006 -> Cathetor OUT
Jan 22, 2007 -> PSA <.04, margins zero, nodes(11) zero

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