Incontinence - Artificial Sphincters and Slings

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Berb
Regular Member


Date Joined Mar 2007
Total Posts : 93
   Posted 8/2/2007 2:25 AM (GMT -7)   
Anyone had an artificial sphincter or sling fitted?

7 months out from surgery and my day time incontinence has not improved - still averaging 8 pads a day, more on weekends when I'm out and about.

I just had a urodynamic study done. This measured the sphincter pressure and looked at the bladder under x-ray in various conditions. The conclusion of the urologist based on the tests he did was that I have a weak sphincter (despite my extensive and diligent kegeling in all it's various forms), and it is unlikely that additional time or exercises would bring about a return to normal continence. I'll be visiting the surgeon who did the operation to discuss these finding with him, but on the balance of probabalities, it it likely that sometime in the next 12-18 months I will be a candidate for either the artificial sphincter or the sling.

I've read about these in Scardino's book and also Walsh's latest book; however there's nothing like hearing first hand from people who have had this done. Would appreciate feedback from anyone who has had one of these fitted.

Regards
Berb
59 years old
Da Vinci surgery Jan 10, 2007, nerves spared
Pre surgery PSA 8, Gleeson 3+4=7, T1C, 3 out of 12 biopsies had cancer
Post surgery pathology says no cancer outside prostate
Complication 1 - urine favoured drain tube over catheter, extra time in hospital, catheter in for 2 weeks
Complication 2 - urinary tract infection - Citrobacter (hospital bug), 6 weeks anti biotics cleared up
Complication 3 - fungal growth on genitals (candida albicans) probably from antibiotics
PSA test 10 weeks after surgery - PSA undetectable


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 8/2/2007 4:28 PM (GMT -7)   
Hi ~ Berb,
I just got off the phone with a friend..... her 75 year old brother has the sling...
He says "It was a life saver".... he's back working in the school cafeteria but must remember not to lift anything over 10lbs... or he leaks. He had a surgical procedure done (she's not sure what it was... but didn't work)... then he had the clamp which caused him a lot of pain.... and the sling was the last attempt ~ and it's working great!!!!
He is very hard of hearing and would not be able to converse over the phone.
I thought I'd share this with you.... Keeping you close in thoughts and prayers as you continue to move forward.
In Friendship ~ Lee & Buddy

mama bluebird - Lee & Buddy… from North Carolina

J  We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

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

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

 


Berb
Regular Member


Date Joined Mar 2007
Total Posts : 93
   Posted 8/3/2007 2:48 AM (GMT -7)   
Thanks for taking the time to find this out for me Bluebird.
Regards
Berb
59 years old
Da Vinci surgery Jan 10, 2007, nerves spared
Pre surgery PSA 8, Gleeson 3+4=7, T1C, 3 out of 12 biopsies had cancer
Post surgery pathology says no cancer outside prostate
Complication 1 - urine favoured drain tube over catheter, extra time in hospital, catheter in for 2 weeks
Complication 2 - urinary tract infection - Citrobacter (hospital bug), 6 weeks anti biotics cleared up
Complication 3 - fungal growth on genitals (candida albicans) probably from antibiotics
PSA test 10 weeks after surgery - PSA undetectable


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 8/3/2007 10:16 AM (GMT -7)   

  Just a question here.  Have you been to a bio-feedback therapist.  After 6 months I found out that I was not working the pelvic floor muscles doing my Kegeals.  You might look at that before the sling.

    Good Luck,  Let me know how you do.  I'm still leaking as much as you!

    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.
    Feb.20th Cystoscope and 2nd Post Op PSA. Another 0.00.....:)
    Dr. said everything looks fine.  Continue to work Kegeal's. Leaking appears to have improved  after Cystoscope?!?!?!  Down to 3-4 pads per day!
    March 1st  Leaking has crept back up to 6 - 8 pads a day ??????? 
    March 8th Started Detrol LA to see if it helps with the leaking?
    March 29th Collagen injection into sphincter / bladder neck area to control excessive leaking.  Worked for a couple of days then back to leaking.
    April 17th (Six Months Post Op) 2nd Collagen Injection to control excessive leaking.  Leaking started back next day at work!
    May 14th Second Opinion about my leaking and Options at OU Medical Center.  After reviewing my records the Dr. feels I will probably need some surgical intervention to stop my leaking.  But did agree to try Bio-Feedback and work hard on the Kegeal's first!
    May 30th Follow up with my Dr. and 3rd Post Op PSA 0.00 agian!!!
    June 1st Start Bio-Feedback to try to control my leaking.
   


Berb
Regular Member


Date Joined Mar 2007
Total Posts : 93
   Posted 8/3/2007 2:54 PM (GMT -7)   
Hi KW.

I've been to a continence physiotherapist and discussed bio-feedback with her. She tested my pelvic floor muscles by pressing on my perineum and asking me to tense the muscles. She said they were very strong - the strongest she had come across in fact (no doubt due to my intensive kegaling), and concluded that I was doing the exercises correctly. Instead she suggested I try neuro-stimulation, so for 6 weeks I placed a probe in my rectum for 30 minutes a day to provide electrical stimulation of the pelvic floor muscles (lots of fun). It did not help.

Despite what my continence physio says, bio-feedback is definitely on my list of things to try. I've been following your story with great interest, and was hoping by now to have seen some comments from you indicating that things are improving as a consequence of your bio-feedback. Have you seen actual tangible results in any way as yet? Has your pad usage decreased? Can you hold any urine at all in your bladder when standing or moving around?

The real question for me (and probably for you given your age) is this: how is it that a strong, very fit, healthy, young (59 is young for prostate) person could fall into the small group of men who are not continent by 6 months? My urologist had told me that by an large the people who fail to regain continence are those who had prior continence problems, or who were overweight or diabetic or were older. None of these apply to me. So what is different with me?

He said to me that prior to surgery, each person's anatomy relied to different levels on the combination of internal sphincter and external sphincter for urinary continence. For most men, the external sphincter did most of the work, he said. It is possible, he said, that in my case the internal sphincter carried a larger part of the load, and now that it is gone, my external sphincter is not capable at this stage of taking over 100%.

I read on the internet (http://www.drcatalona.com/quest/quest_spring03_2.htm) where Dr Catalona says "A recent study at Memorial Sloan Kettering connected the length of the sphincter before surgery with how quickly continence returned after surgery. The external sphincter muscle squeezes the urethra, enabling it to retain the urine until the sphincter releases its hold. Its action is both involuntary and voluntary. The effectiveness of the sphincter is a combination of length and strength. The longer it is, the more efficient it is. The stronger it is, the more effective it is. Patients can not control how long their sphincter muscle is, but they can contribute to how strong it is by doing Kegel exercises as recommended by their doctors both before and after surgery."

I have been extremely diligent in doing my kegals. I've tried all the various suggestions for these exercises that are to be found. I don't think I could have done more in this respect. So perhaps I happen to have been born with a shorter than normal external sphincter. My urologist once said to me that men who are lean of build (I am an ultra-marathon runner and fit that category) sometimes take longer to recover continence because while they may have strong muscles, their muscles are not bulky. As a consequence, it may take longer for this bulk to build up. He's still surprised however that there has been zero improvement in my day-time continence. Night time has definitely improved. I used to fill a pad through the night and sometimes two. I now lose only a few spoonfuls of urine into a pad overnight. So with evidence of some improvement, and I'm not going to move prematurely into surgery until I've exhausted all other avenues.

My plan is to use the next 12 months to continue the process of gaining knowledge and exploring alternatives. The sling and the artificial sphincter are last ditch alternatives. It was pleasing to hear from Bluebird of a happy sling example. I'm a bit concerned about the 10 pound restriction on on lifting though - that would cramp my present active lifestyle.

Sorry to all that this has gone on a bit, but it may be helpful to others.

Regards
Berb.
59 years old
Da Vinci surgery Jan 10, 2007, nerves spared
Pre surgery PSA 8, Gleeson 3+4=7, T1C, 3 out of 12 biopsies had cancer
Post surgery pathology says no cancer outside prostate
Complication 1 - urine favoured drain tube over catheter, extra time in hospital, catheter in for 2 weeks
Complication 2 - urinary tract infection - Citrobacter (hospital bug), 6 weeks anti biotics cleared up
Complication 3 - fungal growth on genitals (candida albicans) probably from antibiotics
PSA test 10 weeks after surgery - PSA undetectable


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 8/3/2007 4:39 PM (GMT -7)   

Hi ~  Berb,

 

Since March you’ve posted 15 times and we’ve never formally welcomed you…  I hope you don’t mind me doing so at this time!!

 

      Welcome to…

                         HealingWell

                                        and      A   Special   Warm Welcome  to  You!   yeah   

 

Your posting is exactly what we need from members like you, KW, and others who are still battling incontinence.  We definitely need to share this because obviously you aren’t alone and others may come forward as they read your postings…and you can each learn from the other as to what’s out there to help.  Something that could very well work for you!

 

Thank you ~ for taking the time to put together a really informed posting… Long???  It couldn’t have been shorter  and the Subject Title is perfect!!!!  This will definitely let others know what this thread is about…. Very important to have a nice clear title…

 

Buddy & I have always felt that we need to protect the sphincter muscle from any undue activities that would injury him.  Some would probably say we go a little overboard in this area…. But ~ we truly feel it is the life rope (muscle) to continence…  for the rest of our lives.  I know that each body is unique in its make up of healing/recovery time… and truly feel that the timeline will and should vary.  During our talks (easy to say when you don’t have to deal with it)…. But we feel that the time frame given in  Dr. Walsh’s book  is one to really hold true to.  Not taking any extra steps until you have come full circle in “recovery/healing” time.  The important thing to remember and to help keep the mind as settled as possible ~ there are options.  We all need foundations to build on and Dr. Walsh’s book  is a rock solid foundation for any member to pull from.  No matter what the treatment…. There is something in it for each of us ~ as is each posting that members who have walked the walk can share and add to this foundation to make it so much stronger!!!

 

I have a few questions ~ mainly to settle in my own mind….

Looking back at your postings…. You started running 6 weeks after surgery. 

Do you feel in any way that this could have caused stretching to the sphincter muscle? 

Did you start kegels before surgery??

 

I’m so thankful that you've shared the information about your sphincter muscle being strong….  And that you have been/and are doing the exercise correctly.  This in itself is an excellent sign.  The other positive is the nighttime improvements you are experiencing…. Makes me think that daytime improvements are close behind.

 

This side effect of prostate cancer is very important and truly needs to be talked about.  I respect you and KW and our other members who are so willing to share this struggle.  And I commend you “all” for staying so “strong” during this time.  I know it can’t be easy…. Heartfelt thank you’s to each of you for continuing to share your stepping-stones with all of us.

 

We are sending a    ~ ~ ~ ~  g~e~n~t~l~e     p~u~s~h   ~ ~ ~ ~ ~ 

 

I always say… if you don’t ask ~ you don’t get….  And if you don’t play ~ you can’t win…  So ~ continue moving forward and I hope and pray this mama blue’s gentle push will help you “all” move on ~ to the next stepping-stone to continence…

 

Keeping you in our thoughts and prayers.  

Hoping our hand can guide you over at least one stepping-stone on your journey.

In Friendship,  Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

J  We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

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

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

 


Berb
Regular Member


Date Joined Mar 2007
Total Posts : 93
   Posted 8/3/2007 6:03 PM (GMT -7)   
Hi Bluebird,

Thanks for the positive feedback. To answer your questions:

Yes, I have considered the fact that commencing running 6 weeks after surgery, and even my continued running 7 months after surgery, may have impeded my progress. I have discussed this with two urologists and both of them have said that running would have helped, not harmed, the recovery process through oxygenation of the muscles, strengthening the muscles and so on. I was careful not to do anything prior to the 6 weeks as I did not want to damage anything while the healing was underway. So while I don't totally eliminate my running as a possible factor in my incontinence, on the balance of probabilities, given the statements by my urologists and stories I've read of others who have resumed running at the 6 week point and have continued their recovery of continence, I have decided to stay with the running. Among other things, it makes me feel that I have recovered my health and that my incontinence is an inconvenience rather than an illness. Having that mindset is important to my quality of life.

Regarding kegals before surgery: I was diagnosed with cancer only 4 weeks before surgery. It took me a week to read Scardino's book, scour the web for information, work my way through the shock factor, and come to the conclusion that surgery was the best option for me. I immediately consulted a continence physiptherapist who started me on kegals. Within 5 days, my lower back had seized up. I am certain that the exercise regime was the cause of this, in that the sudden use of muscles which until now had been dormant strained my lower back. I was treated by an osteopath, but I had little opportunity to do more kegals prior to surgery.

Initially I felt the physio had given me an exercise program which was grossly excessive as a starting point. However, she is experienced in working with prostate patients. I've since concluded that what she gave me was probably OK for most people, and the difference may well have been with me; that despite my overall level of fitness, my pelvic floor muscles were very weak to start with (don't know why). I do know this much however; when I started doing the exercises I was flat out holding the squeeze for 5 seconds before it simply let go of it's own, which is pretty weak. Taking this logic a bit further, if it is correct to assume that I had weaker than normal pelvic floor muscles, does it add credence to my urologist's proposition that my external sphincter (which is part of the pelvic floor muscles) may also have been weaker than normal? So is he on to something by suggesting that perhaps in my case, most of the work of urinary retention had been done by the internal rather than the external sphincter?

I've read the books of both Dr Scardino and Dr Walsh, and recently purchased the newly released 2007 version of Dr Walsh's book to see what changes he may have made (not many changes from what I can see). I was particularly interested to see if he had modified his approach to exercising, but he hasn't. In this area, he differs from other advice in that he recommends clenching the butt cheeks while you are urinating to stop the urination (imagine holding a quarter between them). Other experts warn against this, except occasionally to check that you have identified the right muscles. When I noticed he was still advocating his approach, I switched to his method for a couple of weeks, but stopped after noticing that my flow was becoming weaker and somewhat intermittent. I got concerned that perhaps I was developing a neuro-association which was causing a mental block to the process.

This of course is conjecture on my part; however the urologist who performed the urodynamic study this week was dead against this approach. He felt you could teach your body bad habits by constantly interrupting the flow. Interestingly, he noticed that the internal diameter of my urethra was narrower than normal at the point of the anastimosis. He had some difficulty getting the catheter to go all the way into the bladder, and said there was probably some scar tissue there. This could cause reduced flow, but not enough to be a significant problem, and he ruled it out as a cause of my incontinence. He said surgery right now was not required, and indeed there was a chance I could end up worse than I am now if I had it. If I had an artificial sphincter inserted, it could be done then he said.

I am not morbid about all this. In reality, I am very fortunate. I could be having these problems with incontinence, AND still have life threatening cancer. What I now have is no cancer (at least the PSA says so), and some inconvenience that I find embarrassing at times but which doesn't really stop me doing too much if I am honest about it. The fact is that in 3 weeks I will be joining a group of other runners on a 30 hour non-stop ultra-marathon over the mountains in Papua New Guinea carrying all my food and safety gear in a back pack and getting my water from creeks and rivers en route - not exactly the image of a person with a major physical disability. One challenge is that I have to carry 30 pads with me, and remove the outer non-biodegradable skin and bury the cotton contents along the way. This will slow me down, but it won't stop me from participating. It will give me some added satisfaction to know that I am doing this event with added difficulty, and without anyone knowing I am incontinent.

Anyway, the search for solutions continues. I like to know the facts, even if they are not what I want to hear, and that's what I got from the urodynamic study this week. Only when you have the facts can you move forward. This website has been a significant source of vital information, and I'm appreciative of the time and effort that people put in to maintain it and contribute to it. I check it every day for updates from people like KW who is in a similar boat to me.

Thanks everyone for your feedback and support.

(Now I really have gone over the top with a long post).

Berb
59 years old
Da Vinci surgery Jan 10, 2007, nerves spared
Pre surgery PSA 8, Gleeson 3+4=7, T1C, 3 out of 12 biopsies had cancer
Post surgery pathology says no cancer outside prostate
Complication 1 - urine favoured drain tube over catheter, extra time in hospital, catheter in for 2 weeks
Complication 2 - urinary tract infection - Citrobacter (hospital bug), 6 weeks anti biotics cleared up
Complication 3 - fungal growth on genitals (candida albicans) probably from antibiotics
PSA test 10 weeks after surgery - PSA undetectable


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 8/4/2007 3:32 AM (GMT -7)   
Berb,
I love hearing about your ultra-marathon! I wouldn't give up the psychological and health benefits of such activity for "maybe continence," either.

My observations and reading and consultations agree that interrupting the flow of urine for any other purpose than to identify the muscles involved confuses the smooth muscle valve of the bladder.  This confusion is also why I personally believe slings and clamps are a conundrum:  If you use them any, the valve never learns to join the coordinated effort.
Your testimony that wearing pads isn't the worst "job" one could have is so important.
Especially so to those that are at say month three and are getting discouraged as the healing process tries their patience.

My bio-feedback therapist employed the electrical stimulation you used to teach my pelvic floor muscles different recruiting patterns of muscles.  Elevator Kegels hone this concept even more.  Especially the last "half-power" before resting.  I won't be so presumptious as to teach you anything about training your muscles!  I will, however, take the opportunity of your detailed and so encouraging post to encourage you:

Do you have any control while sitting or reclining?  If so, you are only one (pelvic floor) muscle tone from continence while walking - then stairs - and eventually while running your ultra-marathons.

CCedar
ICTHUS!

2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
Radical Prostatectomy 16FEB07 at age 54.
1+" tumor - touching inside edge of gland.  + Confined:)
Texas Hill Country FRESH Produce Department Manager
Have you had your 5 colors today?


Berb
Regular Member


Date Joined Mar 2007
Total Posts : 93
   Posted 8/4/2007 5:29 AM (GMT -7)   
Hi Cedar Chopper,

Like many others, I read your posts. I've incorporated your elevator kegals into my routine over the last few months.

I don't leak a lot when sitting or lying, unless I move. When driving in the car I am pretty much perfect. It's when I get up that the loss of control happens. If I squeeze hard and the toilet is no more than a minute away, I will usually get around 80% into the toilet. If I have to walk or stand more than a minute or so, it has all leaked out by the time I get there. This has not changed since month 2 after surgery, whereas the evenings have improved.

I don't understand what you mean by the smooth muscle valve of the bladder. Are you referring to the internal sphincter in the neck of the bladder? If so, in my case that was taken out with the surgery - same as described in Dr Walsh's book.

Regards
Berb
59 years old
Da Vinci surgery Jan 10, 2007, nerves spared
Pre surgery PSA 8, Gleeson 3+4=7, T1C, 3 out of 12 biopsies had cancer
Post surgery pathology says no cancer outside prostate
Complication 1 - urine favoured drain tube over catheter, extra time in hospital, catheter in for 2 weeks
Complication 2 - urinary tract infection - Citrobacter (hospital bug), 6 weeks anti biotics cleared up
Complication 3 - fungal growth on genitals (candida albicans) probably from antibiotics
PSA test 10 weeks after surgery - PSA undetectable


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 8/4/2007 7:33 AM (GMT -7)   
Berb,
 
My understanding of the terminology is imperfect.  I don't have a copy of Dr. Walsh's book.  Please forgive my lack of common language skills here:

My Bio-Feedback Therapist explained to me that there is an unconsciously controlled valve at the base of the bladder that is not removed in a prostatectomy.  Two others that reflected the work of the prostrate - and could be consciously controlled - are removed.
This leaves the man with a removed prostrate controlling urination just as women do.
However, women have not had their bladder and urethra traumatized by snipping, sewing, stretching, pulling, and other "disturbances in the neighborhood" as a portion of the urethra, the prostrate, the seminal vessels, the vas deferens, and other connecting tissues are removed.

The "kegel sphincter" that we develop is just the pelvic floor muscles working together to put a "stranglehold" on the urethra. 
Your control without kegeling while sitting or reclining - while it hasn't improved - sparks the optimism in me!
You may have a sensitive bladder and ultra-sensitive remaining valve that are still indignant at how they were treated (Or perhaps they have more tension from a urethra more tightly pulled than others?  Just a thought.)....  
...I hope your situation is just challenging you to learn a different recruiting pattern and develop a different muscle tone to compensate for this valve that seems to stretch open every time you stand up to move.

Another member here, Gene, found he had a different medical issue that kept his remaining bladder valve constantly open (some sort of "deposit" on the valve).  You of course can't rule this sort of thing out. 
We aren't doctors and don't have any idea what we don't know! 
(I include miraculous recoveries in this broad category of my ignorance! :-) )

After a half-dozen sessions with a bio-feedback therapist and without insulting your physician or making him/her paranoid, - if nothing changes - I would perhaps find another qualified physician that specializes in this type of post surgery incontinence challenge - before pursuing corrective surgery.  (For example, the new physician might discuss the idea of "urine favored drain tube over catheter" more candidly.)

Unlike your previous surgery, you can afford to go very slow concerning your next options and gamble that you will still just heal without any further actions.  
I still see it as a safe bet!  You will improve. 

Like you, I'm just happy for you that this is all you are fighting
    - and that you are still running!

Your Friend,

CCedar
ICTHUS!

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 8/5/2007 5:14 PM (GMT -7)   

  tongue Hi ~ Berb,

Excellent posting…… It answered some of the questions I had and it’s made me think on other (issues).  Thanks again for a thought filled reply…  In Friendship ~ Lee & Buddy

 

 

Post Edited (bluebird) : 8/16/2007 9:47:09 PM (GMT-6)


silver05
New Member


Date Joined Aug 2007
Total Posts : 2
   Posted 8/21/2007 7:21 AM (GMT -7)   
I had a radical prostatectomy on 7/31/07. PSA was 2.1 but discovered node during digital exam. Gleason was 6 before surgery and 7 when the prostate was examined. Pathology report indiocated that cancer was contained. I am very concerned about the leakage I am experiencing.
I am 56 years old in excellent physical condition as I used to work out 3-4 times/week prior to surgery.
I am able to control bladder during the night but have leakage issues during the day, especially if I am doing any walking such as walking the dog. I don't feel the leaking but it is very significant. Also am concerned with rectal control. To be blunt, I am afraid to pass gas due to fear of rectal leakage. It doesn't feel like I have control of the muscle there. Is this normal?
I am doing kegals but don't feel like I can hold it for any length of time.
What can I expect moving forward?

IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 8/21/2007 9:29 AM (GMT -7)   

Hi silver.  Welcome to the "club."  There are a lot of experienced folks here that can help. 

Our moderator, bluebird, will probably fly in over the next day or so and ask you to start your own topic or thread so we can get more familiar with your history.

I'm rather new to the game and had surgery on the same day as you had yours.  It sounds like your progress is normal.  I'm probably at the same stage you find yourself in.  From what I've read,  you're making better progress than a lot of folks. 

I have received advice from folks to urinate every one and one half hours whether I think I need to or not.   That is really helping in keeping the leakage down... and yes, the Kegels take some getting used to, but they work over time.  The important thing is to do them properly.   Your doc or others here can help.

'Sounds to me like you're doing the right stuff, including getting more physically active.  The more experienced crowd will probably come on and give you some more advice.

Again, welcome! :-)

Idaho


Age: 54
PSA: 4.3
Biopsy: T1c, 3+3=6, 2 pos. samples in one side of prostate
Da Vinci 31 Jul 2007: saved nerve bundle on side of non-cancerous side
Final pathology: Confined to prostate, T2a, 3+3=6
Working to get back into good shape
Waiting to take that first post-op PSA

silver05
New Member


Date Joined Aug 2007
Total Posts : 2
   Posted 8/26/2007 3:59 PM (GMT -7)   

Hi IdahoSurvivor,

Thanks for the reply. As with most everyone else this is all new to me! Still working on the leakage issues. I guess it all takes time. I am a little impatient. I guess because it has slowed me down so much and infringes on my feelings of independence and immortality!! : tongue


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 8/27/2007 7:22 PM (GMT -7)   
Hey Silver, Try not to worry too much....you only just over a month post op. Just keep working the Kegeals. You may want to find a Physical Therapist that uses Bio-Feedback to detect the pe;vic floor muscles. This way you know for sure that your working the correct muscles.

Good Luck,
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.
    Feb.20th Cystoscope and 2nd Post Op PSA. Another 0.00.....:)
    Dr. said everything looks fine.  Continue to work Kegeal's. Leaking appears to have improved  after Cystoscope?!?!?!  Down to 3-4 pads per day!
    March 1st  Leaking has crept back up to 6 - 8 pads a day ??????? 
    March 8th Started Detrol LA to see if it helps with the leaking?
    March 29th Collagen injection into sphincter / bladder neck area to control excessive leaking.  Worked for a couple of days then back to leaking.
    April 17th (Six Months Post Op) 2nd Collagen Injection to control excessive leaking.  Leaking started back next day at work!
    May 14th Second Opinion about my leaking and Options at OU Medical Center.  After reviewing my records the Dr. feels I will probably need some surgical intervention to stop my leaking.  But did agree to try Bio-Feedback and work hard on the Kegeal's first!
    May 30th Follow up with my Dr. and 3rd Post Op PSA 0.00 agian!!!
    June 1st Start Bio-Feedback to try to control my leaking.
   


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 8/28/2007 7:41 PM (GMT -7)   

Sending a new thread out to Jim & Ann.  Asking them to share their "Journey" with all of us.

Artificial Sphincter!!

 


Ripandburn
Regular Member


Date Joined Aug 2007
Total Posts : 125
   Posted 9/14/2007 10:10 AM (GMT -7)   
Bluebird asked me to leave something here on the sling that was installed during my prostatectomy. All I can say is that my surgeon has been installing a sling to support the bladder. What he has found when he does this is that there is generally less leaking. It goes around the bladder and urethra and is attached to the pelvis. It is made of pig intestine. I can say that since the beginning I have had very little incontinence. I have never "filled up" a pad....even in the beginning. I am 8 weeks after surgery and I will have a couple of squirts a day. Generally nothing till later in the day when I am tired. I have been using Serenity male guards. I have never had any kind of pain or a felling of pulling. It has been completely transparent to me.....mentally and physically. I have no leaking during the night, but still wear a pad for my own security.
51 years old
T1c 3+3=6
DaVinci July 16, 2007
largest cancer .2mm
nerve sparing with both nerve bundles intact
all cancer contained within prostate nothing near margins
PSA after 6 weeks <0.1


Berb
Regular Member


Date Joined Mar 2007
Total Posts : 93
   Posted 9/15/2007 1:06 PM (GMT -7)   
Thanks for post this Ripandburn. The is the first time I have read of surgery for a sling being incorporated into the prostatectomy itself. Seems like your urologist was anticipating that you may be incontinent and decided to be proactive about it. The results appear very good.

Regards
Berb
59 years old
Da Vinci surgery Jan 10, 2007, nerves spared, no cancer detected outside prostate
Pre surgery PSA 8, Gleeson 3+4=7, T1C, 3 out of 12 biopsies had cancer
Complication 1: urine favoured drain tube over catheter, extra time in hospital, catheter in for 2 weeks
Complication 2 - urinary tract infection - Citrobacter (hospital bug), 6 weeks antibiotics cleared up
Complication 3 - fungal growth on genitals (candida albicans) probably from antibiotics
Post surgery PSA tests: all undetectable
Incontinence (as at Aug'07): no pad changes at night, 8 pads per day, diagnosed bladder neck stenosis


Ripandburn
Regular Member


Date Joined Aug 2007
Total Posts : 125
   Posted 9/17/2007 1:13 PM (GMT -7)   
Berb,

I think he is anticipating that all patients will have some sort of incontinence, and with the number of surgeries he has done, he has decided that things just go better for all patients. it certainly can't hurt. I am glad he did it for me.
51 years old
T1c 3+3=6
DaVinci July 16, 2007
largest cancer .2mm
nerve sparing with both nerve bundles intact
all cancer contained within prostate nothing near margins
PSA after 6 weeks <0.1


Hagrid
Regular Member


Date Joined Sep 2007
Total Posts : 60
   Posted 9/23/2007 10:13 PM (GMT -7)   
I had an artificial urinary sphincter installed 4 years ago. Leakage is extremely minimal. I wear a pad, but usually only have a few drops a day. I have experienced some occasional pain problems but I've found it can be mitigated by turning my "device" off for a period of time, usually overnight.

It was the right decision, without a doubt. My quality of life is GREATLY improved.

Diagnosed 1997 at age 49.
PSA 100+ (That's correct!)
prostate and bladder neck removed.
external X-Ray radiation, followed by lupron hormone injections for a year.
PSA held at 0.2 for two years, then went to 0.4-0.6. Put on Casodex, and PSA has held at 0.4-0.6 since.

jerryv
Regular Member


Date Joined Jan 2008
Total Posts : 52
   Posted 1/13/2008 1:23 PM (GMT -7)   
Hi Hagrid
I had an artificial sphincter installed in September 2007.  about three months later i had a leakage from my scrotum.  The urologist operated and said the pump broke and wanted to install a new pump within a week.  I refused and said i needed more time to prepare for it.  When the first unit was put in he told me after the operation that he installed two of them to make sure i would stay dry.  I am a little, no a lot, concerned about this.  Have to see doctor in next three days.  Any words of wisdom would be greatly appreciated.
Jerry

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 1/22/2008 9:56 PM (GMT -7)   

For Member Information:

 

re: (AUS) Artificial Urinary Sphincter

 

Information from Ann...

 

Jim is a professional individual who is willing to talk with anyone in reference to his procedure and his life with an AUS.  Please contact bluebird for their telephone number

You will need to leave a phone number for him to return your call due to his schedule.  His call back to you is covered in his calling plan (no charge for him)…

 

So ~ please …. Reach out to someone who’s willing to talk with you.

 

Jim’s surgeon:

 

Dr. George D. Webster

Professor of Urologic Surgery in the Department of Surgery

 

Link:

http://urology.surgery.duke.edu/modules/dukefaculty/viewDetails.php?u=0108871&t=1&dempo=webst001

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