Exactly What is Continence & Can I ever have it again?

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Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 9/17/2007 8:30 AM (GMT -7)   
Okay.  Wednesday I have my final session w/biofeedback tech. The first session was with a sub since my assigned one was out sick.  Week # 2 my assigned one took over & I've had two sessions with her.  Both were very, very positive about my outcome as was a Uro who looked up inside me with the systo.  Said the Uro, "Your muscle looks good." I supposed he was speaking of my remaining sphincter.  Said tech # 1, "You are a good candidate to being dry when we finish with you."  Said tech # 2:  "You have made excellent progress.  You will be dry by the time we finish with you." 
 
I have one more session and I'm not dry... yet.  So I am asking myself (and I shall ask the tech on my last visit) "What is continence for one who has had an open prostatectomy?"  I will ask you who will give me a little time the same question.  I know your answers will most likely be, "When you stop dribbling."  I know some of you have spoken about being dry and some about being completly dry, even some have been dry from the time cath was removed.  But is that really a good practical answer and definition for dryness for someone like me who is now at seven months post surgery and still dribbling?
 
Tech # 1 wanted me to hold everything and pee only every one and a half hours.  Somehow I could not make her understand that the only way I can hold everything is by sitting for that long, getting up, squeezing until I get to the potty, and then peeing. 
 
Tech # 2 has said go pee from one to two hours. 
 
Can someone like me, who has worked the Kegals and continues to drip during activity really expect continence?  Or should one like me be happy with getting up from the seated position, squeezing, peeing, and forgetting it until I can sit and retain again?  What I have heard and read is that between 3-6 months, continence will return.  It has not for me (and others).  Should I just forget it after these sessions and should I expect that it will happen if I keep kegaling?  How long must I keep keagling?
 
Ok.  It's gotten too long.  
 
I'm not really depressed about my situation... or at least I don't think I am.  I'm willing to go on in life and function.  I just don't know when I should stop all this keagling, padding, etc. and just put the clamp back on and forget it.  What do y'all think?  Is there potential for dry underwear in my future?
 
Gene   
Age: 63
First biopsy 07/05;
Diagnosed: "Suspicious looking cells". Dr. says wait and watch.
Second biopsy: 12/27/06
Diagnosed cancer: 01/24/07
Gleason Grade: 3+3=6
Radical Open Nerve-sparing Prostatetomy: 02-14-07
Cancer confined to prostate
Pathology Stage of cancer: T2c
First Post-Op PSA on 04-18-07: 0.011
Bleeding problem at 6 weeks post surgery...No resolution despite several trips to surgeon, antibiotic treatment.
05/31/07: Cystoscope reveals "stone", due to "Stricture" (narrowing of uretha at prostate removal site).
06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure, but is most likely a temporary fix, and incontinence continues.
8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.  He thinks stricture is back, but send home with Cipro.
8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news!
8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05 (non-deteactable).  PTL!
8/31/07:  First Bio Feedback session.  The little lady is very positive that I can gain control.  That's what I want more than her.  New urologist is not very sold on effectiveness of Kegals???  
 
 
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 9/17/2007 10:23 AM (GMT -7)   

hello gene

It sounds like your urinary problems are at the difficult end of the spectrum.  Obviously you are working very hard to get things back in working condition.

Let me respond to a couple of your questions.  first, what is continence?  My opinion is that when you are able to relax and not always be concious of holding or staying dry you are almost there. If you are still wearing pads or planning your bathroom stops, then you have a ways to go. I am 8 months past surgery and still have a stress squirt now and then, but I do not worry about what I drink or when and where to go. However, I still do some kegals every day and plan to the rest of my life.

The second answer is in regards to your comment about putting the clamp back on.  I hope you and your doctors will take a long time to decide if surgical or mechanical measures are needed. I see by your signature that you have had a tough time during your healing period. I have heard stories of guys who finally found success many many months after surgery. I wish you that kind of success, you deserve it.


 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8
no extra extension/invasion identified
age 65
no continence problems
Back on the golf course...
90 day PSA  less than 0.01 (undetectable)
Six Month PSA still undetectable
ED problems- 20mcg Caverject and 50mg Viagra-success
 
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 9/17/2007 11:08 AM (GMT -7)   
Hey Gene,

You have had a difficult time since surgery with the strictures, bleeding etc. These probably contribute to your incontinence so don't be discouraged about it. Your body will heal in time and with the excellent support you are getting from therapists and doctors, you should be in great shape. We are all different so don't let the few early successes discourage you. They are the exception.

Good luck...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 7/18/07 0.00. 
T level on 4/2/07 - 48     On 7/16/07 - 613
Started Tri-Mix on 8/7/07.  .02 ml and 50 mg Viagra.  It works!!!
Next PSA and T tests on 10/17/07
 
"Patience is essential, attitude is everything."
 


anniea
Regular Member


Date Joined May 2007
Total Posts : 234
   Posted 9/17/2007 9:04 PM (GMT -7)   

Hi Gene

It sounds like you have been through quite a bit since your surgery. I am almost 6 months out and while I have control about 90% of the time I notice if Im tired or if I over due it I still leak. Try to relax and I think your body will heal. Keep in mind even though they let us out of the hosip. right after surgery it is still MAJOR surgery.

Best wishes

Rick


Rick & Diana
6-30-06  PSA 2.54
1-22-07  PSA 4.98
1-26-07  PSA 5.09
Diag: 2-14-07 Gleason 8 Stage T1c PSA 5.09
Bone Scan 3-1-07 Clear
Radical retropubic surgery 4-2-07  Post surgery Gleason 9 Stage T3a Positive margins
4-29-07 PSA 0.02
6-9-07   PSA 0.02
7-6-07   PSA 0.03
8-1-07   CT Scan & Chest X-Ray   Clean
 


Jefnef
Regular Member


Date Joined May 2007
Total Posts : 42
   Posted 9/18/2007 5:50 AM (GMT -7)   
Hi Gene,

I can sympathize with you. I am four and a half months post surgery, the laparoscopic type. My continence situation has remained unchanged since the day my catheter came out, and it sounds like it's exactly the same as yours. I went to my local urologist and he did a cystoscope (tv camera on a tube) up the urethra
and saw what he described as a stricture near the anastomosis (the place where my urethra was cut and sewn back together when the prostate was
removed.) Apparently this happens in less than 10% of patients who have this procedure.

The doc said that the stricutre was preventing my urethral sphincter from completely closing in its relaxed state-- the result is that I have
constant leakage. Slow but steady leakage, especially when I am standing.

This doc said he would not treat me and recommended I talk to my surgeon. I talked to him on the phone, and of course, he said he would treat me, after taking a look
with the scope himself. There are two treatments:

Serial dilation: an instrument is inserted into the urethra to expand the stricture to break it down. Apparently this is done several times with a
larger and larger instrument? or something. And as an outpatient procedure. Also, some patients have to have this procedure repeated several
times.

Surgery: a lot of different methodologies here, but it involves a hospital stay and a catheter for a week or two afterwards. not something I'm eager
to do. And I am not sure exactly what they do once they are inside to fix the problem.

I don't totally understand the mechanics of why the stricture is preventing my sphincter from working normally. More troubling then that, though, is
that I am not sure that the doctor that looked at it really understands what is going on. Another doc I spoke to said that the anatomy of the urinary tract is very delicate, and very complex, and that even very small problems can upset the balance. In other words, "measure twice, cut once".

Before I undergo any of these treatments I want to learn more. I am seeing another doctor in two weeks. I don't want to get any treatments until I
totally understand my situation, and the risks involved. I also want to make sure that I have the absolute best person doing the work.

My situation is neither improving nor getting worse, so I feel like I should not rush into a treatment that I am not sure about. I am hoping that as I learn more I will feel comfortable about another intervention, but at this point, I am more comfortable leaking. By the way I am using the AFEX product on days when I am very active. It's a collection system, versus an absorptions system, and while it's not foolproof, it allows me to go longer between having to visit the bathroom and change pads.
Abnormal DRE 12/06
Diagnosed 1/23/07
Biopsy 6 cores 1 positive
T2b Gleason 3+3 PSA 1.4
Laparoscopic Prostatectomy 5/11/07
pathology: less than 5% tumor by volume
no cancer in margins or vesicles
cath out on 5/22
PSA test Aug. 2007= less than zero
Continence: none while standing
Diagnosed with "stricture" as the cause of incontinence 8/30/07


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 9/18/2007 1:27 PM (GMT -7)   
What is AFEX?  Is it a condom catheter?

Age: 63
First biopsy 07/05;
Diagnosed: "Suspicious looking cells". Dr. says wait and watch.
Second biopsy: 12/27/06
Diagnosed cancer: 01/24/07
Gleason Grade: 3+3=6
Radical Open Nerve-sparing Prostatetomy: 02-14-07
Cancer confined to prostate
Pathology Stage of cancer: T2c
First Post-Op PSA on 04-18-07: 0.011
Bleeding problem at 6 weeks post surgery...No resolution despite several trips to surgeon, antibiotic treatment.
05/31/07: Cystoscope reveals "stone", due to "Stricture" (narrowing of uretha at prostate removal site).
06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure, but is most likely a temporary fix, and incontinence continues.
8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.  He thinks stricture is back, but send home with Cipro.
8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news!
8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05 (non-deteactable).  PTL!
8/31/07:  First Bio Feedback session.  The little lady is very positive that I can gain control.  That's what I want more than her.  New urologist is not very sold on effectiveness of Kegals???  
 
 
 

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