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Collagen Implant Anybody? (Injection)

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Posted 9/20/2007 1:48 PM (GMT -7)
Tried to post on this subject, but somehow didn't take.  If it's posted *twice somewhere, sorry.   * Post edited to add "injection" to title :) and 2nd thread link.... Collagen Implant Anybody? After Bio-Feedback brought me no closer to continence, my therapist dug deeper into my med records and found that when I had my last cysto, the doctor read into my records that I had a sphincter shorter than normal.  He didn't tell me that, and she said she's never seen it written before. But perhaps in desperation and with a desire to help me, she wants me to talk to the doc about Collagen implant.  I've tested for it before but never went through with it.  She thinks there's a possibility that it may help just enough to get that little thing working again (the sphincter muscle).  I think KW had written about it months ago, and how it failed on him, but I can't find the thread with a search.  I would like to read it again if someone can help me and I would like to know if anyone... anyone has had this and has it helped? 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! Still leaking. 8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05 (non-deteactable).  PTL! But still leaking 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??? 9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. Recommended possible callegen implant. She noticed from 8/20 cysto that my sphincter was ... too short?... huh?  Post edited to add "injection" to title and 2nd thread link :)  Post Edited By Moderator (bluebird) : 9/24/2007 12:30:18 PM (GMT-6)
Posted 9/21/2007 7:56 PM (GMT -7)

Hey Gene....I know how you feel.  Dealing with this can be hard.  Have a question about your bio-feedback.  Was your therapist showing you graphs of your muscle tone?  My leaking has only slightly improved but I keep showing a gain each month when I go in for a session.  My therapist now thinks some of my problem could be tightness of my hip muscles that are keeping the pelvic floor muscles from drawing up tight enough to support the bladder.

  As far as the collagen.....I can can it is not a pleasent experience but I would try it once if your Dr thinks it may help.  I did it twice with no improvement. 

    Sorry you are dealing with this....Hope I can help.

      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.

   

Posted 9/22/2007 4:30 AM (GMT -7)
Gene,

I'm interested in your comment regarding sphincter length. Some time ago I read an article quoting a Dr Catalona where he mentions this subject. You can read ther complete post on http://www.drcatalona.com/quest/quest_spring03_2.htm, but here's an extract.

"Eventually, most damage to the bladder and the urethra heal, but it takes time and the improvement in continence is gradual, with complete recovery taking from six to 18 months. "The most common cause of incontinence after a radical prostatectomy is a weak external sphincter muscle," Dr. Catalona said. "The surgeon has to try his best not to injure it and to preserve its length. "Most important is to protect muscle fibers of external sphincter." 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."

One thing my urologist said to me is that the load of retaining urine in the bladder is shared between the internal sphincter in the bladder neck (the one that is chopped out when the operation is done), and the external sphincter. Some men have most of the work done by the external sphincter before the operation, and in these cases, the external sphincter is already strong. For others, the internals sphincter may be doing more of the work, and for these people, it is a longer road to recover of incontinence.

I've wondered for some time if perhaps the cause of my slowness to recover continence is due to a shorter than normal sphincter, which in turn may have been the result of a life time of most of the work having been done by the now missing internal sphincter.

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

Posted 9/22/2007 4:14 PM (GMT -7)

Thanks KW & Berb.  KW, you've no doubt helps lots and lots of us with your lengthy reports.  I know they have helped me at times.  Perhaps I've learned more from your experiences than from any of the books I've read... I know more than any doctor has tried to help.

Berb, thanks for the article.  I've never heard such a thing either.  This all makes me more determined to keagal even it things don't appear any better. 

KW, yes she used the graph to measure my weekly strength.  I improved drastically the first three weeks but only slightly the 4th and even lost a little on that visit too. 

She wants to see me again in 6 weeks but I didn't make an appointment.  Now I think I will.

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! Still leaking.

8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05 (non-deteactable).  PTL! But still leaking

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???

9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. Recommended possible callegen implant. She noticed from 8/20 cysto that my sphincter was ... too short?... huh?   

Posted 9/22/2007 4:55 PM (GMT -7)
Here's another article that gives some insight into the workings of the sphincter. I've reproduced one paragraph below.

http://www.emedicine.com/med/topic3019.htm

"The urinary sphincter is composed of an internal sphincter and an external sphincter. In females, the internal sphincter is composed of the bladder neck and proximal urethra. In males, the internal sphincter is composed of the bladder neck and prostate. Both males and females possess an external sphincter known as the rhabdosphincter. The rhabdosphincter is omega-shaped and is composed of 2 types of striated muscle fibers—fast twitch and slow twitch. Contraction of fast twitch fibers causes sudden stopping of the urinary stream. This is known as the voluntary guarding reflex. These fibers are responsible for allowing Kegel exercises. Slow twitch fibers maintain the constant tonus of the external sphincter, which is important in daily physical activities. This is known as the involuntary guarding reflex."

I'm doing research on artificial sphincters. I'm not planning on doing anything myself at the present time, but getting knowledge now will help me make the right decision in the future if I don't improve over the next year or so.

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

Posted 9/23/2007 7:37 PM (GMT -7)

Hey ~ Gene,

Trying to get all the threads together on one thread for  "Artificial Sphincters, Slings, Collagen Injections, etc"

Is your title correct?  Implant??  or is it like KW's collagen injections ?

Let me know and I'll be happy to change the title to reflect this... and I will also link the other thread to this one...because Biff had a good posting and we don't want to lose it!

Just let me know!!  Okay.... tongue

Keeping "all of you" ~ extra close as you continue to move forward in your search for answers..

Your "positive attitudes" are making the difference in this side path in Your Journey!! 

Hugs from Lee & Buddy

 

Posted 9/23/2007 9:38 PM (GMT -7)
I'm new here, so first my stats:
Diagnosed in 1999, at age 49 with a PSA of 100+. Yes, that's correct.

Treatment:
radical prostatectomy, (bladder neck also removed), followed by external X-Ray radiation and lupron hormone injections. PSA down to 0.2 for two years, then was 0.4 to 0.6. Put on Casodex, and PSA has remained at 0.4-0.6 since.

Tried collagen injections ( total of 3) with some results, but only temporary, and possibly more due to swelling due to the injections than the actual collagen. Had an artificial urinary sphincter installed about 4 years ago, and I am extremely glad I did! My quality of life is tremendously improved. I've had some pain problems with it, but found that if I turn my "device", as I call it, off for a day or less, usually overnight, it is very managable.

Glad to be part of this discussion, and I'd be happy to answer any questions. I feel I have truly been blessed, and know a positive outlook is extremely important.
Posted 9/23/2007 10:02 PM (GMT -7)
Hi Hagrid,

You are a gift from heaven! Several members have had questions you have already answered in just a few short words! Thank you and congrats on keeping a low PSA!

Swim
 

Posted 9/24/2007 1:06 AM (GMT -7)
Yes, glad to hear from you Hagrid.

Do you still use any pads at all?

Since doing some research on these units, I've been a bit reluctant to consider one due to the 17-35% reoperation rate quoted in the article I posted earlier - http://www.emedicine.com/med/topic3019.htm. Other articles say similar things.

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

Posted 9/24/2007 8:58 AM (GMT -7)
I still use one to two pads a day, depending on whether I need to turn my device off at night. If I do turn it off, I have some nighttime leakage, so I use a new pad for my day. Daytime pad is mostly for emergencies. Necessary if I am having irritation/pain and want to turn my device off, which is VERY rare. But having it on saves me the worry. Also, I do have some minor, minor drips if I'm to quick after relieving myself and not willing to stand in front of the urinal/toilet for an additional 30 to 60 seconds until the device reseals itself completely. With the device operational the pad is usually dry when I remove it.

Again, compared to my problems, worries, and accidents BEFORE having the artificial sphincter installed, one pad a day and the occasional need to turn it off are well worth it. The post-surgery problems I encountered, swelling (like a softball!), a couple of early urinary infections, were worth the freedom and confidence I now have. If I have to go back for a reoperation, I know the difference between life before and after, and I'd gladly suffer through the temporary inconvenience.

Be glad to discuss my decision with anyone interested.
Posted 9/24/2007 9:38 AM (GMT -7)
Bluebird, I am probably all wet (what's wrong with a pun?) regarding the callagen.  Actually I don't know how I picked up the word "Implant".  I suppose it really is "injection" since that's what it is, right? Thanks for your good work. Gene :)   * Post edited to add "injection" to title, helping to keep important information together in the 2nd thread link...   Collagen Implant Anybody?  started by Gene6163 :)   Post Edited By Moderator (bluebird) : 9/24/2007 1:04:38 PM (GMT-6)
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