Post Op Bladder restriction

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Grover
Regular Member


Date Joined Jun 2007
Total Posts : 29
   Posted 9/29/2007 6:45 AM (GMT -7)   
I had my DaVinci surgery about 4 months ago. I have no problem with leaking...havent used a pad in 2 months or needed to do the Kegel exercise but I think now I'm showing signs of "strictures" (scar tissue) in my urinary tract. It's not flowing as well as it did right after surgery. I'm back to my pre-op routine: an irritation in my bladder, getting up several times at night to urinate and hitting the bathroom more often during the day. I doubt it's a bladder infection because there's no burning sensation when I urinate. I read this can be treated with some kind of surgical procedure. Anybody have any info or experience on this ? Thanks.
Diagnosed Jan 07
PSA 5.7
Biopsy -12 samples, positive in 4, Gleason 3+3, TC1
Age 59
Surgery (robotic) June 1 2007
Final pathology - fully contained to prostate, 2% TC1, Gleason 3+3
No leaking 2 months after surgery (Yahoo !)
3 month PSA <0.01 (Yahoo again !)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 9/29/2007 7:48 AM (GMT -7)   
Hey ~ Grover,
During our post op visit Dr. Staley mentioned about the possibility of scar tissue.  He said if this should happen he would snip the area (procedure done at the office).  He did not come across as being a major issue... at least we didn't feel that it would be if we had to have it done.
 
It's different when you have to have it done ~ so please... this is just information that we are sharing....
 
Also ~ including an excerpt from Dr. Walsh's book about this issue.
 

Quotes & Partial Quotes…

 

 ** Excerpts taken from a book titled…

 

“Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”…(Give Yourself a Second Opinion) Copyright 2001

Patrick C. Walsh, M.D.

Professor of Urology, The Johns Hopkins Medical Institutions and

Janet Farrar Worthington

 

Excerpt from page 253

Bladder neck contracture, or constriction of the bladder neck:  this is scar tissue that forms where the bladder neck is sewn to the urethra, and it has been reported in between 1 and 12 percent of men after surgery.  Its symptoms are usually manifested by persistent incontinence, and a very slow or dribbling urinary stream when –this is the tip-off—the bladder is full.  Remember, incontinence immediately after surgery is a very common problem.  In the early days after surgery, many men who are having incontinence also worry about having a slow urinary stream.  But it’s hard to achieve a good stream if there’s not much in the bladder—and it’s impossible to store up urine in the bladder if it keeps leaking out.  Bladder neck contracture is different; the bladder is full, but the best you can manage is a dribble, because the scar tissue is blocking the flow, like a stuck washer in a faucet.

            If you are having prolonged incontinence, you should be evaluated with cystometry, a test that measures bladder progress and function by passing a small catheter through the urethra into the bladder.  Changes in pressure are monitored as the bladder fills with water.  If scar tissue is causing the trouble, it can be reopened in a simple outpatient procedure as a urologist, using a cystoscope (a tiny tube inserted through the tip of the anesthetized penis, through the urethra and into the bladder), makes a few tiny cuts to relax the tight scar tissue.

            To keep the area open, your urologist may recommend that you pass a small catheter through the urethra every day for a month or so after the procedure.  This way, the scar tissue won’t re-form, and the normal lining of the bladder and urethra will cover the opening as it’s supposed to.  If the scar tissue is particularly stubborn, your doctor may inject a powerful steroid called triamcinolone into the area of the contracture; this can be effective in preventing the scar tissue from returning.

END QUOTE

 

Hope this gives you a little guidance...

We are glad you're staying close ~ continue to do so please ... so we know how things go for you.

In Friendship ~ Lee & Buddy

 


mama bluebird - Lee & Buddy… from North Carolina

 

v          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

3rd PSA 08-07-2007 Less than 0.1 Non-Detectable :)


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 9/29/2007 9:02 AM (GMT -7)   
Hey Grover, I've developed the same symptoms, and my dr did a cystoscopy to look into the bladder and confirmed presence of scar tissue just beyond the bladder sphincter in the bladder neck. He recommended a dilation procedure in which he goes in and stretches the area to open it up. No snipping. I appreciated the quote from Walsh's book. Thanks, Bluebird! But there is one other issue, at least according to my dr. The procedure to open up the bladder neck will cause temporary incontinence, since the bladder sphincter is also stretched during the process. He told me that the incontinence lasts from a 'few weeks to several months.' Like you, I have been pad-free since about a month after my surgery (also June 2007) and I am very nervous about solving one problem and creating another. My dr did say that the stricture could get worse, but since I'm now almost 4-month post op, that's unlikely. For now, I've opted not to have the dilation. I'm able to empty my bladder -- it just takes longer and I feel a fair amount of pressure at the beginning of the stream. I would definitely talk to your own dr, and I'd be interested in his comments to see if they are consistent with what mine told me. In particular, I wonder if the procedure described by Dr Walsh also causes temporary incontinence? Good luck, Grover, and please stay in touch. So far, you're the only other one who has described this condition other than me.

puget
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 9/30/2007 2:06 PM (GMT -7)   

Uhh... Grover... I have experienced one of those strictures.  I do not have Dr. Walse's book. I have Dr. Peter Scaradino's book, however.

I can tell you my stricture treatment was nothing like the one described above my post. 

I went into the hospital as out-patient 3 months after open radical.  I was put to sleep.  He said he would either dialate, if possible, or cut it out.  I was dumb... again... and I did not read up on strictures.  Neither did my doctor attempt to talk with me about the subject.  What I discovered after the procedure (He was able to dialate) was that any procedure can cause even more scar tissue.  Moreover, the cutting can forever neutralize your last sphincter muscle.  I think it is not a simple procedure if you are the patient.

Please sit down with the doctor after finding out all you can  on your own and discuss your options.  To this day I remain incontinent after 8 months post-op.

The good news is that thus far, the stricture has not reappeared.  According to what I found out, often these things do reappear, causing more problems. As mentioned, I am still incontinent. 

I pray you have a successful outcome.

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?   
 
 
 


Grover
Regular Member


Date Joined Jun 2007
Total Posts : 29
   Posted 9/30/2007 2:44 PM (GMT -7)   
Thanks everyone for your inputs. I did some reading online about the bladder irritation I have and now I think I may have 'interstitial cystitis". I'll ask my doctor about it. At my most recent visit, I mentioned the bladder irritation to him and I asked if my bladder was irritated from the straining I had to do to overcome the restriction caused by the prostate. He just nodded "yes" and I assumed that it would calm down soon thereafter. Now I'm reading that there is no cure, but there are several things that can be done, one of which is to identify what foods cause the irritation. Turns out, it's everything I been eating: coffee, alcohol, tomatoes, canned tuna, yogurt, peanuts !! So until I get to see my doctor, I'm gonna eliminate all the possible "bad" foods and see if it calms down. I dont really want to go thru what was described in your posts if I can avoid it. Thanks again.
Diagnosed Jan 07
PSA 5.79
Biopsy -12 samples, positive in 4, Gleason 3+3, T1c
Age 59
Surgery (robotic) June 1 2007
Final pathology - fully contained to prostate, <2% , Gleason 3+3
No leaking 2 months after surgery (Yahoo !)
3 month PSA <0.01 (Yahoo again !)


Little Jem
New Member


Date Joined Sep 2007
Total Posts : 16
   Posted 10/1/2007 12:08 AM (GMT -7)   
Hello Grover,
 
My Hubby had his RRP in June 06 at age 54.  He had problems with the urethra 'join' not healing and had to keep his cath in for 12 weeks!!!  However, once he finally got rid of all that tubing (hoorayyyy) he's only had very minimal 'stress' incontinence and has never had to wear pads.  He had the same trouble you speak of with scar tissue restricting the flow.  His Doc recommended self catheterisation weekly but Hubby was having absolutely none of that and had to have first one and then a second 'bladder neck incision' to relieve the scar tissue.  After the second incision they didn't put a cath in (they did with the first one and it stayed in for 24 hours) and during the night after the procedure he went into total retention and we had to visit the ER at 3.00 am where they put in a cath for him.  However, all that was before Christmas and he's had absolutely no further trouble since.  Continence wasn't affected after both incisions either. 
 
Little Jem

puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 10/1/2007 8:13 PM (GMT -7)   
The contrasting experiences of Gene and Little Jem demonstrate once again that there are no 'normals' in the world of PCa treatment. I ache for Gene -- and his story scares me silly. What if my stricture gets so bad that I have no choice but dilation or snipping? I celebrate with Little Jem and her Hubby that he came through without any long-term effects. Am I just being a "wuss" and a worry-wart? On balance, for now I'm going to stick with my decision to avoid the procedure as long as I can.

puget
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07 = <.01 (Hooray!!)


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 10/2/2007 8:09 AM (GMT -7)   

Pujet,

I know you will keep close contact with your doc.  I tend to agree with you about waiting, but sometimes these things get so that they have to be dealt with.  In review, I feel the doc did the right thing for me because my stricture was staying irritated and bleeding everytime I walked a mile or so.  I am quite negative about him (he is my former uro).  He did not diagnose the stricture earlier even though I had symptoms.  He did not effectively communicate with me properly, although I (and insurance co.) paid him well to do so.  But I'm sure he did the only thing he could do and I had to have something done.  So just keep close tabs with your uro, and I know you 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?   
 
 
 


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 10/2/2007 1:56 PM (GMT -7)   
Thanks, Gene. Good advice. Sounds like your symptom gave you little choice. So far, so good for me, but I agree I need to stay vigilent and not let the stricture get out of hand if it appears to worsen.
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07 = <.01 (Hooray!!)


Grover
Regular Member


Date Joined Jun 2007
Total Posts : 29
   Posted 10/4/2007 1:05 PM (GMT -7)   
I read the post "reason for my continued incontinence-stricture" and find that I'm not alone. Havent got to talk to the doc yet but meanwhile I've eliminated coffee, beer and tomatoes from my diet and my symptoms have improved. While I may have some urinary blockage due to scarring, I wonder if the penis pump I recently tried may have aggravated my condition? I only tried it once and didnt like it but I'm wondering if the suction it creates somehow pulled at my urinary tract and caused it to swell ?? ( If you havent guessed, I'm a retired engineer and we are always analyzing things ) This is just a thought to anyone who may be using the pump that it may be part of the problem.
Diagnosed Jan 07
PSA 5.79
Biopsy -12 samples, positive in 4, Gleason 3+3, T1c
Age 59
Surgery (robotic) June 1 2007
Final pathology - fully contained to prostate, <2% , Gleason 3+3
No leaking 2 months after surgery (Yahoo !)
3 month PSA <0.01 (Yahoo again !)


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 10/4/2007 1:33 PM (GMT -7)   

Grover,

The pump does command a big force.  Of course I'm no doctor... not even an engineer.  That's probably not the cause, however.  I wish I knew the causes for these things.  Better yet, I wish I knew the fix.  Whatever the cause, I'd say eliminating those substances will take you a long way. 

Gene


Age: 63
07/05 - Biopsy: Suspicious looking cells. 
12/27/06 - Biopsy
1/24/07 - Dignosed cancer: Gleasn Grade: 3+3=6
02-14-07 Radical Open Nerve-sparing surgery
Pathology Stage of cancer: T2c
4-18-07: First Post-Op psa = 0.011
05/31/07: Cystoscope reveals "Stricture"
06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure.
8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.
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
8/31/07:  First Bio Feedback session.
9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. 
9/26/07 - Started injections   
 
 
 

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