continence recovery after prostatectomy

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The sequence of continence recovery after nerve sparing prostatectomy as apparently not been documented in an detail so as to help and reassure patients that they are on the right tract and not to give up hope. Vague and general comments ranging from ....6 weeks to three months to one year and be "patience patient." While patience is certainly a virtue in this case, it is also exceedingly important to arm yourself with knowledge and information to guide your patience along the way.
I am 10 weeks post surgery, and yes, it is early, but still have no idea what to expect or when to expect it...and I have read books and papers that I can access. Dry at night, controlled flow after waking with ability to stop and start the stream. Until now, I flowed freely during the day with no sensation of having to void. Yesterday, I had the urge to void and was successful two times. It happened only one time before that during the day. This seems to disappear and I will freely flow all day with no urge to go.
It would be helpful to hear from those who have recovered about how the progression took place. I know we are all individuals with different types of surgery and in the hands of different skilled physicians, but there has to be a common progression of recovery to continence after nerve sparing prostatectomy

 

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@Wetdrymee2 you seem to be doing very well compared to my experience. I had a problem with scar tissue after the prostate surgery and had to have bladder surgery as well, so I'm not a typical case. I'm sure there are others here who will be able to share a better experience than mine, cheers Phil

 

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I have not had a prostatectomy but have had a couple of TURPS, one of which was after having had radiation treatment for prostate cancer. After having read many medical articles about male continence, I think the main consideration when there is a surgical process is "how much damage was done during the surgery to the internal urinary sphincter?" We are talking about a relatively small area (the prostate, bladder neck, and urethra) in which the surgeon is working. If the surgeon removes tissue that is critical to maintaining continence, then you are unlikely to regain FULL continence afterwards.

I'm guessing the margin of surgical removal of tissue is very small, in terms of whether you will or will not regain continence. And you clearly have to wait until you are fully healed from the surgery to know the final outcome. I know in my case I have had several cystoscopies since my last TURP, and my urologist is able to clearly show me that my internal sphincter is NOT closing like it should, which means at best I will constantly & forever be leaking a small of urine.

I think it's been proven that gaining maximum effectiveness of your external sphincter (ie. think kegels & pelvic floor exercises) will help overcompensate for the damage done to the internal sphincter, and thereby lessen the extent of your incontinence, but you can never make your external sphincter do what the internal sphincter was designed to do.

Hope this helps! If I've gone down an incorrect medical path with my assumptions please let me know.

 

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@cmulwee a very good explanation, better than my surgeon managed, cheers Phil

 

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Thank you for your input". It was very valuable and infromative in trims of final outcome and has given me added information to consider. I am still looking for a detailed progression of progress if anyone has documented a return to continenence post nerve sparing surgery. For me, one function spontaneously returned, which I am exceedingly grateful for, but the continence has been very slow in rcovery.

 

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It has been nearly 3 yrs. since my prostatectomy,and I still am incontinent. I, too, can have urges that I can feel coming on, but have little to no time to get to a restroom. And, I also at times leak without any sensation that I am doing so. My prostatectomy was combined with a large bladder diverticulectomy along with my history of bladder problems has made my incontinence more permanent. Most guys here, however, have had much more positive results. I hope you are one of them. I would like some clarification about the internal sphincter and its connection with incontinence. From what I have read, the external sphincter that one has no control over is removed along with the prostate during a prostatectomy relying on the external sphincter to perform control. In most cases, that is all that is needed. Am I understanding this process correctly?

 

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@Damp the surgeon who did my prostate surgery was hopeless at explaining it. But the surgeon who did my bladder surgery gave me a better explanation. She said that the bottom of the bladder neck is inside the top of the prostate, not separate as shown on diagrams, for this reason she said that it is very difficult to remove prostate tissue without damaging the bladder neck. She later showed me this on the screen during a cystoscopy, in my case there isn't any barrier between my external sphincter and my bladder. Unfortunately, my external sphincter can't cope on its own. She seems to have a good idea what she is doing, so I accept this explanation much more than the explanation I received from the original surgeon.

 

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This thread hits the issue directly. Thanks to physlink and cmulee. It's time we got aggressive ("positive", if you insist) on demanding info, and not just from the surgeon. We can all be "squeaky wheels".
In reading the reports, after, i saw they had removed a short portion (but maybe it wasn't so short in terms of function afterwards) of the urethra, the "tube", for testing for cancer. It may have been negative for cancer, but what was it for incontinence? That's the question i didn't get an answer to, just evasion.

 

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I misspoke in my earlier thread. From what I understand, it's the INTERNAL sphincter that is removed with the prostate leaving only the EXTERNAL sphincter to manage continence. I also found out that the prostate itself aids in continence. So, when you lose 2 out of 3 that last one needs to be strong. I imagine that is why kegel exercises are highly recommended. Didn't really help that much in my case.

 

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I had my surgery 6 years ago. I use 1 pad a day. A few times a week will fully wet the bed so nighttime underwear. A least it's better than not being able to pee.

 

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Interesting input from everyone. Sounds like there are a lot of variables to reach a back to normal life. I feel like the people who have a high degree of success after surgery aren’t on this site.

I am 6 weeks out from surgery and have regained some bladder functions. I have minimal leakage during the day and am able to use the bathroom as normal. But I need to use the bathroom every couple hours or I am at risk of leaking. I also leak when walking in stores or outside. I use 2-3 pads during the day and pull-ups at night. Night time has little to no leakage unless I wait too long to get out of bed. I get up and go about 2 times a night. Seems like I got a little better after week 4 and hoping to see another improvement soon. I have read that if you aren’t back to normal within 3 months it’s unlikely you will be.

 

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When I asked my Doctor if the 2 nerve bundles on either side of the prostate only controlled erections or did they control bladder function as well; his reply was "Good question." In other words, they do not know.
For these Urologists, every prostate they remove is like a notch in the belt of an old wild west gunfighter. All they care about is numbers. Oh, I've removed 2,640 prostates, my Urologist told me. Bragging rights are all they are interested in. They could care less about your bladder control. They dance around direct questions, and minimize potential side effects.
The next step is letting them shove a probe up my asshole, and apply electric current in an effort to 'shock' nerves and muscles back to life. If that doesn't work, another surgery is the next step. A big fat NO to that. Looks like I'll be wearing a condom drain for the rest of my life.

 

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Lots of good input here! On one hand it is frustrating that doctors cannot be more definitive about when or if continence will come back after surgery. But, as the 2019 medical article below documents, there are many factors that come into play regarding the ultimate outcome:

Anatomical, surgical and technical factors influencing continence after radical prostatectomy

Radical prostatectomy (RP) is the most frequent treatment with curative intent performed for prostate cancer to date. Different surgical approaches (perineal, transperitoneal, and extraperitoneal) and techniques (laparoscopic and robot assisted) have ...

www.ncbi.nlm.nih.gov

(BTW, this is a great article but very heavy on the medical jargon)

Also, as someone who has been on this site for a year or so, I came to realize that many of our members (including myself) don't have a good overall concept of what is involved in the process of urination (or micturition, as the medical people call it). I did a lot of searching, and looked at a lot of videos & articles, before hitting on the below animated YouTube video that takes you a website called Osmosis.org.

This site appears to be a Cliff Notes-type educational site for students studying to be doctors, nurses, therapist, etc. The only problem is that you will have to register (ie. user name & password) on the Osmosis site to see the whole video, but it's free & you may find other medical information that is useful to you. The video is a little over 7 minutes long, and I highly recommend it.

Enjoy, and looking forward to more feedback on this thread!

 

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I had my prostate removed 10 months ago. I ended up with a major infection a week after being home.fluid got caught in the pocket of where the prostate was and ended up in hospital on antibiotics to get rid of infection had catherer in for 13 days .four months later stitches didnt dissolve and my body was fighting againts this foreign substance in me ( infection 2)..Well i have been incontinent ever since day 1, go thru at least 5 pads in a day pullups at night to no relief ...seems like the more i do the more i leak out ...I try keagals on a daily but dont know if i am actually doing enough ...this is so frustrating to go thru and i just hope there is light somewhere at the end

 

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@Wetdrymee2 I am 13 weeks post-op on Christmas Day. I am 52 years old. My progression is as follows:

Had catheter removed after 1 week post-op. Voiding sensation was nonexistent for a couple days but slowly started coming back after a week. Had to go frequently. Leaking was frequent and went through 3-4 depends a day. I experienced leaking every time I stood up and often just waking around the office or at home.

Doc set me up with physical therapist for pelvic floor (kegels) exercises and I had first session at about Week 2 or 3. (Forget which). By this time the void sensation had returned and I was going often but still leaking a good bit.

By week 4 I had improved to 2-3 depends a day.

By week 6/7 - I was at 2 pads a day and noticed really good improvement at night and with very little leakage and less leakage during day from sit to stand position. Was still having trouble with stress incontinence from walking around and seemed worse as day wore on (fatigue?)

By week 8 I had visited physical therapist about 3 times and was doing a variety of pelvic floor muscle exercises 3 times a day. I confess I probably did two sets a day most days instead of 3. I was down to 1-2 pads a day. Doing more strenuous activity like yard work or bending and moving light objects often caused leakage even as I tried to brace for it.

By week 10, I’m down to 1 pad most days and maybe 2 pads on a bad day out of every week. Voiding once at night. Trying to spread voiding out to 2.5 hours during the day and leakage is minimal during day. Later in days seem to be most leakage (again fatigue?)

In the last week, and after about 6 PT visits total, I’ve gone a full night in normal underwear without leakage and I’ve just completed 2 full days in a row wearing underwear with slight leakage and nothing to cause a change of underwear or pants. I’m encouraged (finally). My activity level has been walking the dog and normal routines like going to grocery store or other typical errands but I haven’t pushed too hard on activity that could cause stress incontinence. I’m off work for the holidays now and will probably continue with a depends or have one with me just in case when I return to the office after Jan. 1.

All in all I’m encouraged with the progress. I’ve slowly but steadily improved and am a firm believer in positivity. Hopefully I continue to “dry out” in the coming weeks and months.

I’ve read many conflicting and differing personal accounts here and other places. I’m certain everyone’s plight is different regarding surgeons, your age, general overall health going in and coming out of surgery, physical therapy sessions, diet, etc. I feel fortunate thus far based on what I’ve encountered and others have shared regarding their experiences here.

I’ve found what others have posted here to be helpful and encouraging. I’m also empathetic to those who have expressed frustration and doubt while experiencing little or no progress over a longer period of time. I hope detailing my progression helps you in some way. Now, the ED issue is another thing altogether and one I’ve seen a little progression and hopefully will see more from additional healing and prescription therapy plus vacuum device therapy. Fingers crossed.

Merry Christmas and blessings to all during these times of healing.

 

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Thanks for sharing Markus. I am a little behind you at 7 weeks. But I can apply your progress to me, and it’s encouraging to hear you are having dry periods. Keep us posted ever month or when you see changes. merry Christmas

 

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@Kirk glad to share Kirk and sounds like you are on a similar path. Wishing you continued healing and progress. I will continue to post.

 

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8 weeks yesterday from surgery. I did not wear a pad to bed, nor did I wear one this morning, went to the store and bought some men's shields today just for piece of mind. I'm hoping this is the beginning of the end. I'll continue to update you guys. Also stick around to encourage anyone I can. Now let's hope I didn't jinx myself with this post.

 

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Have you been doing Kegel or pelvic floor exercises? I have had on and off discomfort/pain and am three months post op
Did you find that the exercises made a difference if you did them?

 

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I do them, I also walk about 5 miles a day at work, so that may be helping too. I believe they do make a difference. But, everybody seems to have a different experience.