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I've been asked to post my experiences with incontinence and in particular, my decision to have a sling procedure.
I had a prostatectomy in 2018. It was a robotic procedure at Johns Hopkins by one of the top robotic surgeons in the country.
After surgery, like everyone else, I had incontinence issues. Unlike some, I kept extremely detailed records of my urine output in a journal by measuring the weight of my pads. My procedure was in August. By the following April, I could tell that while my incontinence had improved, the improvement was tapering off and I was in kind of a state of "no change." By the standards of some people on this site, my incontinence was extremely mild. On good days, I might only drip around a quarter of an ounce or less. On bad days, which usually involved a lot of extreme physical activity, it might be as high as half an ounce. I should also point out that while I am 64 now, I am an avid exerciser. I bike 14 miles a day, three times a week. On the other three days a week, I spend 3 hours a day in the gym lifting, stationery bike and swimming. There is no doubt in my mind that my high degree of physical activity contributed to my stress incontinence. If I was inactive, I might have had little if any dripping.
I tried all sorts of things to try and reduce my output. Kegels, of course. That didn't work. Electrical stimulation was a bust. So was physical therapy. I also took imipramine, but that too didn't do a thing. I was ultimately told that my problem was probably anatomical. For whatever reason, the length of my urethra, the space left when they took out my prostate, my tightness in my pelvic floor -- all were issues that were unlikely to change.
So after 2.5 years after prostate surgery, I decided to have the sling procedure. A couple of observations. First, don't let them tell you that recovery is a walk in the park. When they cut your scrotum, it is uncomfortable and it stays that way (although improving) for a good 7-8 weeks. The good news is that 2 months after surgery, there is a definite improvement in my continence. The bad news is that it is not a 100% cure. I still leak, albeit at a lower rate, but again, you have to take into account my daily activity levels. Whereas before, I might leak .25 to .5 ounces a day, not it is more like .04 to .10 ounce. That might not sound like a lot but it is the difference between having a soggy pad that smells at the end of the day and something far less objectionable. I've been wearing a pad lately so that I can document the change but I really think that the amount of leakage I have now could be tolerated without a pad. If you drip a little bit, your body heat will evaporate your underwear and you will be technically without a pad.
I can say that there are a number of factors effecting my level of incontinence. If I am physically spent, I leak more than if I am sitting around most of the day. If I haven't had a bowel movement or I have a lot a intestinal bloating, I leak more. But then, there are also some days that are better or worse than others for no obvious reason.
Hope this helps. I will close with the observation that your prostate surgeon will probably not want to hear about your post-op leaking. I think doctors don't like hearing that their procedure was less than perfect, regardless of whether it had anything to do with the competence of the surgery itself. The fact is that probably a lot of prostate patients leak - - a dirty little secret hospitals don't want you to know. They are in business, after all, and incontinence and impotence ( a whole other topic) are BAD for business. There is also the issue of exactly what constitutes continence. Some define it as being completely, 100% dry all the time. Others say you are continent if you use 1 pad per day or less, or that you urine output is less than half an ounce. Nobody has been able to give me a clear definition.
Bottom line ... am I glad I had the sling procedure? Yes. Am I happy that I still leak? NO! Do I wish that I was 100% dry? You bet. I think we all have to realize, however, that a prostatectomy is major surgery and none of us will EVER be exactly the same as we were before. For young men with potential aggressive cancers, surgery is by far the best option, even though it has complications that suck. I guess the saving grace is that if incontinence is the biggest problem we face, we are overall quite fortunate compared to those whose cancer was not eradicated.
I had a prostatectomy in 2018. It was a robotic procedure at Johns Hopkins by one of the top robotic surgeons in the country.
After surgery, like everyone else, I had incontinence issues. Unlike some, I kept extremely detailed records of my urine output in a journal by measuring the weight of my pads. My procedure was in August. By the following April, I could tell that while my incontinence had improved, the improvement was tapering off and I was in kind of a state of "no change." By the standards of some people on this site, my incontinence was extremely mild. On good days, I might only drip around a quarter of an ounce or less. On bad days, which usually involved a lot of extreme physical activity, it might be as high as half an ounce. I should also point out that while I am 64 now, I am an avid exerciser. I bike 14 miles a day, three times a week. On the other three days a week, I spend 3 hours a day in the gym lifting, stationery bike and swimming. There is no doubt in my mind that my high degree of physical activity contributed to my stress incontinence. If I was inactive, I might have had little if any dripping.
I tried all sorts of things to try and reduce my output. Kegels, of course. That didn't work. Electrical stimulation was a bust. So was physical therapy. I also took imipramine, but that too didn't do a thing. I was ultimately told that my problem was probably anatomical. For whatever reason, the length of my urethra, the space left when they took out my prostate, my tightness in my pelvic floor -- all were issues that were unlikely to change.
So after 2.5 years after prostate surgery, I decided to have the sling procedure. A couple of observations. First, don't let them tell you that recovery is a walk in the park. When they cut your scrotum, it is uncomfortable and it stays that way (although improving) for a good 7-8 weeks. The good news is that 2 months after surgery, there is a definite improvement in my continence. The bad news is that it is not a 100% cure. I still leak, albeit at a lower rate, but again, you have to take into account my daily activity levels. Whereas before, I might leak .25 to .5 ounces a day, not it is more like .04 to .10 ounce. That might not sound like a lot but it is the difference between having a soggy pad that smells at the end of the day and something far less objectionable. I've been wearing a pad lately so that I can document the change but I really think that the amount of leakage I have now could be tolerated without a pad. If you drip a little bit, your body heat will evaporate your underwear and you will be technically without a pad.
I can say that there are a number of factors effecting my level of incontinence. If I am physically spent, I leak more than if I am sitting around most of the day. If I haven't had a bowel movement or I have a lot a intestinal bloating, I leak more. But then, there are also some days that are better or worse than others for no obvious reason.
Hope this helps. I will close with the observation that your prostate surgeon will probably not want to hear about your post-op leaking. I think doctors don't like hearing that their procedure was less than perfect, regardless of whether it had anything to do with the competence of the surgery itself. The fact is that probably a lot of prostate patients leak - - a dirty little secret hospitals don't want you to know. They are in business, after all, and incontinence and impotence ( a whole other topic) are BAD for business. There is also the issue of exactly what constitutes continence. Some define it as being completely, 100% dry all the time. Others say you are continent if you use 1 pad per day or less, or that you urine output is less than half an ounce. Nobody has been able to give me a clear definition.
Bottom line ... am I glad I had the sling procedure? Yes. Am I happy that I still leak? NO! Do I wish that I was 100% dry? You bet. I think we all have to realize, however, that a prostatectomy is major surgery and none of us will EVER be exactly the same as we were before. For young men with potential aggressive cancers, surgery is by far the best option, even though it has complications that suck. I guess the saving grace is that if incontinence is the biggest problem we face, we are overall quite fortunate compared to those whose cancer was not eradicated.
