There is hope after prostate surgery – FULL continence can return even for those with initial zero continence

“the fact that he is dry at night suggests that he will eventually be dry during the day as well. Men who are left with permanent problems tend to have no control night or day.” [Source]

RECOVERY IN NINE WEEKS

THE FOLLOWING IS FROM Pre- and Postoperative Pelvic Floor Physical Therapy Enhances the Return to Continence Following Robot-Assisted Laparoscopic Prostatectomy: A Case Report by Natalie Herback, Journal of Women’s Health Physical TherapyJ Issue: Volume 34(1), January/April 2010, p 18–23

Case Description: A 52-year-old man was referred to PFPT 4½ weeks prior to RAP by the urologist. The patient reported good health overall and denied any UI symptoms. The patient returned to PFPT 13 days following surgery and 4 days following catheter removal. He reported constant leakage with all activity, use of 2 to 3 pads per day, use of 1 to 2 pads per night, and full saturation. At the preoperative visit, a full pelvic floor examination was performed, including electromyogram biofeedback. The patient displayed pelvic strength score of 5/5 with 8-second endurance contractions and an average of 66.5 mV on biofeedback. These quantitative measures were used to compare pre- and postoperative strengths.

Outcomes: In this study, objective measures demonstrated the patient’s success with PFPT. After 2 PFPT appointments, the patient’s pelvic floor strength score returned to the presurgical strength score of 5/5. By the fourth visit, the patient’s strength had surpassed his presurgical strength by more than 40%. Additionally, the Internal Index of Erectile Function and Urinary Distress Inventory were used as assessment scales.

Discussion: UI is a common complication of RAP and is most effectively treated with conservative PFPT. PFPT has been found to be most effective if initiated preoperatively and then again immediately following catheter removal. This case report clearly supports this hypothesis, as the patient’s postoperative physical therapy was initiated shortly after catheter removal and he was discharged 9 weeks later, fully continent.

RECOVERY IN THREE MONTHS

“I had surgery so immediately post op I had total incontinence which progressed over three months to stress incontinence which progressed to continence.” [John C. McHugh, Urologist who had prostate surgery himself]

DECENT RECOVERY IN THREE MONTHS

“When my catheter was removed I ( like many others ) had no control whatsoever .… For the first few months I made very little progress and was using between 6 to 8 pads a day ( very expensive! )….
Slowly but surely things started to improve gradually after about 3 to 4 months post op. I am now 7 months post op and still need to use 2 pads daily on average, but am hopeful that I will improve more over the next 6 months or so….” [Source]

RECOVERY IN FOUR MONTHS

“Dryness comes first at night usually pretty quickly as it has with you. The rest takes longer. With me it took 4 months to be completely dry and pad free. Even now though a good laugh, cough, sneeze or fart especially after too much alcohol will lead to a small squirt and some dampness but nothing that would show outside.” [Source]

RECOVERY IN  4 1/2 MONTHS

“30 March: After 2 weeks I have absolutely no flow control. It’s as though the catheter was still in place, since urine dribbles continuously if I am standing or walking. There is no leakage while I am sitting or lying down, but the urine starts flowing as I’m in the process of standing to get out of the chair or bed.

“19 May: I now have some flow control. I can walk around the house, slowly, without leaking. When I get the urge to pee, I can (usually) make it to bathroom without leaking. If I take it easy, I can go a whole day without leaking!

“17 June: I can now walk up and down stair without squirting.

“29 July: I can now run without draining my bladder. Sprinting is out of the question, but I can run for 2 miles at 5 mph then get off the treadmill and go to the bathroom to empty my bladder. Most days I no longer worry about leakage.” [Source]

RECOVERY IN 12 WEEKS (four months)

Terry achieved continence 9-10 weeks after the catheter was removed. He stopped using pads at night during week eight, and 10 days later stopped using a pad in the day. Overall, he was continent fewer than 12 weeks after the operation. [Source]

RECOVERY IN NINE MONTHS – ALL OF A SUDDEN

“An elderly man told me not to lose hope. He had been incontinent for over a year, then one day, out of the blue, it had stopped, and he’d been dry ever since.” [Michael Korda in his book, MAN TO MAN

RECOVERY IN TEN MONTHS

“For the first 3 months he had no bladder control, did his excersizes faithfully. Then he started having less and less leakage. He had to wear a condom catheter when he went back to work as he could feel the need to go, but could not hold it. We are now 10 months post-op and he has total control. Wears nothing.” [Source]

RECOVERY IN 15 MONTHS

My daVinci surgery took place in December 2008. My incontinence lasted for 15 months. I was 100 percent incontinent for about the first 12 months using about 15 super absorbent pads per day. From the beginning I had no leakage as long as I was sitting or lying down. As soon as I got up the flood gates would open. I would keep a jar next to the bed because as soon as I got up to relieve myself I completely lost control.

After 12 months my ability to control urine flow began to return. By 15 months I was fully continent. Here I am more than 6 years after surgery and fully continent. I’m a runner. I wear a light pad for security for runs exceeding 5 miles. Often there is nothing in the pad after a run.

When my journey began and I found myself incontinent I was devastated. Many posts on this site urged me to be patient and my situation would improve. It did improve. It improved beyond my wildest expectations to almost 100 percent.

Others have said you will regain your continence after surgery 98 percent of the time. When I was at my worst I didn’t believe it. Your chances of regaining continence are very good. It might take time but the odds are clearly on your side! [Source]

DECENT RECOVERY IN NINE MONTHS

02/16/2011 – catheter removed, total incontinence, impotence
11/30/2011 – surgery for penile prosthesis, incontinence down to 1 pad a day [Source]

TOLERABLE RECOVERY IN THREE YEARS

My RP was in February of 1998. I am 6′ tall and weigh about 150. My incontinence is still there, but has diminished to the point where many days of the week, my Depends pads are totally dry. I do not need the pads during the night. I still try to keep practicing the Kegel exercises in the hopes that the incontinence will totally be cured. My worst times are when I need to squat down as in weeding the planters and other
jobs close to the ground. Even during the worst times, I estimate the volume as less than a tablespoon. The exercise of stopping and then starting the flow while urinating seems to have been the most help in training the muscles needed to prevent leakage. Each person is certainly different, and the surgury may have done differing amounts of damage, but with the exercises and trying to stop the flow at various times, there has been considerable improvement over these three years. After the RP, I was using several Depends pads per day. I’m still noticing improvements as time goes by, so I would encourage Tom to keep up with the
exercises and concentrating on urinary control.” [MAILING LIST]

ELECTRICAL STIMULATION CAN HELP

“In April 08 Discovered US TOO and went to local session in Fairfax Virginia where I met BJ CZarapata, a nurse practitioner specializing in female and male incontinence with major focus on post RP incontinence. After some exploration and initial testing we started e-stim (electrical stimulation) and low dose of Vesicare to help relax bladder. Over next 12 weeks conducted daily e-stim therapy at home with varying levels of success. Current status is: 25% to 50% incontinent depending on day, how much I move around.” [Source]

Figure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862314/figure/fig1/

“We developed sacral surface therapeutic electrical stimulation (SSTES) as a therapy for urinary incontinence using neuromodulation [11]. In this therapy, skin surface electrodes are applied on the sacral surface to provide stimulation, making the treatment very easy to perform. It has been shown that SSTES has not only an inhibitory effect on detrusor overactivity but also an efferent stimulant effect to the pudendal nerve [11]. It is thus expected that SSTES initiated in an early postoperative period would be effective for early recovery of postoperative urinary continence.”

OBJECTIVES:

To investigate whether sacral surface therapeutic electrical stimulation (SSTES) initiated during the early postoperative period would be effective towards early recovery of postprostatectomy urinary continence.

METHODS:

A total of 35 consecutive patients who underwent radical prostatectomy by a single surgeon were enrolled in this study. Twenty early patients began pelvic floor muscle exercise (PME). Fifteen subsequent patients received SSTES postoperatively with no instruction for PME provided. Immediate urinary function just after catheter removal was evaluated with frequency-volume chart and 24-hour pad test.

RESULTS:

There were no differences between the SSTES and PME groups in maximum voided volume capacity (MVV) and urine loss ratio (ULR) on the first day after removal of urethral catheter. However, on day 3 MVV was significantly larger and ULR was also significantly lower in the SSTES group.

CONCLUSIONS:

SSTES treatment is feasible and appears to be effective for early recovery of urinary continence after radical prostatectomy.

A SERIOUSLY BAD CASE – THE DINO BROWN CASE

[Source]

From day one, I have had continual incontinence and that is how it has remained. I feel no urgency, no flow, no evacuation. I don’t feel anything but the warm wet in my crotch.

Over night, things changed rapidly: Things started to change. Three times, while sitting at my computer, I got up slowly, made my way to the bathroom and was able to pee. The real change came in the night. I couldn’t sleep until about 2:00 AM. Each hour thereafter until 6:30 AM, I was awakened with an urge to pee. I made my way to the bathroom and did, in fact, pee, even felt relief. This miracle was repeated at 8:00 AM and 9:30 AM when I finally decided that additional sleep was not in the cards.

As I enter my 14th week after surgery, I believe I’m gaining some control over incontinence. Points of encouragement: (1) I used fewer diapers on my two week trip than expected; (2) I was able to hold my urine while gassing up, getting off the bike, paying and working my way to the men’s room where I would deposit some pee. I’m far from diaper free. I’m still a 24/7 wearer but they are less wet over a longer amount of time; (3) I am quite good at holding my urine while sleeping although I have to get up about every 1-1.5 hours to pee; (4) I can usually get about 50% of my urine in the bowl if I am only sitting around and talking or working on the computer. As expected, moving around and doing stuff, even as simple as standing up, still causes significant wetting.

After 21 weeks: I’m back at my usual tasks – incontinence is a persistent inconvenience. I am still experiencing continual incontinence. When I sleep there is still some degree of control and I don’t always dribble all over the bathroom after I shower. That is progress but the progress has not continued. I appear to have reached a recovery plateau.

At six months: I am still plagued by near continual incontinence. There is little to no sensation of urgency, flow, or evacuation and as I grow accustomed to life in wet diapers, I tend to overlook the sense of wetness often with embarrassing results. I am best when prone, when I do experience a small sense of urgency that awakens me. My sphincter is strong enough to keep me from wetting the floor or the toilet seat but the urine already past the sphincter does leak out into the diaper when I arise. I can usually make it through the night with a single diaper soiled only by the slight leakage mentioned from a few trips to the bathroom. I continue half-heartedly and sporadically with the Kegel exercises.

NINE MONTHS: “Having reviewed the blood and lab work ordered by my doctor previously, the team that she had assembled agreed that the most likely conclusion was neurological damage incurred during the prostatectomy.”  [The doctor “advised that my anal sphincter had been neurologically damaged by the surgery and that it accounted for some of my symptoms.”. Further “The second sphincter, the one below the prostate, was badly damaged and not likely to ever function properly again.”]

SLING SURGERY: “Dr. Ng and I are on the same page about all the alternatives and the Plan B and C options should the procedure of choice (the latest in incontinence technology, the AdVance Sling, which replaced the Invance sling and has a number of improvements). Dr. Ng, always conscious of the patients feeling and concerns, suggest I think it over and let her know. I say, no. Do it. Dr. Ng immediately set the ball rolling and I expect the surgery will be sometime this month or early March.  … After 8 plus months of persistent incontinence, that is continual incontinence (I feel nothing), I have opted for an implant of the AMS AdVance sling. ”

AFTER SLING SURGERY: “Eleven days later, I still leak when coughing, sneezing, or during any degree of exertion. When the doctor tells you to take it easy for 6-8 weeks – DO NOTHING!!! The bottom line is that despite the slight leakage, I am 99% dry, the cost of pads is significantly lower, and I continue to do my Kegels to aid the process.”

SLING SURGERY IS VERY DELICATE: “the sling is “anchored” only in the muscle, and stretching it by spreading the legs applies pressure to the sling and tends to pull it free from the muscle, this is not a desirable activity. (I should have had my son lift both my legs into the car for me.) The mechanism is like Velcro hooks on a strap which are intended to grow into the muscle to secure the sling. However, great care must be taken not to engage in any activity that might pull the sling taught and this create a little slack when the tension is released. ”

SURGERY DID NOT WORK: “There is a standard for measuring the strength of the sphincter. Either the sling or a normal sphincter requires a rating of 40. Mine is at 12. Very weak.”

NEXT STEP: ARTIFICIAL SPHINCTER: “Six weeks ago I endured the uncomfortable and mind scrambling surgical implant of a device designed to operate as an artificial urinary sphincter (AMS 800 Urinary Control System)”

CASES OF TOTAL INCONTINENCE

This website has a number of such cases.

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