Category: Prostate cancer

Prostate cancer resources/ support groups/ experts


Prostate diaries by Dr John C. McHugh

MAILING LISTS / electronic support groups

Prostate Problems Mailing List

You Are Not Alone (YANA)


These two groups are relevant for me:

Prostate Heidelberg: Website  

Meetings: From 10 am to 12.30 pm on the 3rd Tuesday of the month (except January) at Uniting Church Hall, Seddon Street, Ivanhoe 

Diamond Valley Prostate Cancer Support Group: Website

Meetings: At 7 pm on the third Monday of every month (January to November) at the Eltham Living and Learning Centre, 739 Main Eltham Road, Eltham

Contact the National Continence Helpline on freecall™ 1800 33 00 66. This Helpline can advise you about the most appropriate health professional to see and put you in touch with a local continence service who can help. [Source]


Continence Clinics Australia Wide


Urinary Continence and Sexual Function After Robotic Radical Prostatectomy

Peter Dornan  Peter is author of Conquering Incontinence (2003)

I developed a program to treat incontinence. This involved, basically, designing a strong exercise program for the pelvic floor muscles which were progressively overloaded by integrating the abdominal muscles, as well as developing a super-fit neuromuscular reflex circuitry. My experience led me to write a book outlining the program – “Conquering Incontinence” (see “books” on my website).  [Source]

P – managing the urinary issues of prostate cancer surgery

Dis-Ease: Living with Prostate Cancer

Pelvic Yoga: An Integrated Program of Pelvic Floor Exercise to Support Overall Pelvic Floor Health  [list of exercises]

Beyond Kegels: Fabulous Four Exercises and More To Prevent and Treat Incontinence

Prostate Recovery MAP: Men’s Action Plan 2

Life after Prostatectomy and Other Urological Surgeries: 10 Weeks from Incontinence to Continence

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Assessing the effectiveness of Kegel exercises

WHAT ARE THESE [see my blog post here]

The most widely known exercises which prevent and treat urinary incontinence were created by Dr. Arnold Kegel in the fifities. This American gynecologist was the first to scientifically use exercises to strengthen the pelvic floor muscles in order to improve urinary incontinence mechanisms. These exercises improve the perineum muscle contraction, giving it more power (strong and fast), increase urethral compression against the pubic symphysis, increase intra-urethral pressure when intra-abdominal pressure is increased, help pelvic muscle hypertrophy and increase the volume of such muscles. Hence, structural support of this body area becomes more effective and prevents the urethra from descending when intra-abdominal pressure increases and, consequently, decreasing urinary leaking.

The pelvic floor muscles should support the viscera in the upright position and maintain urinary continence as well. So, they should be kept strong and in perfect condition.

Since Kegel first published the development of these exercises, they have been widely used and quoted in medical academic literature; however, as of then, it is also possible to find not only different techniques and systematization (that is, frequency, intensity, repetitions and associations) but also different instructions given to patients in scientific literature. According to theory on the development of exercises to treat stress urinary incontinence, the aim is to boost pelvic floor muscle (PFM) strength, coordination, speed and resistance in order to keep structures in an adequate position whenever there is an effort which causes intra-abdominal pressure increase and, thus, keeping a proper urethral closure strength. (Ashton-Miller et al., 2001).


“After women were “taught” to contract their PFM while coughing, the authors noticed a significant incontinence reduction” [Urinary Incontinence, edited by Ammar Alhasso and Ashani Fernando].

According to the protocol of the Association of Women’s Health Obstetrics and Neonatal Nurses (Agency for Health Care Policy and Research, [AWHONN]), “PFM strengthening exercises should include 40 to 50 contractions per session, with a sequence of 8 to 12 slow and quick contractions, where contractions are slow and isometric, 5 seconds long at the beginning and lasting for 10 seconds later on. Long term and daily training can, however, allow more contractions per class or training session” [Urinary Incontinence, edited by Ammar Alhasso and Ashani Fernando].


“For kegels to work, you squeeze the muscles as hard as you can. It takes focus”. “To keep your muscles healthy, you relax the muscles completely after each kegel. Close your eyes and relax”

+ Drink a lot of water:

If you don’t drink enough water, your urine gets too concentrated. The extra-strong urine irritates the bladder and can cause urine leaks. It’s true! Drinking more water can help you stay dry. [Source]


“A healthy muscle that works well and feels good is a muscle that is relaxed and supple, not tight and clenched”. [Source]

“kegels done without a device work better than kegels done with weights”. [Source]

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Surgical options for improving post-prostate surgery incontinence

BE AWARE THAT ONCE YOU INSTALL THE ARTIFICIAL SPHINCTER, YOU’VE ELIMINATED ALL POSSIBILITIES FOR A RETURN TO NORMAL CONTROL: “Urologists I dealt with were reluctant to do the sphincter, because there would be no possibility of return to normal control. “Burning a bridge” was the term.” [a mailing list]

This link provides a list of options and their pros and cons.

In the last years, the urological community has been developing new procedures to treat postprostatic surgery urinary incontinence. Despite their long history of use, collagen injections are associated with low cure rates. Moreover, collagen is gradually reabsorbed by the organism, leading to additional applications of the product, along with no significant increase in long-term cure.

** proact device at the bladder neck

The proact device is a newer treatment which involves a minor surgical procedure to place two balloons next to the bladder neck. This is done as a day only or overnight stay procedure. It gives one the opportunity to top up the balloons until urinary control is markedly improved or perfect. It often takes up to six months to get to that stage. There is a 10% risk of infection and a 10% chance of incorrectly positioning these balloons, or erosions. Four-year results appear to have very promising outcomes at this stage. At St Vincent’s we have been performing these for almost two years and results are very encouraging. [Source]

1) Artificial sphincter: Artificial Urinary Sphincter – The AMS 800™ Urinary Control System is  the “Gold Standard Treatment” for incontinence. This implantable device  mimics the function of a healthy urinary sphincter, closing off the urethra  in order to stop the flow of urine. The procedure involves implanting an  inflatable cuff around the urethra, which is inflated by a fluid-filled balloon  that is placed behind the pelvic bone. A pump inside the scrotum allows  the man to deflate the cuff when he needs to urinate. It will automatically  re-inflate, firmly closing off the urethra, preventing leakage. [Source]

The AMS 800 is a body-shaped strap that is placed around the bladder neck or bulbar urethra. This body is connected to a balloon pressure regulator via a control pump, located in the scrotum of the patient. The whole system is filled with saline, hydraulic operation. The pressure in the system and therefore the strength of the occlusive balloon body is determined by the throttle, being maintained in the system except when the pump is activated voluntarily by patients who do not account for intermittent catheterization. This activation provides the rapid emptying of saline in the body, which fluid is directed to the balloon pressure regulator, momentarily removing the occlusive force of the body and allowing urination by the patient. The body is kept empty for long enough (2-3 min) so that urination is complete before returning to gain momentum due to the return of occlusive saline.

Follow-up ranged from 27 to 132 months (mean 53.4 +- 21.4 months). There was a significant reduction in pad count from 4.0 +- 0.9 to 0.62 +- 1.07 diapers per day (P<0.001) leading to continence in 90%. Twenty patients (50%) were completely dry, and 16 (40%) required 1 pad per day. There was a significant reduction on the impact of incontinence decreasing from 5.0 +- 0.7 to 1.4 +- 0.93 (P _0.001) in a visual analogue scale (VAS). Surgical revision rate was 20%.

The main complications related to the AMS 800 are: Revision rate of the device in 5 years (26%), malfunctioning device (8%), pain/discomfort (6,9%), slow healing of wounds (5,7%), bladder spasms (2,3%), activation difficult (2,3%), displacement of the device (3,5%), erosion tissue (2,3%), disabling difficult (1,1%), infection (2,3%), recurring incontinence (3,5%), fistula formation (1,1%), hematoma (1,1%), swelling (2,3%), hydrocele (1,1%), erosion tissue/infection (1,1%), patient dissatisfaction (1,1%), incontinence position (1,1%), wound infection (1,1%), urinary retention (1,1%) (Shellock F, et al. 1988; Litwiller SE, et al. 1996) [Source: Urinary Incontinence (Edited by Ammar Alhasso and Ashani Fernando)]

2) Constrictor Inflatable Periurethral: The AMS 800 is the best treatment for the patients with severe sphincter incontinence, but preliminary data from the Constrictor Inflatable Periurethral are encouraging.  Despite their recognized efficacy, the greater structural complexity of the AMS 800 has a direct impact on their high cost. Meanwhile, the Constrictor has provided preliminary efficacy results similar to the AMS 800, on a smaller device cost about 16 times.

The Constrictor Inflatable Periurethral SILIMED (Rio de Janeiro – Brazil) device consists essentially of 2 parts – body and valve constriction. The main functional difference between the two devices is that the force of the occlusive body Constrictor Inflatable Periurethral remains constant throughout the duration of use of the device. If necessary, the patient’s physician can make periodic adjustments of pressure in order to increase or decrease the force of the occlusive body, through the injection or removal of saline through the valve device in an outpatient setting. Meanwhile, the literature indicates a technical difficulty related to the change in pressure in the system of the AMS 800, possible only after revision surgery for the exchange of the balloon pressure regulator (Mundy, 1991).

The medical and scientific literature presents both AMS 800 and the Constrictor Inflatable Periurethral (preliminary data) as trusted devices and with good durability. Any problems would be reversed, in most cases, for simple or surgical outpatient review, which would ensure good continence rates, according to the criteria of effectiveness adopted by different authors.

The relative simplicity of the Constrictor apparently does not interfere with its effectiveness. Studies of the groups of Dr. Salvador Vilar and Dr. João Schiavini Constrictor present with continence rates of around 85% during treatment, as mentioned ahead. Moreover, the Constrictor was also able to provide some patients voiding spontaneously, especially in adults with urinary incontinence after prostate surgery sphincter. Even in cases where intermittent catheterization was used, the rate of patient satisfaction were generally high. [Source: Urinary Incontinence (Edited by Ammar Alhasso and Ashani Fernando)]

3) Collagen injections: Injecting bulk-producing agents, such as collagen into the  bladder neck, can help keep the urethra and bladder opening closed and  may help prevent small leaks. Even if successful, repeated injections over  time may be required to maintain continence. [Source]

Treatments such as collagen injections and the periurethral sling men do not appear as effective alternatives for long-term treatment of severe forms of this type of incontinence. Despite the long history of use, collagen injections are associated with success rates that generally do not exceed 40% cure rate. Due to the metabolism of collagen in the body, there is a gradual decrease in cure rates associated with the technique. This transient effectiveness usually takes the need for applying multiple injections on each patient, increasing the treatment without increasing the rates of long-term success. [Source: Urinary Incontinence (Edited by Ammar Alhasso and Ashani Fernando)]

4) Male sling:  The AdVance™ Male Sling System from American Medical  Systems (AMS) is positioned in the body with a minimally invasive,  surgical procedure for correcting stress urinary incontinence.  A small “sling” made of synthetic mesh is placed inside the body  through three small incisions. The sling supports the urethra, restoring  normal bladder control. Most patients are continent immediately following the procedure. [Source]

The male sling appeared as a possible treatment for patients with sphincter incontinence after prostate surgery. However, the results were effective only in patients with mild to moderate incontinence. Sahaja & Terris, 2006, also pointed out that the male sling would not be as effective as a device with more physiological action, such as the artificial sphincter. For the structural similarity between the body of the AMS 800 and the Constrictor, this reasoning could be extended to the Constrictor.

In 2007, Schiavini & Resende Jr and colleagues, University Hospital Pedro Ernesto, Rio de Janeiro, study, eighteen patients had urinary incontinence after radical retropubic prostatectomy, and five were previously submitted to procedures for the treatment of bladder neck strictures. In all patients, the body of the device was placed around the bulbar urethra, with activation of the device after 8 weeks. Patients were followed from 6 to 36 months. For the authors, successful treatment was predefined as the need to use a diaper until the day -social continence, together with patient satisfaction.

The patient is subjected to anesthesia. Ureteroscopy with internal urethrotomy was performed when it was not possible to place a bladder catheter preoperatively. To implement the Constrictor Inflatable Periurethral around the bulbar urethra, the surgical access of up to 10cm in the perineal raphe, with the developer in the lithotomy position. The muscle fibers bulb-cavernous must be separated in the longitudinal direction, and the bulbar urethra dissected easily visible and later by creating the space for placing the constriction around her body.

The Constrictor Inflatable Periurethral should have your air completely removed before being introduced into 2 ml of pyrogen-free saline. Meticulous haemostasis is essential to reduce risk of haematoma formation.

The urethral catheter can be withdrawn on the 1st postoperative day. Activation of Inflatable Periurethral Constrictor should be held approximately 8 weeks (at least 6 and at most 12 weeks) after implantation, when a urodynamic study should be performed in conjunction with the measurement of pressure inside the device. [Source: Urinary Incontinence (Edited by Ammar Alhasso and Ashani Fernando)]


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Prognosis of recovery from post-surgery incontinence after radical prostatectomy/ progression of continence & control


I started with close to total incontinence after surgery – except when lying down or sitting. I later came to understand that mine was not 100 per cent incontinence since I was continent while lying and sitting down. There are people (around 1 per cent) who are actually totally incontinent – see diagram below:

“Total incontinence is uncommon, but a possibility.” [Source] (“Men who are left with permanent problems tend to have no control night or day.” – Source)


“As a result of disruption or damage during surgery, the sphincter muscles that control the release of urine may be weakened. The level of incontinence varies; some men may have slight leaking or dripping, while others may experience complete bladder emptying. This unwanted release of urine can happen at any time. Strenuous activities and sports are a culprit, or a simple laugh, cough, sneeze or change of position may trigger it. Biologically, this type of incontinence is actually very similar to what some women experience post-childbirth. … It is important to accept that most men will experience some degree of urinary incontinence after prostate surgery. This is not an indication of long-term damage.” [Source]


I found this study which I believe is the most scientific to date on this subject: An objective measurement of urinary continence recovery with pelvic floor physiotherapy following robotic assisted radical prostatectomy

According to this study, “the mean daily urine leakage during the first recorded week was 408.0 mL. This decreased to 205.8 and 110.1 mL at 2 and 3 months post-RALP (P<0.05). This equated to a significant 57.1% (95% CI, 52.9% to 61.3%) and 75.6% (95% CI, 72.3% to 78.8%) improvement in urinary leakage at the same respective time points.” The following figure is from the above study:

[Sanjeev: I started with 945 ml per day in Week 2 after surgery. By the end of Week 4 I was at 695 ml, end of week 8 509 ml, end of week 10 329 ml, end of week 12 160 ml.]

“You may experience severe incontinence in the first few weeks following surgery. The best way to deal with this is to be prepared for it and learn what you should do to manage it. Incontinence after prostate surgery can take 6 to 12 months to completely resolve.” [Source]

“Regaining urinary control can take several weeks or months and some men don’t reach their full recovery capacity for a year or more. Age, weight and previous urinary issues are also factors in recovery time. Patients of Dr. Samadi’s who experienced normal continence prior to surgery can expect to regain urinary control within 12 to 13 months.” [Source]

A patient: “I have kept careful records of daily urine loss into pads from the time the catheter came out. Initially, I was losing about 450 grams per day. One dreadful day in February it topped 900g! For a few weeks after the op there was little improvement but in the spring it started to decline, although it was rather two steps forward and one back! Now, nearly 12 months on I am stuck at about 30g per day loss and have been there for about two months. That’s a huge improvement on where I started but it’s still enough to have a significant impact on my life.” [Source] (Sanjeev: I think most patients would be very happy to live with 30 ml leakage per day)

“One man who commenced pelvic floor exercises a year after radical prostatectomy kept a chart
of his monthly urinary leakage” [Grace Dorey – Pelvic Dysfunction in Men]



  1. “97 percent regain urinary control within two to three months.” [Source]  This is a massive exaggeration of the reality of incontinence after robotic surgery.
  2. “when continence returns, it seems to come back in large gains. In other words, you realize one day that your control is much better than it was yesterday. It takes patients, don’t try to rush it. Also, doing more Kegels than recommended does not help.” [Source] (Sanjeev: in my case – and as per the study, continence has returned slowly, and in stages. At each stage stage there has been a steady improvement in recovery.)


  • see my slides here.

Most improvement take place in the initial months: “Incontinence can continue to improve for up to a year although the majority of the improvement takes place in the first few months postoperatively. If the leakage continues beyond a year then it is unlikely that there will be further significant improvement.” [source] (Sanjeev: I do not agree that there can’t be improvement after one year: Peter Dornan’s case is solid proof that incontinence can be dramatically improved with exercise even after four years]


Stress incontinence may therefore be classified into four stages or degrees : stage 1, incontinence only
on coughing or straining ; stage 2, incontinence on assuming upright posture ; stage 3, incontinence on
sitting up in bed ; and stage 4, incontinence when recumbent (Some Common Complications After Prostatectomy, J. Cosbie Ross and L. F. Tinckler, The British Medical Journal, Vol. 2, No. 5153 (Oct. 10, 1959).

For most men, this process happens in three distinct stages:

  • Phase one is when a man can remain dry when he’s lying down.  [“My only sign of progress with continence is more ability now than 4 weeks ago to hold it from a chair or bed to the bathroom by squeezing.- source] [Also: “Gradually with constant exercise I gained some control. The first big breakthrough was making it through the night with out leaking ( 3rd-4th week).-source] One other thing, do the cup routine with urine in the bladder. You will not believe how quick you will isolate the proper muscles for continence.  ALSO SEE THIS: “I retain urine in my bladder when I’m lying down (usually have to get up and try to reach the toilet every 1 to 1 1/2 hours at night..I don’t think my bladder capacity exceeds 3 ounces) but..during the day when I sit or stand or walk, I retain nothing in my bladder!” – FROM A MAILING LIST. This suggests that the second stage of Phase one is BEING DRY WHEN SITTING DOWN.
  • In phase two, you’re dry when you’re walking around. If you can walk to the bathroom and not urinate until you get there, that’s a great sign- it means the sphincter is intact. [Sanjeev: This is incorrect. The first stage of phase 2 is when you are dry while standing. Unless this is achieved, there is little prospect of being dry while walking. Then would come walking > then change in posture > coughing/ sneezing > running.]
  • In phase three, you are dry when you stand up (using muscles that put pressure on the sphincter) after sitting. [Source]

Urinary control returns in 3 phases [Source]

  • Phase I – You are dry when lying down at night. [“You may notice that you have better control when you are lying down. That is because the weight of the urine is spread over the sides of the bladder instead of pressing down on the urethra”] [“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]
  • Phase II – You are dry when walking around.
  • Phase III – You are dry when you get up from a seated position. This is the last part of continence that returns. Everyone is different and it is hard to know when you will be dry. [“I find the leakage is worse for me when I squat or sit with my legs apart. I presume this opens up the tubing.” – source]

“The usual order of recovery is: leak all the time, continent while lying down, continent while sitting, while standing, while walking, continent while standing up from sitting. etc. The rough numbers are: 2/3 of men will be continent at 3 months post surgery. Of the remaining 1/3, 2/3 will be continent at one year. For the soggy 1/9 left over (I was in that group) most likely some form of remediation will be necessary.” [Source]

You will notice an increase in being able to control your urine. Generally, this is better in the morning than in the afternoon. [Source]

Why? “The bladder, Emory and the nurse explained patiently (they had obviously done it before), was like a bowl. When I was seated or lying down, it was turned on its side, so the urine tended to stay in it, but when I stood up the open end was inverted, as if the bowl were turned upside down, and the urine simply ran out. Ordinarily, the urethral sphincter would hold the urine back, of course, but since the sphincter was still in shock, there was simply nothing to impede the urine from flowing out when I stood up or walked around, nor would there be until the sphincter resumed its function.” [Michael Korda in his book, MAN TO MAN]

Signs of improvement [Source]

  • Using less incontinence pads
  • Getting up less than 2 times a night and remaining dry
  • Being dry in the early part of the day
  • Being dry all day
  • Not leaking when you cough, sneeze, laugh or lift
  • Being dry with sport and exercise

Continence Products after Radical Prostatectomy


Virginia Ip: The following recommendations are based on experience shared by men who had this surgery as well as my own clinical experience. As each person progresses differently, this is only a guide.

Stage I: Severe urinary incontinence: Immediately after removal of urinary catheter till up to 2 weeks. The bladder does not hold any urine and leaks constantly, needing the use of large capacity incontinence products.

Stage 2: Moderate urinary incontinence, approximately from week 3 to week 8

Stage 3: Mild incontinence, after 8 to 12 weeks: Small amount of leakage may occur especially during sports, coughing, walking or other physical activities. By this time, the pad usage is on average one small pad per day.

Stage 4: Occasional leakage (few drops) a day: This may be a few drops after passing urine.


“Some men dribble urine, whereas others will experience a total leakage. When removing the prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra, thus limiting damage to the sphincter. Still, at this point, any man who is undergoing … surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.” [Source]

Once the catheter is removed after your surgery, you may experience symptoms ranging from light urine leakage (a few drops when you exercise, cough or sneeze) all the way to a complete inability to control your urination.[Source]

Once the catheter is removed you will most likely leak variable amounts of urine. Almost everyone requires urinary pads or some other form of collection device (briefs, drip collector, condom catheter etc) for a period of time. Patients should be advised they will likely be using pads for weeks to months. Most men will experience leakage with activity (laughing, coughing, exercising). Leakage may range from just a few drops intermittently to a large volume of continuous leakage. Others will have the sudden unexpected urge to urinate and feel the need to rush to the restroom. [Source]

For some men, urinary problems may not occur or are quickly resolved. For other men, they can be more problematic, requiring further support and help from members of their healthcare team who specialise in prostate cancer and urinary problems. [Source]


At age 51, I wouldn’t choose to be incontinent, to wear “male guards,” but in the end it’s just a biomechanical flaw. Same with impotence. Don’t get me wrong, I like the physical life. It’s important to me. I regularly walk five miles a day, and I’ve started running and lifting light weights again. But I decline to feel diminished by incontinence, to be defined by biological drizzle. [Source]


[Source for the above diagram]

“Men have a very high prevalence of incontinence after prostate cancer, but in the research world the understanding about how men actually recover continence after they have surgery is far from complete” [Source]

“a range of 8%-63% of men will report some degree of stress urinary incontinence (SUI) to be a significant problem one year after their prostatectomy”.[Source]

One study that sent periodic surveys to 279 patients to proactively seek their responses both before and after treatment for prostate cancer, which was published in the Journal of Clinical Oncology, found that at three months after surgery, 58% of men reported wearing an absorbent pad in the previous week, and at 12 months after surgery, 35% reported using a pad in the previous week. [Source]

In one of his studies he prospectively followed a group of 70 men, with a median age of 57, undergoing open RRP. Patient-reported continence rates, defined as “no pads” at 3, 6, 12, and 18 months post-operatively were 54%, 80%, 93%, and 93% among the 59 men who had complete follow-up (Walsh et al 2000) . This study is a good example of what can potentially be achieved with arguably the best open surgeon and a relatively young cohort of patients.  [Source]

at three months after surgery, 24% of men reported leaking urine “a lot” in the previous week, and at 12 months, 11% were still experiencing the problem. [Source]

an analysis of the outcomes of 1,291 men who underwent radical prostatectomy, published in the Journal of the American Medical Association, found that 8.4% remained incontinent 18 months or longer after surgery. Another study of 901 men treated with surgery, published in the Journal of the National Cancer Institute,found that 14% to 16% were incontinent five years after treatment. Finally, an analysis of the Medicare claims records of 11,522 men who underwent radical prostatectomy, published in the New England Journal of Medicine, found that, depending on age, anywhere from 18% to 24% of men continued to experience incontinence more than one year after surgery, and 7% to 9% sought out some type of corrective procedure, such as the placement of an artificial sphincter. [Source]

More data (including of robotic surgery) available here.


I have had a radical prostatectomy and my incontinence is good when lying down or sitting…if I move…I urinate. Doing Kegels. No change. Do you people have ANY idea how depressing…disheartening and thoroughly frustrating this whole mess is. I am 54…otherwise healthy…in very good shape and my life…as I knew it…is over. I can’t cycle…work out at a gym…and can barely get through a walk without completely soaking a heavy duty pad…or those stupid underpants that make you look like you are walking around with a load of crap in your pants. [Source]




“This is how my consultant explained things to me: Before surgery I had 2 sphincter muscles to control urine flow…….. …..One internal sphincter muscle which was / is situated near the base of the prostate and bladder neck. This was either partly removed along with the prostate or possibly damaged / disturbed during surgery and reconstruction of the urethra in order to remove all of the prostate and associated tumour(s)….. The second is an external sphincter muscle which is located and works in conjunction with the pelvic floor muscles ….
This muscle was secondary in urine control before surgery……. After surgery it now needs to be stronger to in effect do the extra work of the missing / damaged internal sphincter muscle….hence pelvic floor exercises may help urine control by strengthening this muscle and aid continence…. although there is no guarantee full continence will be achieved if the internal sphincter has been too badly damaged… Pelvic floor exercises may well help in regaining continence quicker, but the overall outcome will be dependent on how much trauma the internal sphincter muscle has endured during surgery.” [source]


“The reason that post-operative leakage occurs is that the apex of the prostate is intimately associated with the sphincter muscle that controls urinary continence. In order to remove the prostate this muscle needs to be divided. It is therefore fairly common for patients to have a period of post-operative urinary leakage after surgical treatment for prostate cancer.” [Source]


When your prostate gland is removed entirely by radical prostatectomy, two things occur during the surgery that can cause urinary side effects: a) A gap is created between the bladder and urethra, which is
then surgically reconnected; b) the bladder neck (where the bladder and urethra join) can
be affected and this can cause urinary problems; and (c) the external sphincter may be weakened, or very rarely, damaged during surgery, and this can cause urinary problems as well. [Source]

At the point where the bladder and urethra join, there is a ring of muscles, known as the bladder neck sphincter, which opens and closes like a camera-shutter. The bladder neck sphincter is closed most of the time to prevent urine leaking out but when it gets permission from the brain, it opens to allow urine to be passed. Another (external) sphincter is part of another set of muscles below the prostate called the pelvic floor. These muscles are also involved in bladder control. If the bladder neck sphincter is damaged during prostate cancer surgery, the pelvic floor muscles are now relied on to control the bladder more often. If the pelvic floor is weak you may experience urinary incontinence. [Source]

Post-prostatectomy continence is dependent on the distal sphincter system, primarily the intrinsic striated sphincter. With its slow-twich fibres it maintains the ‘passive’continence. – see figure below.

A comprehensive review of the literature and urodynamic results concluded that the male urethral
sphincter has two parts and is composed of an inner smooth muscle layer that is more pronounced proximally at the bladder neck and an outer skeletal muscle layer which is more distinct distally at the membranous urethra. It is thought that prostatectomy can potentially damage both the smooth muscle sphincter mechanism and the skeletal muscle component. It should be noted that this alone is not
responsible for all post-RP UI and other factors such as detrusor overactivity and damage to nerves have a role. [Source: An objective measurement of urinary continence recovery with
pelvic floor physiotherapy following robotic assisted radical prostatectomy by Niranjan Jude Sathianathen1, Liana Johnson, Damien Bolton, Nathan L. Lawrentschuk]

The impairment of both the sphincter and the supportive system, including the endopelvic fascia,
the Denonvilliers fascia, the puboprostatic ligament, the LA muscles and the arcus tendineus
fascia, is responsible for UI after RP. [Source]


“The internal sphincter is removed during all forms of prostatectomy, as it is anatomically at the junction of the prostate and bladder”. [Source]

“the internal sphincter muscle, the muscle that involuntarily controls bladder output, is removed with the prostate.” [Source]

“After the operation, men who had three layers for holding back urine – the internal sphincter muscle, the prostate lobes pressing against each other, and an external sphincter muscle – have only one, the external sphincter.” “The external sphincter can do all the necessary work to hold in the urine, but it has to be strong. That’s why the Kegel exercises, both before and after surgery, are so important,” Dr. Catalona said. [Source]

It is alleged that Dr Samadi’s SMART method does not cut off the internal sphincter: “In the hands of an experienced robotic surgeon like Dr. Samadi, preservation of the urinary sphincter and competent rebuilding of the urinary tract can eliminate the risk of longterm incontinence. Uniquely, Dr. Samadi does not sever the endopelvic fascia and cuts the bladder neck very narrowly during robotic prostatectomy.” [Source]

“Whereas conventional laparoscopic prostatectomy utilizes an outside–in approach, SMART prostatectomy uses an inside–out methodology, avoiding damage to surrounding nerves and tissues. This is how I achieve 96 percent continence and approximately 80 percent preserved sexual function rates.” [Source]



Stitches in the valve take 6 weeks to dissolve and the scar tissue surrounding it takes up to a year to soften, so we need to help it after the operation. By creating a strong pelvic floor with your exercises, the muscles are able to squeeze around this valve and help it to close during the recovery period. [Source]

You can do NOTHING about this – it will heal on its own. Just don’t stress the healing process excessively.


“When the catheter is removed, the bladder is a shrunken version of itself.” [Source]

Basically, the bladder atrophies when there is no need to inflate (by holding urine). The remedy for this is NOT Kegel exercises (!!) BUT re-filling it and bloating it in whichever position it doesn’t leak (in my case it is the lying down position – in the initial days after catheter removal). Once it is filled and there is an insistent urge to urinate, that’s when the bladder is re-activated.

As the bladder is reactivated, the external sphincter can start “remembering” its function and start tightening on its own. This is the hypothesis of the brilliant physiotherapist Stuart Doorbar-Baptist [see this].


“Use of one pad per day after surgery” is strongly linked with EARLY recovery of continence [Source]. SEE FULL LIST OF FACTORS AT PAGE 4.

” Craig feels that some men use the smooth muscle of the prostate as their primary continence mechanism before surgery and these men are apt to have much more UI after surgery if they are not able to get the PFM working. Other men use the PFM for continence beforesurgery and will do better after surgery as the PFM is still working.” [Source]

Pad use at 4 to 7 days, however, was highly correlated with median time to continence. The median time to continence for men using one pad was 35 days, two pads was 42 days, and for three or more pads was 73 days (P=0.0001). [Source]

five and a half percent of his patients have a very mild incontinence 18 months after surgery and one and a half percent have severe incontinence. Age figures strongly into these outcomes and so does the fact that some men go into the surgery with previous incontinence. [Source]



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My prostate surgery experience – and report on progress/ recovery for the first two weeks

Date of robotic prostatectomy: Monday 7 August 2017 – reached the ward at 9 pm. Discharged from hospital at around 4 pm on Wednesday 9 August.

DAY 0 7 AUGUST Monday

I was prepared for surgery at around 2:30 p.m. and rolled into the operating theatre at around 3 p.m. I do not know when the surgery took place but I remember that I was in the recovery area and complaining that I was very cold. I remember being a bit angry, nevertheless I must have recovered reasonably well so they rolled me into my room in the ward at around 9 p.m. By then I could sense what is going on and was half awake. My wife left after about 2 hours.

A nurse kept coming and looking after me every half an hour or so during the night. That night I felt like being in a straight jacket. I had a strong feeling that I needed to urinate but that was because the catheter was not being fully accepted by the body. There was very little pain. That must have been because of the strong painkillers administered during anaesthesia.

DAY 1 8 AUGUST Tuesday

The strong urge to urinate that urge subsided but was replaced by bladder spasms that showed up as short painful bursts towards the tip of the penis. These spasms started reducing later that day. By evening they had come down quite substantially. (These spasms come again towards the end of the third day after surgery, but only very sporadically.  The main issue was the passing of gas – which did not happen that day. Bloating and severe pain were key symptoms that day. Lots and lots of painkillers. Liquid diet (apple juice, orange / lemon flavoured jelly, lemon sorbet, black tea without milk). Was given a shower today as part of catheter replacement. Doctor visited once in the morning.

DAY 2 9 AUGUST Wednesday

Took a shower today as part of catheter replacement. Gas started at around 12 noon on the third day with small farts. It extended throughout the afternoon till late evening for a total of around 20 farts. Each fart provided great relief.  Doctor visited once in the morning.

Reached home. Mostly liquid diet.

DAY 3 10 AUGUST Thursday

The main issue of the day was passing stools. It was a complete surprise to me that even a strong laxative like dulcolax does not work. By now I had taken at least four tablets of Coloxyl, 6 spoons of Agarol, 4 tablets of DeGas + one sweet laxative + a 250ml bottle of prune juice, 3 tablets of probiotics and 6 capsules of Metamucil.

The main reason why stools are not moving is the use of painkillers. In particular Endon stops the movement of the intestines. So I decided to cut down as many painkillers as possible on the afternoon of Thursday.

Diet: started  light khichri – 3 big bowls, including one cup of diluted yoghurt liquid and some additional is yogurt mixed with khichdi , one bowl of chicken soup, and 8 small  leaves of lettuce. I had my first cup of tea with milk on the late evening of Thursday.

DAY 4 11 AUGUST Friday

I noticed strong pain from the spot where the artery had been used to monitor blood pressure.  The pain became very acute on Friday. The pain is insistent.

Finally at about 8:45 a.m. I started feeling some activation in my lower bowel. In addition to previous laxative in intake, I took a magnesium tablet with water + more Coloxyl.

By 10:30 am a lot of  pressure started building and I sat on the toilet. Unfortunately nothing came out. After straining, two tiny “rocks”. Straining was impossible given overall pain levels, so I stopped.

Finally my wife brought this (an anema). I applied it and went without any delay to the toilet and sat there waiting. It just took a minute for the bowels to move freely.  I lay down for about 35 minutes and again pressure started building. Did this twice. These were my first stools for over 5 days.

At around 3 p.m. – around 3 hours after the motion, I felt a somewhat normal urge to eat food. I went down and had rice, rajma and cauliflower sabzi. I felt much better now, although I have continued to take Panadol throughout the day.

Spoke with the anaesthetist about the arm pain.

DAY 5 12 AUGUST Saturday

From mid-morning, motions were natural (around three times) – with reasonable comfort.  The pain in the arm and the rest of the pain is continuing- taking Panadol as per normal dose. Pain around 7 out of 10 (compared to around 8 out of 10 most of the first few days).

The level of pain in the arm increased + one can see that it is swollen.

DAY 6 13 AUGUST Sunday

The swelling in the left arm increased and one could see a patch of blue down the left-hand side of the forearm. A couple of relatively  smooth motions.  I was able to go to the garden and harvest some lettuce and rocket. Able to bend slightly without acute pain. I also sat for about 10 minutes at the dining table and had my lunch. This is the first time I sat in a chair (apart from the trip via the car from the hospital) since before the surgery. Did not take shower on Saturday but did so on Sunday.

DAY 7 14 AUGUST Monday

Main thing today is the pain in the left arm which will need painkillers. In anticipation of you need to go early in the morning for removal of catheter I had taken Agarol on Sunday night. I had a motion in the morning at 6 a.m. Pain in the stomach is milder than before. If needed I could potentially sit for 10 to 15 minutes now without severe pain

Got the catheter  removed. The first step was the removal of the dressings on the wounds. My dressings are mostly dry. After that an antibiotic injection was administered on my bottom. Then came the removal of the catheter. The catheter removal started in innocuously but very quickly became extremely painful leading me to scream. The nurse then stopped and again restarted soon because it is better to remove the whole thing completely and then allow complete rest. The total time taken to remove the catheter was not more than 1 minute or so (most likely in 10-20 seconds). During this period was unbelievably excruciating pain. But there was no choice about it.

After the catheter was removed l kept lying down for a few minutes as the pain slowly subsided. After that I put on a continence pad that I had taken with me. (During the process of putting on the bed itself, some leakage occurred.) I was then told to go out and drink water for about 1 hour and then I will be tested for whether my bladder is being adequately cleared. I was then called in and asked to try to urinate but nothing came out. All the water probably went into the pad. The nurse administered an ultrasound test and confirmed the bladder had been emptied. She declared me fit to go home and hope that I would be able to get some control fairly soon.

Upon returning home I was tired and lay down for around 45 minutes. Upon getting up I realised that I might have some urine still in the bladder and not everything was therefore leaking away.

There was at least some control while lying down. However, the situation was still very painful and I realised that I needed to be very slow and gentle in trying to get my bladder up and running. My doctor had already told me that the bladder becomes very lazy after the surgery and takes time to return to its original level of control. I was also told by my physiotherapists to only undertake very few pelvic floor exercises in the initial days.

The good thing is that my ability to walk is returning to normal.

A lot of pain in the penis continued throughout the day.

I started (very gently, and only  a couple of times) my pelvic muscles.

At that point I was able to have around 100 ml of toilet in one go in the toilet. After that the normal leakage started again.

The only real downside is the acute increasing pain in the wrist area which is making it very difficult to move around so I have took my second painkiller for the day.

On the first day I used four nappies of which one was half-used (at the nurse’s – I threw away a half-soiled one before starting out for the journey home).

Fifth bag I wore at night. At 11:45 pm I had a good flow ( I had been lying down before that) – of nearly 250 ml, I think. That showed that the bladder was able to retain urine while lying down.

DAY 8 15 AUGUST Tuesday

Sixth bag disposed at 2:35 am that night. There seemed to be rudimentary bladder control but the fifth bag was getting wet and I wanted a dry bag. Before replacing the bag, had a bit of direct urination – maybe around 100 ml – but with pain.

Plus pain in arm at night, so took two Panadols.

I stopped counting bags since I’d need to closely monitor weight of uncontrolled urine from day 2 after catheter (ie from 16 August). I’ll be counting these as at 8 am sharp each day (i.e. the pads for 16 August will be counted and weighed at 8 am on 17 August).

Went to see the doctor at 12:15 pm. Confirmed that the swelling in the left forearm is not dangerous (not an aneurysm) and should heal over the next week or so. I should expect some pain for another 10 days or so.

The doctor also gave me a pill + prescription for Cialis to take everyday to keep the penis oxygenated with blood otherwise it would shrink. He gave me a blood test recommendation for PSA to be taken 4 days before the appointment.

Observation re: continence: While I’m able to accumulate some urine in the bladder while lying down, it is literally impossible to do so while sitting or standing or walking, at which stage the entire urine drips into the pad.

DAY 9 16 AUGUST Wednesday

Woke up mid-night with a lot of pain in wrist/forearm. Had no choice but to take 2 panadol + 1 Celexi + 1 Endone.

Virtually no bladder control during the day – exactly as on the first two days. Some control while sitting on a chair or lying down, but the moment one gets up one has to rush to toilet. Zero control while standing/ walking. Also, a lot of pain while passing urine after retention (after sitting/ lying down).

Received instructions to get a urine test on Friday.

The penis continues to be very painful. Possibly some injury by the catether. I need to urinate after getting up from the bed/ chair and each time there is a lot of pain.

The bladder has absolutely no control except while laying down. But once one goes to the toilet, there is a dribble that goes on for a long time instead of a proper flow.

Took anticipatory Endone etc before sleeping.

DAY 10 17 AUGUST Thursday

Went to the toilet twice last night. Both times around 200ml or more came out. Pain was there but somewhat manageable. Bladder seems to be becoming a bit more active but not easily able to clear, takes a long time.

Remained largely painless most of the day. Able to sit for longer duration at the PC. But incontinence remains a BIG issue. Also some pain in the penis while clearing any accumulated urine (while sitting/ lying down). A bit better than yesterday.

Doctor confirmed via email that the internal sphincter had been REMOVED during surgery. I now only have the external one.

DAY 11 18 August Friday

Most pains have subsided to manageable levels. Did not take any pain killer the whole day yesterday and last night.

During the night when going to toilet (thrice), penis was sore towards the head, around one inch from tip. Had to lie down since could not walk or sit. This is almost certainly due to catheter – since the pain is specific and not general. Clearly some part of the urethra was injured during catheter insertion (and maybe that’s why I had such acute shooting pain while it was taken out).

My research on the internet shows that this pain can take months to heal. Nothing be done about it.

I started drinking a LOT of water during the day in a systematic manner, to ensure that (a) the bladder learnt once again what it is to be full and (b) to soothe pain in the urethra. Pain seemed to somewhat come under control later during the day.

I’m largely pain free now (90 per cent). I can even sit on a chair largely pain free (which is what I’m doing as I write this). And as far as general health is concerned, I’m in pretty good shape and should be mobile (including driving car) from next week.

The issue now is managing severe incontinence. This can often take a long time to improve (some cases need further surgery after a year or so). This is a very bothersome but not life threatening issue. I’m reading up a lot on this (including the medical literature) so I’m aware of all relevant information and options to fix this issue.

I’m therefore moving on from the post-surgery record. I’m going to focus on incontinence etc. – and that will require keeping a daily record – but not here.

Note: I’ll keep updating this BY EXCEPTION (i.e. if something other than continence emerges that’s worth remembering)

DAY 12 19 August Saturday

Unbelievable pain in the penis (the same spot – where catheter injury probably occurred) at night. The pain also forced less than full evacuation, which caused trouble. Was forced to stand for nearly 15 minutes to have a drip flow that finally relieved the bladder. Forced to take painkiller after this in order to sleep.

The pain seems to have broadly resolved by the morning, with normal flow resuming. I suspect the pain will continue for a few more days till the healing is completed.

Continuously leakage as on the first day. No change whatsoever

20 August 2017 Sunday – Went for a 20 minute walk in front of the house today but most of the day after that was spent in dealing with acute pain in the front portion of the penis, likely from the catheter. Spasms at 2:40 pm in the day while standing in the kitchen. Acute and sustained pain in the penis.

21 August 2017. At 7:50 am sat on the computer. Debilitating strong and pulsating pain in penis tip started again. Could not walk, was forced to lie down. Even then it did not go away quickly. Took around 10 minutes to subside.  A kind of bladder spasm, it seems.  I suspect these spasms are caused whenever the urine gets concentrated and starts hurting the joint between bladder and urethra. Drank a lot of water as well to keep the urine diluted.  At 9 am the pain started again although it was not as bad as the first time full stop first to lie down. Did a short 25 minute walk later in the day.

22 August –  Today is Tuesday and I have increased the walk to a total of 40 minutes (two rounds near the house). Each time I go for these walks I come back and check whether even the slightest amount of urine is being held by the bladder. Unfortunately till today, Tuesday, there has been not the slightest to retention of urine while walking. Massive spasming started again at around 3:40 p.m. today. Took the strong anti inflammatory medicine

23 August Wednesday – Walked only 15 minutes today. because I started feeling pressure in the intestines – possibly some gas. However upon lying down there was no gas. Nevertheless the pressure went away after about half an hour. Further, catheter pain is still causing problems. It took me 20 minutes to eliminate urine it came in drops continuously for 20 minutes there was no stream. This has happened periodically over the past few days. Then again the stream starts off after some time and I forget about this event. Is it possible that there is some blockage inside the bladder or urethtra?

24 August Thursday– 51 minute walk at Ruffy Lake. Started driving on Thursday when I went first to Ruffy Lake Park.

25 August Friday – Went twice to toilet last night. Stream continues to be very thin. Takes 10 minutes to empty bladder (which is not full anyway but gives signal). 49 minute walk at Ruffy Lake

26 August Saturday: Drove for 50 minutes today (to Thomastown) + 50 minute walk today (around the house)

27 August Sunday: Sharp but short spasms in penis while walking at Ruffy Lake Park today. Had to slow down. Time taken 45 minutes – an improvement. No urine held while walking.

28 August 2017. First visit to physio after surgery. Each time I get up I’ve been going to the restroom to void. My physio has suggested I avoid that, as it will give my bladder a bad habit. On the other hand, isn’t it better to let the bladder start using its own muscles to void whenever that is possible? How will the bladder remember to void if everything is allowed to leak?

29 August: Walking uphill is much easier than walking downhill. So while walking downhill I have started working on the grass where possible. That is much easier. I’m trying to hold the pelvic floor a little bit while walking even though I know it’s not going to work at this stage. Having said that, it appears that I did succeed in holding around 10 millilitres of urine in my bladder even while walking. It appears that there is at least some attempting made by the bladder to hold and so there is a spurt of urine every few minutes.

30 August: I was hoping that the during today the walk I was able to hold at least something, and it seemed that my muscles were fighting the bladder, but in the end was just around 5ml that came out. 98 percent leaked out.

1 September The pain in the penis might have reduced comma but there is heaviness and a sense of something happening between the legs, such as dripping. Definitely nowhere close to normal. Same thing around 42 minutes walk, constant sensation of dripping, and less than 2 ml retained. Just a few drops.

3 September – It appears i am able to hold urine for short periods.

4 September: Learnt very useful things from the new physio.

5 September Did not do any walking on Monday.

6 September: At night, when there is some accumulation of urine, it is generally difficult to pass the urine. The stream is very slow, and there is still some pain inside the urinary canal. This was extremely bad in the early days, I recall nearly 20 minutes taken to void, but now it takes 4-5 minutes

8 September: At night the urine stream was very noticeably thin at “full” flow. Took nearly 6 minutes to clear.  During the day it is generally not possible to know whether the stream is thin since most of the time it is dripping away into the pad.

Wrote to the doctor who fixed a fresh surgery for 11 September.

11 September: Admitted at 12:15. Surgery at around 3 pm. The second surgery was much less traumatic than the first one. The anaesthetist did not put the arterial monitoring system – which was a big relief. Further, during the recovery area, I did not feel freezing cold as I had felt the last time.

12 September – Next day after surgery at the hospital.

Catheter was removed at around 6 a.m. and passed the first urine at around 8:40 am. Removal of catheter did not cause much pain this time. The nurse removed the water from the bulb then went to get a container for my urine (given incontinence) after the catheter was removed. In the meanwhile, the catheter came out on its own due to the weight of the urine bag.

Sharp pain where urine touched the cut made by the surgeon. Before release a test was conducted. Very painful while standing, walking, sitting. Almost a hobble.

Took long time to pass the first urine after two and a half hours after removal of catheter, because of the stinging pain. Around 200 ml voided. Ultrasound showed i had 43 ml still inside the bladder. Nurse said that after surgery it is acceptable for up to 100 ml to remain unvoided. And I was allowed to go home.

Nurse gave me 4 packets of Ural. Eight packets can be taken per day to make the urine less acidic, to minimise the burning pain.

Doctor said the pain would largely go away after one day. And that I should start my kegel exercises again.

13 September: Motion started only on Wednesday, and was a bit slow and difficult till Friday.

Last night the  flow started and pain reduced. The flow was greater than what it was prior to first surgery, which suggests an existing but harmless blockage in the system which had got badly aggravated by the cathether inserted during the first surgery.

After having reduced significantly last night come on the pain has come back at about 4pm on Wednesday. Also significant bleeding during urination.

15 September: Administered aloe vera liquid gel through urethra.

16 September: A big issue is that the bladder is now giving strong signals of being full (at night) even with barely 150 ml. Last night the first round was with 200ml and then I got up after 2 hours with the just 150 ml or so. The bladder should basically have capacity for nearly half a litre

My measured urine output at 6 a.m. in the morning prior to surgery was 325 ml. However I believe that my bladder can comfortably hold up to 400 ml at night. Therefore, it needs to be retrained to hold much more than it is currently holding at night.

On Saturday morning (16 September) I had a major bowel motion and pretty vigorous (too much irregularity after repeated surgeries). That caused an anal fissure to develop.  Fortunately I know the guaranteed cure for this – just directly apply a cut aloe vera leaf. Have done so once and immediate relief. Repeated thrice. Also on Sunday.

Have virtually abandoned all Kegel exercises for a week now. Unlikely to be able to resume them till the anal fissure and the penis pain from surgery has subsided.

Administered aloe vera. Each time I have administered aloe vera gel, there has been absolutely no pain whatsoever inside the urethra. I am confident that the healing properties of aloe vera are at work. When purified sesame seed oil is received from the Indian ayurvedic shop, I will also administer that oil .

Note that on 16 September I tried the glass 10 ml syringe. Its actual is pretty much the same as that of the 5 ml plastic syringe. I did use it but believe that glass is heavy for a person to use with one hand. Plastic is was slightly more comfortable. The disposable plastic is superior for the purpose at hand.

Good news? Despite urine flow being strong, not all the urine in the bladder leaks when I get up and walk. A small amount of dripping starts immediately but I am able to hold a reasonable quantity for anywhere from 5 to 15 minutes. Maybe this is a good sign?

17 September:  Second day of the anal fissure. Have been able to pass stools with a lot of care. However, there is still a fairly significant level of pain after passing stools. I had a applied aloe vera around three times yesterday and will do so today as well. Improvement in clearly there.

18 September: Things became pretty bad with anal fissure and could not attend the appointment with the surgeon. Have added coconut and finally also purchased a medicine: Proctosedyl (containing hydrocortisone and cihcocaine hydrocholoride).

19 September: Mark from Australian Catholic University called at 10:45 am today. He said his program is different to the one from Movember/beyond blue. His is focused on exercises. He will call me in a few weeks. They run a gym in ACU on Vic Parade and a supervised program of one hour is offered thrice a week.

Booked appointment with specialist reconstrictive surgeon and also with GP (so I can get a further referral).

25 September: Went to the gym after having changed the pad two hours earlier. Literally impossible to do anything because of the weight of the pad. Need a fresh change prior to going to gym.

27 September: Met a third physio – Terry. She was good; told me about dynamic pelvic floor exercises.

29 September: First signs of regaining continence today. I’m somewhat continent while standing. I’d attribute this to the knowledge imparted (and exercises taught) by Terry.

1 October 2017: Given my incontinence post surgery, I’ve not experienced an urge to urinate during the day. However, today at around 3:30 pm, I was surprised to get an urge after being in the garden for nearly 3 hours. I had not sat down and experienced an ongoing leakage. When I went to toilet I voided probably around 100 ml or more. That’s probably a sign that even while walking, I’m not leaking everything. The external sphincter has started working at least to a small extent.
Later in the evening, during a walk in Ruffy lake Park, I kept trying to hold the urine despite but the result was no better than before: less than 10 ml after the end of the walk. Two things: the hills are very hard to overcome. During gardening I stood in one place for some time, but walking was continuous.

3 October: My continence is definitely improving. Today morning, after a 30 minute car drive I went for a walk for 15 minutes and after that I finally voided nearly 50 ml. This means that much of the urine during the 45 minutes was held in the bladder. However, the ability to hold is dramatically restricted (essentially zero) while I’m walking downhill.

5 October: Going downhill creates more pressure on the bladder then going uphill. I think I can retain at least some of the urine while walking on a flat surface.

6 October: It appears that when the bladder is relatively light, there is greater continence, but as the bladder fills up, the force of gravity makes it harder to hold.

19 October: Went for a walk again to Ruffey Lake Park. Second walk after the surgery. Most of the urine leaked out while doing the hills. But there’s something interesting that happened. There was a traffic jam due to an accident, but then I went to Safeway, walked around and did some shopping, came back home, and urinated 300 ml. That is quite astonishing.

This shows that I’m becoming largely continent while walking on flat surfaces. The next challenge will be to become continent while going up and down hills, then while playing tennis, coughing, laughing, etc.

30 October: Managed three hours at work in DTF today – a total of five hours of work. By the end of this month should be able to do 4 hours per day in DTF, with total work of 6 hours. Beyond 4 hours at work is going to require a major breakthrough.

3 November: Finally I can feel some improvement while walking uphill. I still get a sporadic spurt or two, but I suspect there is greater holding ability now.

5 November:  20% incontinent while going uphill: If the bladder is full it’ll leak even while going uphill

6 November: Almost 98 percent continent while standing now

7 November. Even on a flat surface continence is only about 80% when the bladder is full. However, the reduction in leakage so far has mainly come from flat surface continence.

9 November: At least partly (very little) continent while running downhill. This proves that trying downhill is the most important to exercise for recovery of continence. I feel that I am almost 90% Continent while walking uphill now.

10 November: Nearly 50 per cent continent while walking downhill.

11 November: I had a lot of hayfever and  sneezing today. Despite that I went up and down Ruffey Lake Park, including jogging downhill etc. It is clear that I’m getting much more continent while walking (uphill and downhill). In addition, I also felt that I was somewhat continent (but very little) while jogging including downhill.

12 November:  Today I challenged myself with a full bladder running downhill in front of the house.  This really is not sustainable at this stage. Running downhill is not more than 10% continent.

The way this is going to work is that for the next few weeks there will be an increase urine flow as I push harder and harder, particularly with the full bladder. I’m expecting the leakage to reduce after about 3 to 4 weeks of heavy exercise.One more reason why leakage is high at this stage is that I am letting the bladder pressure build up. This was not practicable earlier and I was making excessive visits to the toilet.

15 November: Pretty close to 90% continence while walking downhill. A few drops here and there.

17 November: Around 95% continent while walking downhill from the Thompson Road Heights. I had got used to constant leakage; but now, any sensation of urine pushing to leak is very irritating. The body has started expecting continence as a default condition.

19 November: Things really have not improved too much. Today while at the Northland Shopping Centre and Bunnings I felt there was some leakage even though I was walking on a plain surface. This implies that the muscles tend to forget very quickly, and a lot of exercise will be needed to keep the continence going.

20 November: There is perhaps an additional 5 to 10% improvement in continence from having an antihistamine for hay fever. Obviously this is not a sustainable solution, and it also dampens the feedback loop. Lunch time walk for around 40 minutes to Swanston St. Not more than 95% continent while walking downhill from my office to Swanston St. I would also rate going uphill walking uphill as 95%.

22 November: Roughly 99 per cent continent at night. not 100 per cent. When walking in the  gardens at lunch time I felt constant pressure. It is not practical to keep holding and pulling in the pelvic floor at such a time.

23 November: The problem with the current level of continence is that there is excessive pressure on the bladder to void after a walk in RFL. There is no doubt that it has been a very significant improvement in incontinence. After today’s RFL walk, I voided more than 150 ml. The last I remember, a month or so ago, was not more than 10 ml. The problem, however, is that one can’t walk now without access to a toilet. I am sitting at work I can manage for a reasonable time, but if I’m out on a walk I need access to a toilet.

5 December 2017 Today I’m doing a baseline walk through Ruffey Lake Park. This will tell me what leakage takes place just by walking. I suspect it is quite heavy, pretty much in the range of 70 ml. Actually it was , much heavier (see the data).

8 December 2017: There is some leakage when I start running for the first time downhill. However it seems to improve or what the next few minutes and towards the end I can barely feel any leakage. It’s possible For some reason the urine has already leaked out initially. But my suspicion is that I’m genuinely holding some urine despite running downhill.

17 December 2017: At this point I think I have around 50% or more control over leakages even while running downhill. This improvement started a couple of days ago. At this rate I would expect other continents before the completion of the 6th month after surgery.

24 December 2017: Can feel genuine reduction in leakage while running downhill.


2 January 2018: Pretty awful leakage while walking in RLP. It seems that running downhill does not exercise all the necessary muscles. It is essential to do the normal exercises in addition to running downhill.

10 January 2018: Last stage of continence is while running downhill with a full bladder. I’m becoming partially continent with an empty bladder but still significant leakage with full bladder. Learning: Run downhill slowly, till continent. Then increase difficulty level.

22 January: In RLP I had stomach reflux while running (that’s because I now have dinner before going to RLP), so I started walking but noticed that there is significant leakage while going downhill. The data confirm higher-than-normal leakage. Yes, there’s been improvement over the past months, but now there are some signs that not only has improvement plateaued but things maybe going backwards. [Addendum: this fear turned out not to be true. There was actual further improvement in the next few weeks, but at a slower pace.]

19 February 2018: I expect a long drawn out battle to achieve full continence. That is because the better I get the more I increase the aggressiveness of running and exercise. I’m currently not running full steam downhill because it’ll be pointless to do so. But as I get a little better and also build more stamina, I can run faster and for longer, thereby increasing incontinence during the run. I am aiming for 100 per cent control even in the most extreme event.




Patient experience of prostate surgery, case study of prostate surgery,

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