Incontinence after RARP

User

Posted 09 Mar 2017 at 21:46

Incontinence after RARP

I am not clear on the physiology of what was and what is, what I had and what I lost but I presume that every man that had the same operation as me (RARP) had cut and had removed the same things as me and so MUST (within margins) be experiencing the same ‘experiences.’ My question is - are you?

I had my RARP on 26th January 2017. Pre-Op I was told something along the lines of . . “men have two controls (stops) on the flow of urine and women have just one, one of those controls (the one that women don’t have) would be removed with the prostate and I would have to train the other (pelvic floor exercises) to take over control.”

Prior to the operation whatever stopped urine flowing from my bladder was in an ‘at rest’ position of closed i.e. I didn’t have to try or even think about stopping urine coming out, in fact I had to make a conscious decision to relax (open) that control and push urine past that control and out. After the operation I have the opposite situation in so far as I have control but it is something which has an ‘at rest’ position of open and I have to consciously and physically close it to stop that flow. That mental and physical control (stop) is unconscious (I don’t have to think about it) up until the pressure (anything after 100ml of urine) builds up and I then need to mentally and physically exert control to stop urine coming out (and the max (with eye watering discomfort) I can do is a max of 250ml). The point here being, my bladder is not full or anywhere near full and I don’t feel the need to urinate because I feel pressure from a full bladder the pressure I feel, feels like it’s in my penis trying to get out. So what . . . . when I am not conscious (asleep) the control/stop I have wants to go back to it’s natural position of open and (although I am asleep and don’t know for sure) it opens when the pressure (100ml) builds up behind it and it relaxes. I repeat . . . previously the control/stop had a preferred natural position of closed, now the control/stop has a preferred natural position of open.

All of the above is the detail of my incontinence which isn’t good but frankly does make sense, what doesn’t make sense to me is the suggestion that most men first get greater continence at night (when they are asleep) before they get it during the day. For me that simply just does not make sense for the reasons stated above but I would like to know from those that have had better continence whilst they are asleep and why they think that is?

Note: I do understand and accept that there are different operation options and RARP (which I had) is just one of those options and clearly other options will produce different incontinence issues.

User

Posted 09 Mar 2017 at 22:52

This link is quite good to see what is involved in urinary continence.
http://learn.visiblebody.com/urinary/urine-storage-and-elimination

I think whilst many men have the same RARP procedure the finer details are not always the same. The size of the prostate varies a lot, where the cancer is within the prostate and whether it has or is thought to have spread outside the prostate will all be factors in how much the surgeon needs to remove or feels comfortable to leave. E.g some men get nerve sparing and some don't. In the same way how close the surgeon needs to go to the urinary sphincters will also vary.
From reading your description it sounds like the external sphincter was removed or compromised. Meaning you are relying on the internal sphincter which acts involuntarily. I am not sure this was the case for my husband as he says it's pretty much as before except that on release the flow is much faster.
Note of caution this could all be completely wrong as it is all conjecture, I am not an expert.
Perhaps a call to the nurses on here is in order. I'm sure they'd be able to talk you through it.

User

Posted 09 Mar 2017 at 23:52

Hi Michael

Interesting post. I found this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469827/

Does that make any more sense ?

I need to re read when I have more time. First reaction is you are doing fine. I was dry practically immediately however post op I get the urge to go around 100 ml which I ignore and hold about 250ml then go. I haven't tried recently to see what my max could be. Maybe others will post. Most if not all of us will have numourous nerves damaged.

Gordon

User

Posted 10 Mar 2017 at 22:40

One other thing I would like to add on the question of 'dry at night.' I've been keeping a daily log of everything including continence/incontinence and I week back I wrote in my logs that I had 'dry' nights on a couple of nights and then I started to wonder and testing the weight of the pads I opened up the back and discovered that the pads are VERY good at transferring wet and feeling dry inside but that doesn't mean that they are dry - I opened up the back of the pad and it was clear that there was a wet patch which had been taken up by whatever it is at the back of the pads i.e. just because the pads feel dry to the touch inside does not mean that there has been no leakage.

User

Posted 11 Mar 2017 at 21:55

Try weighing pads. 1cc of liquid for every 1gm of weight increase. Then if you have a particular bent (yes, like me) you can enter the results in a spreadsheet and plot graphs of your progress. Urologists like graphs.

Tony

TURP then LRP in 2009/2010. Lots of leakage but PSA < 0.1 AMS-800 Artificial Sphincter activated 2015.

User

Posted 17 Mar 2017 at 17:33

I'm posting this for others who may read this in the future. . . . . .

After 7 weeks I have 99% control during the day (I don't wear pads). That said, I still very much feel that my control is me controlling (stopping) the flow rather than it being that the flow is naturally stopped and I have to open it to pee. Nights are a different issue, as I am unconscious clearly I don't have conscious control that said, there is some form of control but I am not sure how it happens. Take last night for example (which was a good night) I went for a pee once during the night and it measured 250ml and my morning pee was 200ml yet when I opened up the back of the pad there was a 5cm wet spot. So, my unconscious body had held onto an impressive volume yet it had also leaked. How all that happened/occurred I don't know as I was asleep!

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.

Notification

Join the online community now.