Post robotic incontinence

Had radical diVinci surgery in 2008.  1 positive margin Gleason 3+3,.  While it has gotten better over the past 8 years I still need to use a small safety pad for incontinence. It's usually wet by days end, and can't trust a small pad to hike or drink whisky with.  Anyone know of any technique to solve this?

JerryG1234 said...
Had radical diVinci surgery in 2008. 1 positive margin Gleason 3+3,. While it has gotten better over the past 8 years I still need to use a small safety pad for incontinence. It's usually wet by days end, and can't trust a small pad to hike or drink whisky with. Anyone know of any technique to solve this?

Wow, still damp after 8 years and a positive margin but only with G6? I am surprised to hear that, but hey it just shows we can end up with any combo of outcomes.

But as to what to do, there are certainly some surgical fixes available. Slings and artificial sphincters(AUS).

Jerry,
I am 3 weeks out from Advance Sling surgery. I am pleased so far with the results. My surgeon and my other coach, Worried Guy, have made it adamant that I remain very careful with my movements so that the Sling will scar into place and become permanent. If I bust it loose, I will be worse off than ever. Right now I am not wearing a pad in the house. My uro said I can walk a mile a day around my block daily which I have. A few times I have had a little spurt on about 1/2 of my walks, so it is not perfect. But it is so much better.

Have you ever calculated how much you leak per day? I got a food weighing scale and weighed the pads
full and empty and calculated my leakage. I turned out to be in the mild to moderate range, 100-200ml/day. Sounds like you might be less than me which would be good.
My surgeon said that I was borderline for the sling, the less you leak the better. He did a cysto and some
urodynamic studies and said he thought I would do well with it. The selling point versus the Artificial
Urinary Sphincter was that I might probably need 2 -3 revisions of the AUS. The sling is a one shot deal
usually. The urethra can have atrophy with constant pressure on it from the AUS. It often has to be revised and moved to a different spot on the urethra to clamp onto.

I feel I can put up with a light pad which may be what I will need for safety and be very happy with
it if that is the final outcome. I won't really know until I am free to do my 4 mile walk and golf and yoga
but so far so good.

The surgery wasn't that bad. I only had 4 Vicodin postop. I could control the pain with Tylenol and I
didn't want constipation which comes with too many opoid narcotics (Vicodin). I still have an odd sensitivity
on my scrotum and some swelling and soreness but nothing really painful. Seems to be getting better. By far the biggest challenge of the surgery is to not lift over 6 lbs, squat, and get in and out of bed and car
with knees together to keep from stretching the sling. Hard to remember that when you are feeling good.
I still sit on a donut and am sore in the scrotum and groin but it keeps getting better. Another tip is take
Docusate 100mg (brand name Colace) as a stool softener because the incision if from anus to part of the
way up the scrotum. Being constipated is not good.


Another thing that was tried on me was Coaptite injection to beef up the urethral sphincter. It did not help.

If you decide on the sling surgery, get someone who has experience AND a good success rate. In the urology
office that I go to, the surgeon that did my robotic prostatectomy has lost faith in the sling and sent me
to Dr. Williams who does the sling and AUS in their office, thinking I would get the AUS. Dr. Williams convinced me that he had good success with the sling even though some of his partners had given up on it.
So far I am glad he did.

Good luck with your decision. Incontinence sucks.

I have a question for you. My pathology was a Gleeson 3+3 with extracapsular extension 1 mm short of the surgical margin. Has your PSA remained good? My next one is in December at about the 21 month point.
I am sure I will be nervous as we approach.

Jess
Biopsy 12/13 1 core positive G 3+3
Robotic Prostatectomy 3/14, G 3+3, pT3a. Penetrated capsule, short of surgical margin :Incontinent 100ml-200ml / day
Impotence improving with Viagra.
4 post PSA's <0.008: 5/14; 8/14; 11/14; 5/15