Incontinence

Is it any better? Meaning leaking just a little or you have to still use adult diapers.

I am 30 months out from RP and I leak a little during the week but when I do physical work on the weekends I have to use the diapers.

My great solace is that I'm alive even though my PCa is incurable.

DanchW, I scanned through some of your old posts to briefly review your background and some of the feedback that had already been given to you in order to better understand your case. I saw you were initially diagnosed with favorable intermediate case (3+4, 3 cores) and it was recommended that you get a reading from Epstein, an expert prostate pathologist...what was that outcome? I also saw that you were considering open vs. robotic RP, and that it was recommended to focus on choosing a highly experienced surgeon and let him pick the tools he uses...what was that outcome? And, what's been our journey since then? Help fill in a little more detail, and maybe you can get some better feedback here.

Have you looked into an artificial urinary sphincter (AUS)?

If you put AUS in the search bar on this site, you'll read from a lot of guys who have had one installed. Mostly good reviews, I think.

DanchW,

We have a number of guys here who have a sling and also a few who have artificial urinary sphincters. I am one of the latter. I have an AMS 800 AUS.

If you are still leaking after 2 1/2 years you ought to at least talk to your doctor about fixing it.

In general, a sling works best for men with a persistant moderate leakage after prostate surgery. An artificial urinary sphincter works better for men with heavier leaks and/or men who had follow-on radiation after their surgery.

A sling works by moving the part of the urethra near the bladder to a more-natural position which takes some of the strain off of the urinary sphincter and helps the sphincter work better. This works well for men who only leak a little bit since their sphincter can almost do the job and only needs a little help.

Men whose sphincters are more compromised (generally heavier leakers) or men who have had radiation (which stiffens the tissue so the sling has trouble shifting the urethra) will tend to do better with an artificial sphincter.

Before I got my AUS I was a heavy leaker (200ml a day, more or less) and would go through three or four adult diapers every day. Now I generally get through the day with one smaller pad stashed in my tighty-whities. I was hoping for dry but I am, nonetheless, much improved.

Let me know if there are any other questions I can answer.

My urologist told me that at 6 months post RALP I would know about how incontinent I would be. At 6 months I got a referral to a pelvic floor specialist and did 3 months or so of the exercises. I saw little improvement. When I met with the urologist for my 1 year checkup we talked about sling vs. AUS. Since I leak quite a bit, 4-5 pads per day, and I am a runner, she suggested the AUS. She mentioned that for distance runners they recommend against the sling. Something about the back and forth motion possible abrading things inside. I run 25-30 miles per week and will run a half marathon in Pittsburgh on May 5th. I get the AUS installed on May 16.

BTW, since I most always have a wet pad to some degree, I no longer eat asparagus. The smell follows me around. Anyone else notice that? After the AUS I plan to binge eat some.

DanchW, yes, regarding orgasms. They tell us that post surgery we have "dry orgasm" but that hasn't been the case for me. And it's really been a turn off all around.