Why is incontinence so different among us?

Recently we had a survey about ED. I think we should have another one about incontinence. From reading various posts, it seems that some are continent almost immediately yet others suffer for a long time. I'm curious to know why. It doesn't seem to be related to age or surgery type. Could it be the the physical condition of the patient prior to surgery? The skill of the surgeon? The amount of nerves damaged during the surgery? The size of the prostate prior to surgery? What else?

EdC, I think its all of the above you mentioned, plus other factors that we aren't even considering. If a poll were to be done accurately, you would have to have some good pre-surgery base questions, i.e. Did you have any non-PCa prostate probems before your PCa dx?
Were you getting up at night to urinate? Were you straining or retaining urine in any way pre-surgery? Did you have prostate infections prior to surgery? Etc, etc.

From a purely surgical point of view, there would be lots of things I have read about that could cause the variances that you mention. And you are right, there are men among us who are dry as soon as their catheter is removed, others in a few days, myself - let's call it a month at the most (and most of the time it was in my head), others for 6 months to a year, and others way beyond that.

Some men faithfully do their kegals even pre-surgery, and around the clock post surgery, and with some it helps, and others it doesnt. My own uro/surgeon feels they are a waste of time generally, and that if you do them too much post surgery, you actual make things worse by tiring out the bladder control muscles by not allowing them to heal. Once again, we would find a thousands variations and exceptions.

David in SC

EdC

I too, was not in great physical shape pre-surgery, somewhat overweight (not obese), and suffered from years of Chronic Fatigue. Pre-surgery, could hold my bladder all day if needed, never ever got up at night to pee, never had an UTI in my life, and my prostate was not enlarged pre-surgery. Perhaps some of those factors helped me post-surgery, or just the luck of the draw. I did kegals post surgery for at the most, 10 minutes total, and decided on my own that it wasn't for me.

With both of my post surgery corrective surgeries/procedures to clear those annoying sticture/blockages, I was fully continent again within 24 hours of having the catheter pulled.

In my odd case, I often wonder if the magic card for me is the fact that I was on catheters for so long, which gave my parts up there a much longer chance to heal without strain, unlike the way it is for most men, who have surgery and their one and only catheter is pulled lets say 7 to 14 days out from surgery, when everything is still so swollen and sore up there. My own uro/surgeon does not discount that possibility. I wonder too if it explains me having no ED problems from the get-go, again because of all the extra healing time.

Might just be guessing, but interesting to think about.

David in a very rainy soggy South Carolina, boo

Colin, Is it any wonder why you're a "marked man" if you ever come to my town? Watch your back, buddy. You lucky, lucky b*stard. (And you know why I repeated the "lucky")

Ed, I was curious about this subject too, and found a few standardized incontinence surveys. Another factor that needs to be considered is the PCa state at the time of surgery. What was PSA? What is the pathology report. T1 T2 T3? Gleason.
Someone who has a a very mild case should be rated differently from someone who has a more aggressive form.
I can look up those surveys if someone is interested.

Post Edited (Worried Guy) : 9/19/2009 11:21:00 AM (GMT-6)

Colin,

You quite correct, that first zero will be a big plus in your favor, and a string of them will give you confidence you may the beast under control.

David in SC

Think of the analogy of the foot on a hose-pipe. Whether you can shut off the flow depends (pun intended!) on a few factors:
* The water pressure
* How broad the foot
* How much force you can apply
* How flexible the hose-pipe

I expect all those factors apply to our internal plumbing too -- after surgery we are using a different sphincter to hold back the flow, so if it is out of shape, it will take some training to improve. And if you happen to have a narrow "foot", no amount of training will improve that.

The nerves that control erection are separate from those that control the sphincter. I was non-nerve-spared, Gleason 8, T2, but fully continent from the outset.

So I think the major factor is the shape of our internal plumbing, but I will concede that damage to the sphincter control nerves, if it happens, would also be a factor. If it does happen, do the doctors ever tell us?

I think Colin and Piano have it right. The surgeon's technique has to be the main factor.

Also, have you ever seen the suturing technique that is used to re-attach the urethra to the bladder neck??

It is amazingly complicated where the suture thread is loosely looped many times from one side to the other side all the while the two ends are only loosely in contact with each other. When all the loops are done the thread is then slowly pulled taking up all the slack and the two ends are draw together.

I would think then the surgeon has to guess about how tightly to snug it all down (around the catheter tubing etc).

There has got to be a lot of variation in that. I think also the surgeon has to balance between making the seal tight, but not so tight that later on the scar tissue contracts too much causing too much constriction later on.

Finally, I would say that having a short period of a few months of incontinence and still be able to gush like a firehose rather than dribble is worth the extra wait (if it were the case that quick IC end means a really snugged down sphincter to start with).

That might be a survey question to ask in relation to how well you can void urine after continence is reached : gusher, normal or dribble -- to see if it has any correlation with the quickness that continence is reached.

Greetings, everyone. Good discussion - I tend to come down with several others that it is the skill of the surgeon and his experience.  My surgeon had a great reputation (still does) as it relates to both incontinence and ED.  One thing he told me when we met together for the first time on January 2.  He said don't worry about doing a certain amoung of kegels - I just want you to stop your flow of urine a minimum of 5 times every time you urinate between now and your surgery (which was Feb 4).  I know that is a subtle difference but for me it worked.  I was basically dry the day after catheter was removed. 

I am also not in great physical condition - I'm overweight and always have been.  I do walk and even used to jog but still was overweight.  I don't eat healthy - I can go weeks with no sweets but I do love fried foods and salty type snacks like chips and dips and pizza and stuff like that.  I have gotten better the last couple of years, but still not nearly where I should be.

So, I come back to skill of the surgeon - I'm grateful mine did such a good job.  David

David/CPA - I tend to agree, I think precise surgical skill in the hands of an experienced surgeon, makes so much difference too.

Jim I also watched a video of a Robotic operation and I agree with what you say but it must give the experience open surgeons a big advantage to be able to feel in his hands how tight to put to close the gap so no leaking occurs

What the ?!? Are you telling me for 56 years I had a choice on how to stop my flow?!?! Did you guys actually say "Oh I think I'll use my lower sphincter today. I've been using my upper these past two days." ?!?! I didn't know I had a choice! And where exactly did you switch over? Do you pull out and rotate your drain pipe 180 degrees like a Delta faucet cartridge?

I'm kidding about the cartridge concept but I am serious about the other stuff. If I've been doing it wrong for 56 years years I want to tell my two sons about this now while they still have the walnut. So, anyone out there with the aforementioned skill please enlighten me. Is there a manual?
Maybe we can practice during the GFMPH weekend - oh wait... The only choice the attendees have now is: Tena or Depend.

Hey engineer, I am in a very similar situation. I can last all night but as soon as I sit up - out it comes! Also I can also sit just fine but stand up and the flood gates open. I try and kegel before standing up for as long as I can (one minute max). that gives me just enough time to get to the outside and then let fly. This is not a procedure suitable for office use or mixed company.
How about you? Same?
I start incontinence therapy tomorrow. Will let you know what they do and if it works.
Have you done this?
Jeff