Sphincters

Sorry if this has been done before, but being a relative newby to prostate removal, I am trying to find out exactly which muscles are left intact and which are removed/damaged. I realise there are two sphincters controlling flow, inner and outer. The inner at the bladder neck and the outer south of the prostate. Surely both are left after surgery but are likely damaged, hence the incontinence until they heal and control is restored.  Any of the more experienced members comments would be much appreciated. Best wishes to all from England.

I agree with Purg. When the prostate is removed we lose the upper valve as well as the prostate itself which can have a significant impact on flow. We are left with the lower valve only so we are much closer in function to the female system which, I believe, is controlled with just a single valve. This info came from discussions with my uro (and from looking at the diagrams on the wall while I was in various uncomfortable positions) so my translation may not be 100% correct.

Garth

www.ivy-rose.co.uk/HumanBody/Urinary/Urinary_Bladder_Urethra_Male.php

This website has a great diagram of the whole system. The sphincter at the neck of the bladder is taken with the prostate because in actuality, there is no space between the prostate and the bladder. If you read Patrick Walsh's Prostate Cancer book, there is a whole great series of drawing of what happens in the surgery. The only sphincter left is the External sphincter right at the top of the bulb. If a surgeon is sloppy, this sphincter can be damaged and continence will not come back. In the old surgeries, the whole area was taken out and men ended their lives incontinent and impotent. We've come a long way baby.

Men hardly use the external sphincter. In sexual arousal, this muscle locks open so that semen will readily evacuate. The Internal sphincter and a secondary valve in the prostate shut. Post surgery, our body still tells this muscle to open wide...which is why so many men leak or ejaculate urine. After all the trauma it simply takes a while for this small muscle to take over and learn to compensate for the loss of the other mechanisms. On reflection, it's amazing it happens at all. We're pretty fortunate.
Paul

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