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One Month since Radical Prostitechomy.... A few issues

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Posted 9/24/2016 4:43 PM (GMT 0)
Hi,

Yesterday was my one month since my surgery. I am doing pretty well. My energy level hasn't been that great. I actually played some doubles tennis this morning for the first time in a month. My doctor told me 6 weeks, but... it was just doubles.. My main issue is having to urinate quite frequently. Last night went to be at 0830pm made it to 1:30am then again to 5:15am and just got up. Had a coffee prior to tennis and had to urinate after the first set. Then after the match.. but only a few teaspoons... I am not drinking much water due to the need to urinate. From the posts I read here (now closed) I guess it's normal. However, having to urinate so frequently (like 10-15 times a day) is freaking me out. So much I emailed my cardiologist at Stanford who said this:

Have you talked to your urologist about the frequent urination? Could be due to bladder irritability, but also could be due to incomplete emptying of the bladder leading to over flow incontinence and urgency. Bladder irritability canbe treated with an agent like ditropan to relax the bladder. Obstruction to flow can probably improved with things like lfomax resulting in improved emptying.

David

I don't know if I need to drink more water/liquids to try and get my bladder use to more liquids or if this just goes away? My incontinence is pretty good. No pad last night or yet today as of 10:00am. Trying to just figure this urination issue.

Thanks,
Brian :)
Posted 9/24/2016 4:51 PM (GMT 0)
It is possible to have both incontinence and retention - the worst of both worlds. Why are you asking your cardiologist rather than your urologist? There are different medicines for bladder spasms than for other causes of urinary frequency. Cialis may help too. Medicines like Flomax may aggravate incontinence. You should be asking your urologist.
Posted 9/24/2016 5:02 PM (GMT 0)
I am going to ask my urologist. I just happen to work with this doctor at Stanford who helps me with my AorticDissection.com site and just happens to know the head of urology at Stanford. I am taking 5 mgs of Cialis daily as well.
Thanks,
Brian

I am just trying to figure out physically why this is happening to me.. Take care.
Posted 9/24/2016 5:26 PM (GMT 0)
Tennis23 - First off I'm not a doctor and you should talk with yours as Allen suggested.

With that said what you described about urination frequency and urgency at one month post surgery is probably little better than where I was at. For example, at one month I had the large happy hour 20oz beer and had to make a 3 trips to the urinal over 30 minutes or so once I started to drink it.

From other posts on this board - they suggested to drink lots of water and exercise daily the best you can. I did that and my bladder control improved dramatically. Seems like a harmless thing to try and for me I saw results in a week or so. Of course it could have just been coincidence but again, might be worth a try.

Jon
Posted 9/24/2016 5:45 PM (GMT 0)
Tennis23-

Seems like you are moving along pretty well.

Possibly, when you are further along the heal process your urination frequency may go away?

Bobby Mac
Posted 9/24/2016 9:23 PM (GMT 0)
I wouldn't sweat it, though it is a nuisance. Been there.
Posted 9/24/2016 9:34 PM (GMT 0)
Your CARDIOLOGIST ? Really?
Posted 9/24/2016 9:36 PM (GMT 0)
On the other hand you did ask here as well. :) Just doing your "due diligence" is suppose. :)
Posted 9/24/2016 10:10 PM (GMT 0)
Playing tennis a month after RALP????? Dude, you are a STUD!

What I found about the urinary frequency, even today 18 months post surgery, is that frequency...especially if i then just let out a few drops...is actually a sign of dehydration. Seriously. If I really work at keeping myself hydrated....with water, gatorade, etc (I don't do caffiene hardly at all, haven't for years), I find my retention and my emptying is actually better.

What you're finding out is the reality for most men post RALP: because of the surgery, we are missing one of the valves that we used to have that was located inside the prostate. The only voluntary muscle we have to hold it in is the pubo-coccygeal muscle...the one you exercise with the kegal. It has to get stronger...and it needs to be trained against a regularly full bladder.

Cialis will actually help as well, by increasing the blood flow down there which seems to help the healing process.

And, yea, you had a major assault on your urinary tract, so a urologist is the expert.
Posted 9/26/2016 3:32 PM (GMT 0)
Hey Brian,

Sounds like you are doing quite well. Out playing tennis (even though it was only doubles). I couldn't even play tennis if there were 3 to a side. I was a baseball player (played at EWU)... but that tennis .....too much work. And you are playing already! Easy does it though.

You had your surgery just as I was starting RT. I've got 5 more weeks ( if they would stop cancelling fractions for one reason or the other). It's good to hear that you are doing so good especially because we kinda started this journey at the same time with the same Uro. I kept looking for you to post and glad you did.

Keep us up to date!

Blessings

The Artistic One - Mark
Posted 9/26/2016 4:44 PM (GMT 0)
Hi Brian.....

8:30 pm; 1:30 am; 5:15 am; I'll be honest with ya, that doesn't sound all that abnormal for anyone! Every 4 to 6 hours seems normal prostatectomy or no prostatectomy. What am I missing?

Empty your bladder right before bed. The one thing that's a little different with yours truly is that I just cannot hold it quite as well as pre-surgery (when, if I felt like pizzing, I'd just keep on going, knowing I could hold it along time) I don't do that now. Now....I go more often but, it's more "pro-active". IE...if I feel a bit of an urge and I'm getting in the car...I go before I get in the car, etc.

Plus...it's this layman's belief....it'll continue to get better.. hang in there. As long as you don't go to a urologist when when you're having a heart attack I think you'll be fine.

Good deal on the tennis. Way to go man.
Posted 9/26/2016 7:52 PM (GMT 0)
Hey Brian,

I had my prostate removed on July 31st and I too, find myself peeing 10-15x per day. Had my follow up ast week & was told to keep doing Kuegels. My doc told me that it takes longer for some than for other. 6 months is where we should see a marked improvement as I understand it.

Good luck!
Posted 9/29/2016 5:12 PM (GMT 0)
I'm not a doctor.

I think several things can be at play (no pun intended)

How long did you have the catheter in? Mine was 9 days. My urologist said that the pulling of the balloon in the base of the bladder, really irritates the bottom of the bladder which is the trigger for need to urinate. As the bladder fills, that bottom section feels the weight and pressure on the bottom of the bladder (more like a boda bag than a balloon) and its said "empty". That irritation and in essence incorrect trigger can take a while to heal and to reset. You can work to reset it a bit by healing and by trying to delay emptying a bit. Drink more, drink a lot more. there is no downside in this and will work to hydrate you. Don't hold it to pain or anything but you'll rebuild the muscle (of the bladder).

I actually was measuring volume and urination post catheter removal (I was pushing 6-8 liters a day through the bag) and started at 200 ml during the day and 500-600 at night before needing/wanting to go and moved it up to 340-400 during the day and 800-1000 at night. That can really help. Get a cheap measuring cup at the store and put it next to the toilet and measure you output and track it.

Also, prior to bedtime I found the best thing was to yes, try not to drink any large volume 2-3 hours before sleep time. Also, put your feet up in bed and that will draw the daily accumulation of fluid in your legs back up and you'll go one last time. That will minimize any night time need as much as possible.
Posted 9/29/2016 6:52 PM (GMT 0)
Brian,
I agree with the others you are not too bad this early out of surgery. First, are you doing kegels? Seeing a PT to make sure you are doing them correctly? The kegels got more intense with each session. I am convinced the PT was a great help in my recovery. She also said to reduce bladder irritants. Coffee, tea, alcohol. I cut back dramatically on the tea an coffee, and do not do use alcohol. Also drink lots of water, which i think was to "train" bladder while full. Good luck, you will be ok.
Posted 9/30/2016 6:01 AM (GMT 0)
I found coffee to be a nightmare for me. I would double my leakage for the rest of the day. Gave up coffee :( helped me a lot. I also got great advice from the group to drink MORE water not less. Made no sense to me but it worked.

That's all I know, except you are in the right place for advice. The information shared is tremendous.
Posted 9/30/2016 1:21 PM (GMT 0)
Hey Tennis, I hope everything is still progressing for you. I think your expectations may be a little too high this soon after surgery. What you have described seems to be very good progress. I would be careful with the caffeine and don't over do it with the exercise, tennis at 1 month is a lot to ask. I definitely leaked more and had a lot more frequency after coffee and exercise, it's fine that you are doing it but just understand you will have some issues.

My surgery roommate basically followed none of the instructions for how important rest was after surgery and did not cut back on coffee and his progress was horrible. He's a bit of a type A personality and he could not sit still at all. Yet he was baffled as to why he was continuing to have leaking/frequency issues.

Personally I kept in mind the 2 month mark and tried to get plenty of rest, walk often but not to the point of fatigue; I wasn't trying to exercise and lose weight; just keep things moving a bit. But I rested a lot. I drank coffee but I knew during those times I would leak more and have more frequency, but I was trying to train my bladder to handle it because I did not want to give up coffee. I also agree with some here and I drank plenty of water to stay hydrated, esp. after a major surgery I did not want to be dehydrated. I would drink water at night also but I knew I would be getting up multiple times during the night and was okay with that. Removing the prostate pretty much insured that I would have more frequency issues for the rest of my life and that is true today. We lost our automatic shut off valve.

Of course your Dr. can help you decide if there is any issue to address, but from your description of progress you seem to be doing very well. Your expectations may need to be lowered a little.

All the best, Jim
Posted 9/30/2016 1:24 PM (GMT 0)
ps....and of course Kegel, Kegel, Kegel. Very important. After coffee and during exercise I would kegel even more just to battle any anticipated leakage.
Posted 10/1/2016 8:55 PM (GMT 0)
yes, as others have said do anything you can do reduce irritation to the bladder..

high irritants are of course all the nice things in life.

coffee, caffeine, tea (less so herbal and green tea), alcohol (this is a double whammy as it is both and irritant, diuretic and it relaxes everything including the bottom of the bladder and any remaining sphincter functions one might have in the bladder neck or the urethral sphincter so hello leakage.

sadly chocolate falls into this category as well, save for dark chocolate so develop a taste for that.

And fatigue (and this includes doing too many keggels) and pressure on the pelvis from maybe pants a bit tight can irritate this as well.

Water is your best friend as are quality juices - although not too much juices. There is some more than just anecdotal evidence that green juices that are higher in arugula and spinach can promote NO production which can support blood flow to the region and help those muscles down there (the bladder is muscle tissue) regenerate and strengthen.
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