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Posted 2/25/2019 2:10 AM (GMT 0)
My husband will have a RALP robotic assisted lap prostatectomy. He will like not be able to preserve the nerve. What are the best post surgical incontinence management systems for an active male?
Posted 2/25/2019 2:37 AM (GMT 0)
Kegel exercises. Before your husband has the op. they'll probably be telling him to do these in preparation - at least a few weeks out from the op. I'd ask for a referral for a physiotherapist familiar with kegel exercises to explain and show the exercises. I learnt them just from googling but it's a huge help to find a physiotherapist who has an ultrasound that shows whether you're working the right muscles or not. It's interesting to see the actual muscles move as you do the exercise and they run the ultrasound over you. You can quickly modify the exercise to get it exactly right.
Posted 2/25/2019 2:56 AM (GMT 0)
Go to the bathroom. Stop in midstream. But instead of using the front to stop the stream like he’s used to doing, tell him to use the muscles behind his testicals and under his butt. He’ll understand when he tries it a few times.

That’s a Kegel. There’ll be a muscle that gets tired after 3 or 4 times of stopping the stream. That’s the muscle they want exercised.. The more he does it, the more he’ll understand how to do it.
Posted 2/25/2019 2:58 AM (GMT 0)
Welcome:
The nerve sparing or not relates to the ability to get an erection (or ED if you prefer) after surgery. Incontinence is a result of the surgery and is indeterminate from my observations since there appears to be no explaining why some people sail through the surgery and catheter with minimal effects and others have issues for long periods of time or forever. Age, prior urination issues, and the skill of the surgeon all contribute to the outcome. No question the kegal exercise are important prior to surgery as well as afterwards for many men.
Posted 2/25/2019 5:52 AM (GMT 0)

island time said...
Go to the bathroom. Stop in midstream..

Ok to simulate that (use the muscles as if you were stopping mid-stream), but personally I wouldn't recommend actually doing it more than the odd occasion. Otherwise you might inherit other problems - supposed to be bad for your bladder.
Posted 2/25/2019 5:53 AM (GMT 0)

Blindesided said...
What are the best post surgical incontinence management systems for an active male?


AMS800 artificial urinary sphincter.
Posted 2/25/2019 3:18 PM (GMT 0)
Walking more walking and then do more walking along with kegal exercises is your best recovery for incontinence after surgery. The skill of the surgeon really comes into play in this area that's why you want to have the best that you can find. We haven't had a lot of guys lately here on the forum talking about having surgery but a year ago to 2 years ago there were lots of us here and almost everyone talked about the benefits of walking and kegals.

Larry
Posted 2/25/2019 4:17 PM (GMT 0)

island time said...
Go to the bathroom. Stop in midstream..


jasperx10 said...
Ok to simulate that (use the muscles as if you were stopping mid-stream), but personally I wouldn't recommend actually doing it more than the odd occasion. Otherwise you might inherit other problems - supposed to be bad for your bladder.

Now you tell me? That explains a lot. lol
Posted 2/25/2019 4:26 PM (GMT 0)
Gentlemen...women know how to kegel...the advice is good...instructions not needed...the knowledge she may have gained...came from Mumbo and nerve sparing...now if she doesn't come back...do not blame me...or do...either way ...its a reveal...so kew
Posted 2/26/2019 1:33 AM (GMT 0)
Thanks Guys. So the Kegels are underway!
What products have you used to manage urinary leakage post cath removal?
Pads? Undergarments?
My husband is very active, I want to help him find the best option for incontinence management.
Thanks
Posted 2/26/2019 1:51 AM (GMT 0)
First of all, incontinence is not guaranteed. Many men were dry--or almost dry--immediately after the catheter came out. Others takes a while. A few are forever. It's hard to predict.

That being said: In the men's health aisle at the drugstore, there are thin pads (shields), heavy pads, and depends underwear. I bought the heavy pads--and used them from the time the catheter came out. After a few weeks, I went to the shields--and after a while I didn't need them either.

It's just so variable, it's hard to suggest. For me, I'd get the heavy pads and the shields. You can always move 'up' (or down?) to the full depends if needed.
Posted 2/26/2019 1:59 AM (GMT 0)
Walking is always good. Kegels done properly, but not overdone are always a good idea. A skilled surgeon, for sure. But, I've come to the conclusion that, to some degree, the regaining of continence, even in the hands of a great surgeon, depends upon each man's individual anatomy in the area of the bladder neck. Some are more repairable than others, depending perhaps on their length. But, I'm only a guy who had a prostatectomy, not a doctor, so this is just an opinion.
Posted 2/26/2019 3:09 AM (GMT 0)
Blindesided--

Don't buy a ton of supplies pre-RP. It may turn out he's nearly dry right away and you've wasted your money. Diapers and pads are super easy to find in the stores, so there's no need to stockpile beforehand. Also, you might invest in a brand that he finds uncomfortable.

That said, buy one package of diapers to bring to the uro's office the day they remove the foley catheter. Since there's no way to predict if he'll be dry, semi-continent, or niagara falls, you want to be ready for any contingency. If he's gushing, he could go through several diapers the first day, so have a package at the ready. If it turns out he doesn't need it, you're only out $15-$20.

By Day 3 post-catheter, you and he will have a decent idea of his needs and can buy more supplies. If it turns out he's fairly incontinent the first weeks, he'll want to try different brands to see which one is most comfortable for him. My own preference was for Depend men's disposable undies (fit-flex, if I remember right) and Tena pads. I didn't like Assurance (Walmart brand). But every guy's different.

I was pretty much a gusher the first two weeks and then steadily improved. By four weeks I'd ditched diapers and was exclusively a pad man. By three months I didn't need pads anymore. Mileage may vary -- some guys are continent from the get-go and some never reach continence without mechanical/surgical aid -- but it seems to me my timeline was typical of many of us.

Good luck!
Posted 2/26/2019 3:19 AM (GMT 0)
"My husband is very active, I want to help him find the best option for incontinence management."

radiation instead of surgery -- have you considered it? since they know they are taking the nerves ditto for ED.
Posted 2/26/2019 4:16 AM (GMT 0)
What Halbert said is very true...and the fact that your husband is very active bodes well for odds of little to no incontinence...I was 99% continent when catheter came out...it was only when I sneezed or coughed and then a dribble...close to 10 years later...I wear a thin pad when I hit the gym but rarely is it "tainted" when Im thru and I do extreme workouts...I agree with pretty much all the advice given....If you are interested In a switch to another treatment as F8 mentioned...talk to surgeon and hook up with a radiation oncologists...if you are sold...an appropriate term...btw...on ralp...fine...either way my suggestion is that oyu create a signature for your husband detailing particulars of his diagnosis...much like you see in other folks posts...just for further advice yuou may need post recovery...etc....I strongly suggest...if you are using a small town surgeon...especialy a urologist that your husband has known for years...you reconsider all options. you get one shot at this... most variants of Pca...are very slow...even t the most aggressive...are slower than most other cancers...Caveat to all this...none of us here are medicos...read/study some of the books in the sticky list and keep an open mind...you do not appear to be a big worrier...and I do not sense a bit of panic...which is sooo important in outcome...are you a nurse by chance... any way good luck...regards...
Posted 2/26/2019 4:24 AM (GMT 0)
Why are you thinking his nerves will be removed. Has the cancer escaped the capsule? If so surgery will not be effective and radiation or some other treatment would be better. Does he know the total ramifications of RP with nerve removal.? Slow down and learn all the treatments.
Posted 2/27/2019 1:23 AM (GMT 0)
Logoslidat: nailed it. I am a nurse. Looking out for my guy. Feels little weird on this mostly male forum but helpful. Despite being hopeful that prostate ca is "slow" he does have an aggressive disease sad. We are hoping for the best and taking one step at time. At this time the idea of incontinence is dreadful for him. I am looking at the bigger picture. Thanks.
Posted 2/27/2019 1:49 AM (GMT 0)
Blindsided:

A few questions we ask all newcomers--because we (most of us) are information and numbers junkies, and we want to know the whole picture of a newbie--so maybe we can help steer in a positive direction.

So:
When was he diagnosed?
What is his current PSA? What about his PSA history?
How old is he?
What was his biopsy pathology? How many positive cores? Gleason scores from the biopsy?
Has he talked to anyone besides the diagnosing urologist? Such as a radiation oncologist?
Where is he getting his testing and treatment? Is it a major center?
Is his surgeon (assuming he's going that route) highly experienced? Like thousands of procedures done?
Posted 2/27/2019 2:06 PM (GMT 0)
The incontinence scared me too, no way around that possibility if the cancer is significant. There are a lot of horror stories from all the treatments years ago that my Dad likes to relate to me. Luckily, the techniques and equipment have gotten much better and the odds are getting better all the time that side effects will be less than prior years. That being said, it is still a crap shoot who does well and who does not so getting a good up-to-date team for his treatments would be the prudent course of action to reduce risk.
Posted 2/27/2019 9:59 PM (GMT 0)
"That being said, it is still a crap shoot who does well and who does not so getting a good up-to-date team for his treatments would be the prudent course of action to reduce risk."

well.... if incontinence or ED are side effects you want to avoid do not have surgery! when your doctors says he cannot spare the nerves you should be more concerned about ED, and that's not to say you should not also be concerned about incontinence.
Posted 2/28/2019 3:54 AM (GMT 0)
Surgery has side effects for sure, but radiation can too.
It's a bit of rolling the dice whatever treatment is chosen.

I wouldn't go the surgery path if there was a high chance of needing radiation fairly soon post surgery (say, 0-2 years). For me that's just getting 2 sets of possible side-effects. I'd be asking the docs for their best guess there. That's only my thoughts. It really is a personal decision - everyones circumstances are different.
Posted 2/28/2019 4:24 AM (GMT 0)
"Surgery has side effects for sure, but radiation can too.
It's a bit of rolling the dice whatever treatment is chosen."

when it comes to incontinence and ED I think surgery is the where you roll the bones. I think that's especially the case when you opt for surgery when SRT will likely be needed.

but even the "successful" surgeries often result in incontinence and or ED. sure it happens with radiation too but rarely incontinence and ED can often be treated with oral drugs (not shots in the Johnson).

to be clear surgery would ALWAYS be my last choice to treat prostate cancer. I don't see any benefit in the vast majority of cases but I know sometimes there is no other choice.
Posted 2/28/2019 5:30 AM (GMT 0)
gentlemen...have you no discernment at all...blindsided will let us know. when and if she needs our help...in the order of her priorities...not yours...she has made that perfectly clear by her last post and not responding to your timetables...do not turn this thread into another dia tribe on surgery vs radiation...F8's remark about her priorities was actually sexist( he will not admit this)...he appears to assume that because she is a woman... she automatically MUST want ED addressed before incontinence.. He just knows her priorities are wrong from the jump and he does not! ...she is not stupid...she may or may not want all our so called " "wisdom"...let her breathe...for goodness sake......Ok now look ashamed...and go about your business...BlindSided...the forum does have a lot of good advice and a lot of stanky and very misleading advice...it is like anywhere that more than a few gather and especially with this amount of men...that the ego factor and a whole bunch of what the late Allan Watts referred to as " one upmanship " occurs... We are here for you and yours whenever and for whatever...regards logo... gentlemen..... " I am looking at the bigger picture, Thanks " Blindsided's last post...DOH....
Posted 2/28/2019 6:21 AM (GMT 0)

logoslidat said...
gentlemen...have you no discernment at all...blindsided will let us know. when and if she needs our help...in the order of her priorities...not yours...she has made that perfectly clear by her last post and not responding to your timetables...do not turn this thread into another dia tribe on surgery vs radiation...F8's remark about her priorities was actually sexist( he will not admit this)...he appears to assume that because she is a woman... she automatically MUST want ED addressed before incontinence.. He just knows her priorities are wrong from the jump and he does not! ...she is not stupid...she may or may not want all our so called " "wisdom"...let her breathe...for goodness sake......Ok now look ashamed...and go about your business...BlindSided...the forum does have a lot of good advice and a lot of stanky and very misleading advice...it is like anywhere that more than a few gather and especially with this amount of men...that the ego factor and a whole bunch of what the late Allan Watts referred to as " one upmanship " occurs... We are here for you and yours whenever and for whatever...regards logo... gentlemen..... " I am looking at the bigger picture, Thanks " Blindsided's last post...DOH....

sexist? I mentioned ED because taking the nerves has nothing to do with incontinence. nothing to do with her being a female at all. hey I understood you for once! that in inself needs to be examined. maybe i'm having a flashback and you're spinning the album backwards
Posted 2/28/2019 3:35 PM (GMT 0)
The "standard " sequence of concern in treatment choices since I have been involved in any thing pca related is:
cancer elimination/control...preserving continence...preserving erectile functionality...BlindSided...every one has their personal sequence choice...Im sure 99% choose cancer control. as first..I am 100% sure this couple chooses that as well( as are you) you chose for this couple what you thought should be their sequence of concern...I was wrong to posit a rational for you doing that and apologize for that...but doing that....you certainly did...any other points on this issue should be on a new thread with distance from this thread and this couple...Im sure we can all agree on this(a new thread on the issue}... personally... I see no need for it....who knows... I stand by the essence of my post...especially the last few lines and the last words of blindsided...that I quoted...lets end it here...
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