Collagen Implant Anybody? (Injection)

Tried to post on this subject, but somehow didn't take.  If it's posted *twice somewhere, sorry.   * Post edited to add "injection" to title :) and 2nd thread link.... Collagen Implant Anybody? After Bio-Feedback brought me no closer to continence, my therapist dug deeper into my med records and found that when I had my last cysto, the doctor read into my records that I had a sphincter shorter than normal.  He didn't tell me that, and she said she's never seen it written before. But perhaps in desperation and with a desire to help me, she wants me to talk to the doc about Collagen implant.  I've tested for it before but never went through with it.  She thinks there's a possibility that it may help just enough to get that little thing working again (the sphincter muscle).  I think KW had written about it months ago, and how it failed on him, but I can't find the thread with a search.  I would like to read it again if someone can help me and I would like to know if anyone... anyone has had this and has it helped? Gene Age: 63 First biopsy 07/05; Diagnosed: "Suspicious looking cells". Dr. says wait and watch. Second biopsy: 12/27/06 Diagnosed cancer: 01/24/07 Gleason Grade: 3+3=6 Radical open Nerve-sparing Prostatetomy: 02-14-07 Cancer confined to prostate Pathology Stage of cancer: T2c First Post-Op PSA on 04-18-07: 0.011 Bleeding problem at 6 weeks post surgery...No resolution despite several trips to surgeon, antibiotic treatment. 05/31/07: Cystoscope reveals "stone", due to "Stricture" (narrowing of uretha at prostate removal site). 06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure, but is most likely a temporary fix, and incontinence continues. 8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.  He thinks stricture is back, but send home with Cipro. 8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news! Still leaking. 8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05 (non-deteactable).  PTL! But still leaking 8/31/07:  First Bio Feedback session.  The little lady is very positive that I can gain control.  That's what I want more than her.  New urologist is not very sold on effectiveness of Kegals??? 9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. Recommended possible callegen implant. She noticed from 8/20 cysto that my sphincter was ... too short?... huh?  Post edited to add "injection" to title and 2nd thread link :)  Post Edited By Moderator (bluebird) : 9/24/2007 12:30:18 PM (GMT-6)

Gene,

I'm interested in your comment regarding sphincter length. Some time ago I read an article quoting a Dr Catalona where he mentions this subject. You can read ther complete post on http://www.drcatalona.com/quest/quest_spring03_2.htm, but here's an extract.

"Eventually, most damage to the bladder and the urethra heal, but it takes time and the improvement in continence is gradual, with complete recovery taking from six to 18 months. "The most common cause of incontinence after a radical prostatectomy is a weak external sphincter muscle," Dr. Catalona said. "The surgeon has to try his best not to injure it and to preserve its length. "Most important is to protect muscle fibers of external sphincter." A recent study at Memorial Sloan Kettering connected the length of the sphincter before surgery with how quickly continence returned after surgery. The external sphincter muscle squeezes the urethra, enabling it to retain the urine until the sphincter releases its hold. Its action is both involuntary and voluntary. The effectiveness of the sphincter is a combination of length and strength. The longer it is, the more efficient it is. The stronger it is, the more effective it is. Patients can not control how long their sphincter muscle is, but they can contribute to how strong it is by doing Kegel exercises as recommended by their doctors both before and after surgery."

One thing my urologist said to me is that the load of retaining urine in the bladder is shared between the internal sphincter in the bladder neck (the one that is chopped out when the operation is done), and the external sphincter. Some men have most of the work done by the external sphincter before the operation, and in these cases, the external sphincter is already strong. For others, the internals sphincter may be doing more of the work, and for these people, it is a longer road to recover of incontinence.

I've wondered for some time if perhaps the cause of my slowness to recover continence is due to a shorter than normal sphincter, which in turn may have been the result of a life time of most of the work having been done by the now missing internal sphincter.

Regards
Berb

Here's another article that gives some insight into the workings of the sphincter. I've reproduced one paragraph below.

http://www.emedicine.com/med/topic3019.htm

"The urinary sphincter is composed of an internal sphincter and an external sphincter. In females, the internal sphincter is composed of the bladder neck and proximal urethra. In males, the internal sphincter is composed of the bladder neck and prostate. Both males and females possess an external sphincter known as the rhabdosphincter. The rhabdosphincter is omega-shaped and is composed of 2 types of striated muscle fibers—fast twitch and slow twitch. Contraction of fast twitch fibers causes sudden stopping of the urinary stream. This is known as the voluntary guarding reflex. These fibers are responsible for allowing Kegel exercises. Slow twitch fibers maintain the constant tonus of the external sphincter, which is important in daily physical activities. This is known as the involuntary guarding reflex."

I'm doing research on artificial sphincters. I'm not planning on doing anything myself at the present time, but getting knowledge now will help me make the right decision in the future if I don't improve over the next year or so.

Berb

I'm new here, so first my stats:
Diagnosed in 1999, at age 49 with a PSA of 100+. Yes, that's correct.

Treatment:
radical prostatectomy, (bladder neck also removed), followed by external X-Ray radiation and lupron hormone injections. PSA down to 0.2 for two years, then was 0.4 to 0.6. Put on Casodex, and PSA has remained at 0.4-0.6 since.

Tried collagen injections ( total of 3) with some results, but only temporary, and possibly more due to swelling due to the injections than the actual collagen. Had an artificial urinary sphincter installed about 4 years ago, and I am extremely glad I did! My quality of life is tremendously improved. I've had some pain problems with it, but found that if I turn my "device", as I call it, off for a day or less, usually overnight, it is very managable.

Glad to be part of this discussion, and I'd be happy to answer any questions. I feel I have truly been blessed, and know a positive outlook is extremely important.

Yes, glad to hear from you Hagrid.

Do you still use any pads at all?

Since doing some research on these units, I've been a bit reluctant to consider one due to the 17-35% reoperation rate quoted in the article I posted earlier - http://www.emedicine.com/med/topic3019.htm. Other articles say similar things.

Berb

Bluebird, I am probably all wet (what's wrong with a pun?) regarding the callagen.  Actually I don't know how I picked up the word "Implant".  I suppose it really is "injection" since that's what it is, right? Thanks for your good work. Gene :)   * Post edited to add "injection" to title, helping to keep important information together in the 2nd thread link...   Collagen Implant Anybody?  started by Gene6163 :)   Post Edited By Moderator (bluebird) : 9/24/2007 1:04:38 PM (GMT-6)