Hello! I’m new to this community. I had a RALP (Robot Assisted Laparoscopic Prostatectomy) 11 months ago. I had a Gleason 8 prostate cancer. That problem was solved, my PSA has been zero since then. However, I was left with significant urinary incontinence. I have been doing Kegels ever since the surgery as recommended by my surgeon, but still leak a lot. As I was not improving, four months after surgery I started therapy with a PFM (Pelvic Floor Muscles) therapist. She has told me that my problem is that my PFM are not sufficiently relaxed. We have been working on that for many months, they have relaxed some, but still are too tense. She is not a fan of biofeedback, but is not an enemy of it. We have tried with biofeedback a few times. Bottom line, I have made little progress during all this time. More recently I have seen a voiding specialist. He did a urodynamic test and a cystoscopy, told me I have stress incontinence and talked to me about a sling. So, I have two questions: 1. What experience has anyone had with PFM therapy? Recommendations? Results? 2. What experience has anyone had with a sling? Recommendations? Risks? Successes? Failures?
Thank you.
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The success depends on how much the the membranous urethra is elevated in to the abdominal cavity by the sling and for how long the sling maintains the new position of the urethra. The rate of "cure" is between 45% and 70%.
Glad to hear about the 0 PSA. I had an RP some years ago now and a year and a half later had the sling surgery after significant incontinence...filling three diapers every day was a real drag. The surgery itself was a breeze and I had very good results; I'm not perfect and for a long time wore a pad, but now don't even do that most of the time. I know that not everyone has results as good as mine, but I am pleased, would do it again. The only negative is that it was a further interruption in the progress I had made toward better sexual functioning, but that was temporary, maybe six months to get back to where I was. Since constantly pissing makes sex kind of a mess and a bother anyway, it was a good trade to make.
Pelvic floor therapy was a godsend for my husband, particularly the biofeedback. He was on a catheter 4 full months before RALP, so his bladder had lost its memory. PFT worked for him within two weeks.
PFM Therapy: For me, urinary incontinence improved significantly during the course of physical therapy that included pelvic floor muscle (PFM) therapy with bio-feedback from an electrode in the rectum. Regarding PFM relaxation, going through the relaxation routine prescribed by the therapist, "Physiological Quieting" by Janet A. Hulme was the most effective part for me: Before beginning the routine, I usually thought my body was fully relaxed, but in the course of that routine, I often found that my jaw muscles weren't fully relaxed. Later, during bio-feedback with the therapist, the monitor indicated PFM relaxation coinciding with jaw muscle relaxation. ("Physiological Quieting" is available for streaming from Amazon Music, at no charge for Prime customers. After the end of the therapy series I continued to use it to help me fall asleep.)
Of course, I have no way of knowing whether the improvement would have occurred without PFM therapy. I was physically fairly fit at the start of the therapy, having worked my way back to running ~3 miles/day by that time, first with pad, then wicking undershorts, now just lined running shorts. (One month post-RALP, the physician's assistant told me it would be okay for me to run until I peed blood, then back off, but to continue to adhere to the restrictions on lifting. However, I never did push running to the point of peeing blood.)
However, for me, incontinence was fortunately mild: At the beginning of therapy, ~2 months after RALP, I was no longer using a pad at night, but typically had a number of "short squirt" releases during the day, most often when making sudden unplanned changes in motion such as side-stepping. If I replaced a pad during the day, it was due to concerns about odor, rather than saturation. By the end of therapy, I was no longer using a pad, but did sometimes have a very short squirt release, typically when tired, true to a lesser extent to this day. And, all along to this day, I cannot force passing of gas without releasing a short squirt, and I cannot stop urine flow after it begins. "Jockey boxer" weakly elastic undershorts made from wicking fabric (e.g. "Champion SmartTemp") have been sufficient to absorb the now-rare short squirts. And, I carry a disposable wide-top drink bottle in my vehicle and backpack in situations where there might be need to "go" with no bathroom available. Also, I get up to go to the bathroom nearly every night, but that was also true before RALP.
So, all in all, I've been fortunate, with only slight incontinence, PSA still below the limit of detection (<0.014 ng/mL) 23 months post-RALP, although still significant ED issues. (Urologist says not to give up hope, he as seen improvements in ED up to three years post-RALP.)
Best wishes for progress and a good outcome for you!
Thank you MNfarmboy! I will look for that Physiological Quieting video. Sounds like it may help. BTW, I am also a runner (19 marathons). However have not been able to run since the RALP. Running with a diaper just doesn't work. I really miss it. Good luck with your ED.
I had a prostectomy, and had incontinence. It came and went even when I did the exercises like they said. The exercises helped me, but was when I didn't do them enough, I had issues. What worked for me, was just keeping my mind aware of it. The exercises were like a daily constant thing, not doing them and quitting. I mean treat them like they're not exercises, they're how it works now. Train the mind to keep the muscles holding. After a while my mind was trained to just keep things held, and I didn't have to think about it consiously anymore. After learning that, it was automatic again. Kind of like accepting a new feeling in your body, only you gotta train it to happen.
Its been years now for me, and the only time I have an issue is when I lift something heavy from an awkward position, tensing my abs real hard that overpowers it. I get a spurt of urine until I catch it an flex my urinary muscles harder.
Now when I stand next to a guy in the restroom at the urinals, and he's been there when I came in, I'm there for seconds, and gone, I say a prayer quietly for that guy cause I remember what he's going through. Then I praise God because I can out pee a 20 year old!
Thank you. I will keep your recommendation in mind and try it. I have wondered if the thing is to hold the Kegel like constant. Seems to have worked for you. All the best!
No lifting for 3 weeks. Take it very very quietly during that time. This is very important to let the healing do it's job to keep the sling in the correct position.
Hi,Had exactly the same problem. Nothing worked. Eventually went for the artificial urinary sphincter which works. It requires surgery and the recovery is not pain-free, but tolerable. If you decide on this route, let me know. I have further advice.
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