Incontinence with Nerve Sparing on One Side

[gamma909]

Does anyone have information or experience with removing nerve bundle on one side only? Most of the research I found was related to an increased likelihood of ED but right now, I'm more concerned with incontinence. I've found somewhat conflicting information on the extent to which a nerve bundle resection on one side only affects this condition. I think that the somewhat confusing information is related to, as I understand it, the fact nerve sparing technique and preservation of the nerve bundle are not the same thing.

[btl258]

It's too early in my recovery (I'm ~3 weeks out from surgery). I only had one side spared and I'm down to one pad during the day and one at night. It is almost all just dribbles too. I'm going to switch to the thin shields once I use up my max flow pads in a couple weeks. In short, I believe I'm on the way to regaining continence in ~2 months (hopefully!). I've heard that it also may depend on age and condition prior to surgery (I'm 46 and had no issues prior to surgery). As for ED, still no progress there yet.

[gamma909 in reply to btl258]

Thanks - good luck with your recovery and I wish you continued good health. Your experience makes me a bit more hopeful. I've also read that age and precondition are big factors.

[wclee]

Hi Kurt65. I’m about 3.5 years past my prostatectomy. The surgeon tried to spare one side, but had to cut the other nerve bundle. He wasn’t confident that I would have an erection again. I have ED but respond pretty well to Levitra. I was incontinent for the first month following surgery but since then am fine. Everyone responds differently. Hope this helps.

[gamma909 in reply to wclee]

Thanks. I think like most things related to PCa, every individual case is different and a lot will be up to surgeon's skill as well as their judgement once they take a look. My mpMRI indicated possible extracapsular extension on one side so I'm guessing that the surgeon may end up taking more of the neurovascular tissue from that side. Your positive experience with incontinence is reassuring. I wish you continued good health.

[Smallfall]

Kurt65, I'm 69, dx'ed with PCa on the left side of the prostate in October of '17. Because of insurance complications, I couldn't do anything until July '18. A mpMRI on 7/13 showed the cancer still on the left side but bulging toward the nerve bundle. The MD assured me that even with only one bundle I should be alright. I had HIFU done on 7/26. I'm not clear on whether he took the whole left side bundle or only "shaved" it. I took out my catheter a week after the procedure; there was some passing of blood clots but no continence problems or leaking. My wife and I had our first "Date Night" (a weekly ritual for 30 years) after HIFU, last night, and everything worked fine. I am very grateful for my outcome and wish you the same or better when you rid yourself of cancer.

[gamma909 in reply to Smallfall]

Thanks Smallfall. I've read quite a bit on this topic and there seems to be very little consensus on the exact relationship between nerve sparing and incontinence. It really seems to come to down to the experience of the surgeon (assuming surgical treatment) and the condition of the patient prior to surgery. Right now, surgery and radiation seem to be my options. I've read some promising things about HIFU and wish you continued success with your recovery and good health.

[Svnupsf]

Kurt, I had surgery mid-2016 to remove my greatly enlarged (90cc) prostate. My doc was able to spare the erectile nerves on one side only and ED is still an issue that injections appear to be the only effective option two years out.

With respect to incontinence, my doc explained it this way. We (males) have three components that control our ability to hold our pee. There is a sphincter at the bladder and upper area of the prostate, another at the bottom of the prostate, and the prostate itself. Women do not have a prostate so have only the one at the bladder and that fits with the common notion that women are more prone to "lose it" when excited (or frightened) than men. When our prostate comes out, we are left with the same single sphincter as women. But, if that upper sphincter is also damaged in the surgery...there is going to be an ongoing incontinence issue that will likely require an artificial (AUD) valve to control.

Compounding this is that our "upper sphincter" is weaker than a woman's because it's never had to do all the work. This is where kegel exercising comes in...to beef up the remaining sphincter. Age is also a factor. Even with out a prostate issue, older guys can develop incontinence issues. (I'm now 73).

My case: I needed pads for about six weeks but was down to a single thin pad per day by about two months out. I made use of a continence therapist after that and have been without need for any pads after about six months. The fact that my prostate was as large as it was had some impact on regaining control. All-in-all, I'm doing fine...a few drips now and then but nothing serious.

I hope this is helpful and good luck!

Ken

[gamma909 in reply to Svnupsf]

Thanks for all of the information - good explanation. I also appreciate you sharing your personal experience; as I noted in earlier posts, the relationship between nerve sparing and incontinence is not entirely clear while the relationship to ED is very clear. I wish you continued good health.

[Svnupsf]

Kurt, I doubt there is much relationship between nerve sparing (vs not) and incontinence. The erectile controlling nerves are connected to the outer wall of the prostate and must be very carefully separated from the gland to spare them from damage during gland removal. Often, the nerves on the "near side" of the surgery can't be saved (as in my case) as they are in the way of getting the gland out. There are no nerves that go down past the prostate to the penis for pee control. As previously described, the lower sphincter and the prostate itself get removed in RP...nerve sparing or not. We are left with fewer "valves" or constrictors (the prostate) than before. If the surgeon also messes up the upper sphincter...it's likely going to require an AUD for control.

Good luck!

Ken