Retzius sparing prostatectomy, 1 week later

[PCInPA]

Hi all,

I still need to update my journey blog, but thought I would give an update as it has been a week today since my procedure at Georgetown.

The procedure itself went really well. Turns out my prostate was 100 grams. Pathology came back showing 4+3, versus original 3+4 from biopsy. No positive margins which is great news. Perineural invasion present with multiple foci. Would prefer different outcome on that last item, but I understand this is quite common and not a huge concern. Both nerves spared.

I have to say that the post-op has gone much better than I expected or feared. I was released next day and had a 3.5 hour trip home with zero issues.

Some soreness, but the only real pain has been when I cough. I have not taken anything stronger than Motrin and Tylenol and I stopped those on Weds morning. I am usually a big baby when it comes to pain.

I was really tired for a few days following. Still feeling a lot more fatigue than I would expect at this point. Albeit, any multi hours surgery under anesthesia is not insignificant.

My surgeon uses a suprapubic catheter which is far more comfortable than the traditional Foley shoved up the Captain! Insist on that my friends.

Since Georgetown is a distance, surgeon agreed that it can be removed by local uro once I can urinate. That big test came today when I capped the catheter. After 3 hours there was zero leakage and I felt enough in bladder to give it a try. The results were positive. Felt a little strange and a bit of blood but I was able to fully empty and again no leaks even after climbing up down stairs.

Cath should come out tomorrow. Once I am fully confident regarding continence I guess the next thing will be to see if my new friend, Mr. Softy, awakes from his slumber.

[Tall_Allen]

The other nice thing about a suprapubic catheter is that you can begin penile rehab even sooner.

[Hidden]

Great news! Best wishes for fast recovery and high quality of life. Pls keep us posted.

[EaNa]

Had mine done 8 mo ago. Things are going well and by the sounds of it you're doing well also. Wish I had known about the suprapubic catheter, that was no fun. Be patient with Mr. Softy, it's quite a traumatic experience!

[WilsonPickett]

These good outcome reports give me some consolation. My surgery Is coming up in September. I’ve asked about the suprapubic catheter, waiting to hear back… Thanks for the report, and continued positive recovery.

[oldbeek]

Sounds great ! Wish mine went that well. Heal well.

[PCInPA]

Catheter came out today. I would say that was slightly worse than taking out a Foley, but only took about 5 seconds and neither is pleasant to remove.

Slept through the night with no issues. Got up once to go and that was mostly my being cautious.

I am beyond pleasantly surprised with the lack of leakage. I wonder if dealing with BPH for a number of years had me subconsciously using other muscles? It almost seems too good to be true, I certainly hope it stays that way.

Yes, it does feel a bit odd when I pee, but nothing terrible and I imagine it is just post trauma from the surgery.

I am wearing what I am calling "birth control underwear" just in case. Still, there has been nothing more than a few drops over 24 hours. If things continue as they are, in a week I may be donating the remainder of the case to local good will.

I did ask primary uro about rehab for Mr. Softy. He is having me come back in 3 weeks and will begin whatever at that time.

[Justfor_]

Praise your good luck, you have tried the "Russian roulette" of blind catheter removal and exited safe and sound. I was not lucky like you, but had the surgery in Germany where they don't leave things to luck. As a routine, they DON'T remove the catheter unless cystographic confirmation of anastomosis tightness. I had 3 cystographies and wore the catheter for almost a month as the first two, 5 days and 15 days after surgery, showed a leaky anastomosis. It is not that rare as you may guess. My surgeon claimed a ~5% of incidence, 5 days after surgery, but it depends on the skill of the person.

"After RALRP, vesicourethral anastomotic urinary leak may occur, with reported incidence of 8.6–13.6% [5, 6], which is similar to the reported incidence of leak after open radical prostatectomy (3.9–23%) [7, 8]." ajronline.org/doi/pdf/10.22...

[redonthehead]

Sounds great Mike (IIRC)!

what's the plan for penile rehab?

[PCInPA in reply to redonthehead]

Don't really know yet. Primary uro said we will begin that in 3 weeks. I may ping surgeon to see if he advises anything sooner.