Prostate Cancer And Gay Men
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post-prostatectomy incontinence and ED

I had a radical prostatectomy in April 2016 performed by Dr. Jean Joseph at Univ. Of Rochester, Strong Memorial Hospital. I was very fortunate that this very skilled and expert surgeon was able to spare my nerves so I am not impotent but still have some degree of ED. I have a pump which I rarely use. I was on Cialis but it was too expensive. I now take Sildenafil (viagra) 10 mg a day. This is helping. An additional 50 mg as needed (for sexual activity) enables me to have erections (sometimes) sufficient for penetration.

The other side-effect, incontinence, has proven to be more problematic. Twenty months after surgery I am still in Depends undergarments. There was definitely improvement for a long time and there may still be but if so it is too slow to be noticeable. I do kegels daily and am in very good shape at age 67. I work out regularly and am not obese. I do not have diabetes or high blood pressure. I had some physical therapy in Binghamton, NY but did not follow through with it because I was moving. I am now in Montreal and I need to find a General practitioner and a urologist here. I am wondering if more improvement is possible and if I should try physical therapy again or consider surgery (male sling). Your advice and the benefit of your experience would be greatly appreciated.

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If I were in your situation, I would give the P.T. another shot. That said, about a year and a half ago I had reached seven very wet pads on a regular day and more on an active day. I had surgery last February to install an artificial urinary sphincter. The sling did not seem like a good option for me. My only regret is that I waited that long. Good luck with your decision.

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Same situation Yost. Had my artificial urinary sphincter implanted Sept. 2013. Very big difference.

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Thanks for your good advice. I am going to look for a good urologist and hope that he will refer me to a PT who specializes in this problem.

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Hello jmhomanich

The success rate of male sling is inferior to artificial urinary sphincter. So if you choose a surgical option I advice you a sphincter.

In the meantime, some general advice

1-Try to cut down on coffee, tea, sodas, beer

2-Try to empty your bladder regularly like every 2 hours even if you don,t feel you need to do so.

3-If the problem is mainly urge not stress leakage , i mean if you feel you wanna pee and you cannot hold it try Ditropan 10 mg XL once daily/or Myrbetriq 50 mg and see if these will help. These are prescription drugs so you will need a doctor to prescribe either for you and with some precautions.

Mohamed

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It still may be possible to recover some continence. At Memorial Sloan Kettering (MSK), among patients who did not recover continence in the first year, 30% became pad-free after another year, 43% after two more years, and 49% after 3 more years. At MSK, "physical rehabilitative therapy for incontinence or ED is typically initiated after 12 mo for continued impairment." Their rehab programs are second to none.

ncbi.nlm.nih.gov/pmc/articl...

One effective rehab procedure is the combination of pelvic floor electrical stimulation and biofeedback to retrain you in how to control continence:

siu.it/app/webroot/img/cont...

Slings are good for light incontinence; artificial urinary sphincter for moderate to heavy incontinence:

ncbi.nlm.nih.gov/pmc/articl...

Jewish General Hospital in Montreal has an excellent reputation. You might try sending a message to StephanB on this site who is being treated for advanced prostate cancer. He might be able to recommend a good urologist.

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I am interested in any more information you could provide on the MSK post surgical program. Thank you.

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I don't have details of their urinary continence program. On their penile rehab program, John Mulhall wrote a book:

amazon.com/Saving-Your-Guid...

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Thanks. I have heard very good reports about John Mulhall.

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Thank you for your advice.

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Thank you for your fyi as is very helpful to me.

Sorry but I haven't any info re incontinence.

All the best.

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i live in Chicago, but at one point, prior to leaving for Montreal my urologist was Dr. Kevin Zorn. i truly regretted his departure. he is on Facebook, but his info is: Centre Médical Brunswick / Brunswick Medical Center. if anyone can help you, he can - i pass on his name with very high recommendations! if you contact him, please give him my best [St. John].

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I was in a similar situation--medium to sometimes severe incontinence; I did Kegels, etc., had some PT, finally opted for the sling surgery. My surgeon said it would not take care of all of the incontinence, but would help a lot, and it did. If I keep my coffee intake down to a couple cups early in the day, things are pretty good, and while I do wear a pad for occasional drips, some days it's completely dry (some days it isn't). I've found a few other things increase the incontinence (e.g. raspberries! and of course alcohol) but I seem to tolerate spicy foods well. I now some people on the site have had not the best results from sling surgery, but I would do the same thing again based on my results. But when you get professional advice if the consensus is that you can still improve significantly without surgery, great. One word of warning--the sling surgery did cause (at least in my case) a temporary setback as far as ED, but nothing like what the RP caused, and I did regain a second time everything I had already regained the first time, and then some.

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Thanks for your good advice. I am going to look for a good urologist and hope that he will refer me to a PT who specializes in this problem. I do drink coffee and white wine, no soda or beer; so there may be room for improvement there. I go through 2-4 pads a day but they are not always soaked through.

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