2 months after radical prostecotomy, incontinence issue now, what should i expect, im 52 yo

I was very fortunate.  I had open surgery and had only  two instances of leaking in the to two days after catheter was removed .... and then fully continent.  It has been 17 months since surgery and no problems.

I know some men are lucky like me and for others it is a big problem.  I have no idea why.....

Now ED is another issue.  I am still struggling in that department!

Good luck.  

robotic

Mosski's reply only underscores the unpredictability of this thing! The prostate is adjacent (attached) to the Internal Urethral Sphincter (one of three ways, an important one, of controlling urinary flow). Because this sphincter is composed of smooth muscle it is not under voluntary control (it is controlled through the autonomic nervous system).

Two issues  - the fist is that when the prostate is removed this sphincter is damaged. The extent of the damage playes an important role in the speed of recovery. The kegel exercises we are told to do have no impact on this sphincter as it is not a voluntary muscle - they build up the external urethral sphincter (a voluntary muscle that plays a more important role in female urinary control than in male urinary control). Hence if you have complete failure of the Internal Urethral Sphincter, even though you work hard at the kegel exercises, it can take a long time to regain continence (and some people who have serious damage never regain continence).

The third way urinary flow is controlled is the urethral wall itself which is muscular - again smooth muscle so not under voluntary control.

I hope this explanation is helpful.

Thanks romneyj.  Very well explained.  

I give thanks everyday that I was most fortunate to be 100% continent and leak free from the moment the catheter was removed 7-days after my RALPR (performed on 03/31/17). I think that this most welcome and appreciated outcome had a lot to do with two things: the condition of my urinary function going in, and likely for the most part the skill and experience of my most excellent surgeon and his team. 

I did rigourous kegel sets every day standing, sitting, and while fast pace walking starting about 4-weeks before surgery (12 sets of 12-one-thousand count squeezers).  However, based on your description (that from what I've read is spot on), it is clear to me that while the strengthening of my lower pelvic floor has likely given me a helpful security blanket, it is most likely the expert preservation of the internal urethral sphincter, urethral wall, and associated smooth muscle on the part of my gifted surgeon that is by far the major reason for the terrifically better than expected result that I've been blessed with.

Thanks n-mac. I too was lucky (though it too 5 weeks till complete continence for me). It's clear that the surgeon has more control using RALPR but it's clear also that there are big variations from surgeon to surgeon. I agree with your conclusion that your surgeon is clearly highly  skilled! To be continent from day 1 after catherter removal is astonishing.

It is not simply the robotic surgery that increases your chances of continence. I had open surgery and no incontinence.

A less skilled surgeon with the Da Vinci is still a less skilled surgeon!

Of course that's true - the skill or care of the surgeon is key, but if you talk to surgeons that are skilled in both technoques they will tell you that their figures show lower levels of postoperative incontinence with robotic surgery.

Absolutely agree.  Da Vinci or not, it is the skill and expertise of the surgeon that counts.  Everything I've read makes it clear that no robot out there can improve the skill of the surgeon.  Whereas, the outcome and results achieved with the robot are 100% dependant on the inherent skill of the surgeon.

In support of romneyj's point, I was advised at the institution that treated me that with rare exception for specific medical reasons, almost all prostatectomys preformed there are perfomed with the Da Vinci robotic system, and it is rare that an open prostatectomy is performed.  From what I could tell the overal team of leading urology surgeons there seem to believe strongly that the Da Vinci surgery together with the set of related techiques they've devoloped and pefected provides better outcomes, benefits, and advantages over open surgery.