Incontinence following GreenLight laser procedure

 I've posted about my months of total incontinence following GreenLight laser surgery, and I'm now up to 7 months.  I finally bit the bullet and scheduled an appointment with a second urologist located in another city.  I selected him because he is associated with a university teaching hospital, and because he is listed as as an expert in dealing with incontinence and urinary reconstruction, and especially in surgery to emplace artificial urninary sphincters (AUS).   I had that appointment yesterday, and I am so glad I had it.

I went to the appointment prepared with a detailed chronolgy of my history and the two procedures, starting with the GL followed by a Gyrus Turp two months later, and then months of PT with zero improvement. First, he asked why I had a second procedure only two months after the first, and I said it was apparently to clean out the debris and resulting inflammation from the first.and to help me regain some bladder control.

While he didn't explicitly say so, it was clear that he thinks there was injury to the external sphincter with the GL procedure.  (My wife, a retired RN was with me and she got the same "between the lines" reading of his comments.)   He went on to say that he used to do GL procedures and had taught doctors that procedure, but he no longer will do it because it is difficult to control precisely.  In particular, he said that GL should only be considered for very large prostates where a lot of the prostatee is to be removed.

I didn't have a massive prostate, but had the median lobe kind of BPH, so I know now that GL was not a good option.  I did request it, I wish I hadn't and I wish the doctor had said,  "No, it's the wrong procedure for your BPH."  So that is now just history for me.d

I then asked him whether there was much chance of my regaining natural continence, and was told that given my lack of any improvement after 7 months, No, it was not going to happen.  He went on to explain in detail that men who have a radical prostatectomy may have a longer recovery time.   In that case, the urethra from the bladder mouth to the external sphincter is cut out, and the urethra is pulled and attached to the bladder.  It is absolutely crucial the external sphincter and nerves are not damaged in this process.  (The area of the extral sphincter is called the "no touch zone" by some experts in the field.

He then took the time to explain how the GL works.  He said that the 532 nm wavelength light must have red blood, or the heating and prostate ablation will not occur.  (I wonder if my BetaThalasemia trait with the smaller red blood cells created an issue?)   Being an engineer, I found this interesting.

I finally asked about how many of the AUS surgeries he does in a year, and learned that he does well over 100 each year, and in fact does one or more about every week.   (Even surgeons need vacation.)    Finally, I feel fortuante and blessed that he and the hospital are within 45 minutes driving time from our home.

His surgery scheduling person is going to call me, and he took a look at his calendar (on his cell phone) and said it should be before the end of the year.   He had some requirements, that a patient not be diabetic, not have had hernia surgery and not be a heavy drinker.  My infrequent social drinks were OK, especially when my wife pointed out that I'd only had one beer and one glass of wine in the last six months.

I'm going ahead and stopping my daily 81mg aspirin and fish oil capsules today, since those have to stop 10 days before a procedure.  That way, if a surgery date opens up becaue of a cancellation, I will be ready to raise my hand and say, "Do me!"    

1 like, 14 replies