Here we go-90 days post RALP

Jerry--

First off, could you give some more details about your pathology report? Nerves spared? Any PNI or EPE? Still T2b?

Continence/urination: Sounds like you're in a normal range of recovery at 12 weeks. Some guys better, some guys worse. Your day/night pattern is familiar. I consider myself dry (it's 4 1/2 months since my RP), but tend to leak a bit in the late afternoon, I figure just sphincter fatigue after a long day. If you describe things to your uro the same way you did here, you've got a good starting point for a discussion with him/her. It's possible there's some scar tissue restricting your urine flow, definitely bring it up with your uro, but my guess is you're ok and the stream will strengthen in time. I assume you're doing kegels and exercising.

ED: At 12 weeks, you're ahead of where I was if you're a 5 out of 10. And you've been getting some response without taking meds yet -- that's pretty good. Recovery of erectile function seems to be all over the board for RP patients, and not entirely dependent on how much of the nerves were spared. Orgasm doesn't depend on the nerves required for an erection, so it's not surprising you're doing ok in that department.

My stream was like a fire hose when the cath came out and stayed strong for a year or two. Now it's slowed down and takes a little while to start. I assume this is due to scar tissue but it's just as good as it was pre-surgery.

If you're not filling the bladder, that could be why your stream sometimes isn't very strong.
Using 2-3 pads a day suggests quite a bit of leakage, but on the other hand you're drinking coffee in the morning and doing fine till afternoon, that sounds like pretty good sphincter control. Maybe you're more finicky than I was about changing pads -- I could care less if a pad was wet as long as it wasn't showing or smelling. Some guys weigh their pads to get an objective measure of how much urine they're leaking during the day. Not a bad idea if you're concerned about your progress, then you can review the data with your urologist.

dry from day one. when a leak does occur....it's normally when I'm tired....or I've moved my body a way it's not used to moving.


My bladder wasn't filling up either. My PCP suggested holding off on going to the bathroom even though I needed to go. His theory was...that would stretch the bladder. Sounded good at the time. Seems to have worked.

My stream is slow to begin and slow as well. But the cure is worse than the problem. And can cause other problems as well. Worse things in life than slow stream.

Take care.

Dr. Catalona's article is a good read on the subject:

"When the catheter is removed, the bladder is a shrunken version of itself.

"Over weeks and months, the bladder expands again and, most often, returns to normal size and normal function," Dr. Catalona said.

Also, when the bladder is exposed during the surgery, it takes some physical blows and it swells, just as other parts of your body swell when they take a hit.

"Frequent urination is normal after a radical prostatectomy," Dr. Catalona said. "The main cause is that the bladder wall is swollen and thickened and irritable. Normally, the bladder wall is thin and very elastic and maintains a low pressure until it has stored 8 to 10 ounces of urine. After surgery, the swollen bladder does not store much urine at a low pressure. As soon as it starts to fill, the pressure goes up and the patient feels the need to urinate. In the great majority of cases, this gradually improves with time, but it can take more than a year in some cases."

Other consequences occur too.

"You create surgical planes or in lay terms, cuts, and as those cuts heal, it's possible they create scars," Dr. Catalona said.

Later in the healing process, those scars can cause difficulties for the bladder because they make it difficult for the bladder to expand as it should. The scars increase the time it takes for the bladder to expand and therefore increase the time to return to continence."

http://www.drcatalona.com/quest/quest_spring03_2.htm

69yr,1948 Troy MO-W of St. Louis
PSA 3.2 7/08
PSA 51.2(7/11/17)
DRE hd lft, 31g 7/24
Biopsy8/11 No PNI GS 4-8s, 4-7s/12
NUC Scan/CT Urogm8/29-CLEAR
Prolaris 9/11 T2b, 3.8/10, 10yr Mort Risk 23.5%, Met Risk 29.6%.
Consult 9/11 Rec RT/Brh/RALP
MRI 3T Ca in gland?
RALP11/15
PATH11/16
T3b,GS 9
70G Pc 40%
PLN+Rt-1/1,Lt-2/6
+Margins-apex,ureth,blad nk,SV
Lupron/Cas11/21
Axumin1/2/18,RT?

Post Edited (john4803) : 12/22/2017 12:41:17 PM (GMT-7)