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RALP after TURP

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User
Posted 16 Nov 2021 at 18:38

Hi,

I had my RALP 11 days ago (following a TURP four years back) and catheter removed today. I have been doing pelvic floor exercises for some months before the operation but nonetheless expected some leakage once catheter had gone. What I found today is that I have absolutely no control over urination. First I know of it is when the pad gets warm. If I squeeze my pelvic floor to try and stop the constant dribble, it merely makes me squirt.

I have been told different things by different people. Can anyone tell me if this Day 1 experience today is normal?

 

Thanks

Edited by member 22 Jan 2022 at 12:48  | Reason: Change title

User
Posted 17 Nov 2021 at 11:54

I found there were three stages to contracting the pelvic floor muscles. The first stage slightly lifts the penis, when we had erections it was easier to spot. The second stage is how I would stop a fart. The third stage is how I would stop a poo.

I was told it was the second stage that need to be practiced.

https://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/pelvic-floor-muscle-exercises

The above link is from this site.  

Thanks Chris

User
Posted 17 Nov 2021 at 13:02

Hi Chris,
Stopping a fart? There's a novel idea. Wouldn't let me out of hospital after the RALP until a good deal of wind had passed. But I can see you have a point. It seems the bio...... test measures pressure on a tube inserted in the anus. Makes sense. Also, I can see that it is recommended to tense the muscles after urinating to clear the urethra. That may explain a problem I posted earlier about tensing producing a squirt when, no doubt, I had urine in the urethra but had not actually urinated. (Unless, that is, I was squeezing my bladder as Francij1 as suggested I may have been). Having read the instructions, I am sure I am doing the exercises properly - but practise makes perfect, no doubt.

Thanks Chris - and all for your posts

User
Posted 11 Dec 2021 at 13:17

Final histology should give the definitive picture and allow the consultant to predict longer term outcome based on the data. Ongoing PSA’s for the first two years underwrite this to an extent. Other than that I had a few leaks and drips here and there but these improved over time as the surgical site scaring softens over the year post op. Potency can take longer but very individual. 

id say make a list of any points you want to cover as easy to forget them in the heat of the moment. 

User
Posted 18 Dec 2021 at 17:05

Great news, Peter πŸΎπŸ»πŸŽ„

User
Posted 22 Jan 2022 at 13:00

I've changed the title of this thread since I am no longer immediately after RALP. I am aware of complications that may be caused by the internal scarring from a previous TURP (2017) and also that such statistics that  I can find indicate a slightly poorer (or later?) continence outcome may be expected for some men. I am now 11 weeks post op, virtually dry overnight, can collect urine in my bladder and hold it when sitting, not very good when standing or moving around. Using 4 Tena level 3 protectors during the day. I was hoping to be better at this stage. I should be interested to learn about the experience of any other members who have had RALP following TURP. 

Peter

 

User
Posted 22 Jan 2022 at 13:55
If you are virtually dry at night and when stationary there is no mechanical damage (which is the slightly raised risk with previous TURP); your brain and pelvic floor just need a bit more time to learn how to communicate with each other again. Try not to be impatient.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 16 Nov 2021 at 21:12

Peter, it was a long time ago but i don't think I had much control on the first day of catheter removal. I did months of PFEs before surgery. By day four post catheter I was 99 percent dry. 

In the first few days I do remember getting up slowly and squeezing those muscles but still leaking. The fact that your flow alters when squeezing the pelvic muscles means something is happening. 

Thanks Chris

User
Posted 16 Nov 2021 at 21:38

Chris, 

Thanks for your prompt response. I needed that and it is really encouraging. It's all a bit distressing and a bit of a shock at the moment. 

99% day 4, you must have been mightily pleased with that.

Once more. Thanks.

Peter

User
Posted 16 Nov 2021 at 22:24

I can't speak from experience, but that is a very common experience post op. It is way to early to expect control. Perhaps 10% of men have any reasonable control in the first week. You have plenty of time to re-educate those muscles and reroute some of the signals down different nerves.

Dave

User
Posted 16 Nov 2021 at 23:17
Sadly I was in hospital 14 nights so my catheter was withdrawn still in hospital. They dragged me out in the sun in hospital pyjamas and I never dripped a drop ! I did have stress incontinence for around 3 months but found removing the pad removed the leaks if you get it. Crutches are never good unless totally needed ! So I was totally dry until I planned sex again which resumed random squirting everywhere. Another challenge.
User
Posted 17 Nov 2021 at 07:12
Sounds like you are working the wrong muscles if it's making the flow stronger? The sensation for me is the same as stopping a poo and is distinctly different from squeezing my bladder to speed flow.

I was urine incontinent for several weeks after catheter removal. Getting an appointment withe incontinence nurse fixed me, she didn't actually help but the appt took so long to come through I had fixed myself!

User
Posted 17 Nov 2021 at 09:36

I didn't have a lot of control on day 1 and in the early days as soon as I got tired I lost control.

I'd give it a few weeks before getting concerned

User
Posted 17 Nov 2021 at 10:30

Am I working the wrong muscles? Instructions I received were:-

a. to squeeze anus as if stopping a poo and then..........

b. immediately draw penis in as is trying to stop urinating.

Are you saying that 'b' isn't necessary, or even counterproductive? 

 

 

User
Posted 17 Nov 2021 at 11:38
No I am saying you may be squeezing you bladder
User
Posted 17 Nov 2021 at 11:51

OK Francij1. Subtle difference. Thanks for the tip. I will concentrate next time to ensure I am not doing that. Thanks.

User
Posted 17 Nov 2021 at 11:54

I found there were three stages to contracting the pelvic floor muscles. The first stage slightly lifts the penis, when we had erections it was easier to spot. The second stage is how I would stop a fart. The third stage is how I would stop a poo.

I was told it was the second stage that need to be practiced.

https://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/pelvic-floor-muscle-exercises

The above link is from this site.  

Thanks Chris

User
Posted 17 Nov 2021 at 13:02

Hi Chris,
Stopping a fart? There's a novel idea. Wouldn't let me out of hospital after the RALP until a good deal of wind had passed. But I can see you have a point. It seems the bio...... test measures pressure on a tube inserted in the anus. Makes sense. Also, I can see that it is recommended to tense the muscles after urinating to clear the urethra. That may explain a problem I posted earlier about tensing producing a squirt when, no doubt, I had urine in the urethra but had not actually urinated. (Unless, that is, I was squeezing my bladder as Francij1 as suggested I may have been). Having read the instructions, I am sure I am doing the exercises properly - but practise makes perfect, no doubt.

Thanks Chris - and all for your posts

User
Posted 18 Nov 2021 at 11:23

I’d recommend a couple of sessions with a physiotherapist as they can get the technique nailed down fairly quickly.

User
Posted 18 Nov 2021 at 12:29

Years ago I used to do 1 to 1 Pilates Classes before it got popular. Very few men did them. My teacher explained to me that PFE were simple for women as it was natural for them when they stopped peeing. I was told to that in order to engage my pelvic floor muscles as a man I should imagine sucking up a column of water through my bottom. Always worked for me......................

User
Posted 18 Nov 2021 at 17:17

Just watched a video on UCLH website. Explained clearly to me that the long 'hold fart' PF exercise is separate to the short 'stop peeing' PF exercise. Not one immediately after the other in the same count as I had previously understood. They recommend 3 sets of 10 for each exercise 5 times daily. Won't leave much time for anything else!

I will see a physio if necessary but far too early yet. Have an appointment to see the surgeon in four weeks so I will persevere and  try and be patient until then and hopefully improve in the meantime. Only Day 2 after catheter removal at the moment.

Just received the surgeon's letter to my GP. Confirmed I had a clear margin and that both sets of nerves were saved. I'm a lucky guy.  Also that I had an anterior bladder neck reconstruction. Is that a normal procedure during RALP? I understand it helps continence.

As an aside; I don't suppose direct commercial mentions are permitted in this forum, but I have found some cheaper pads and pants I have tried to be more comfortable, easier to remove and just as absorbant and retaining as a notable brand always being advertised on TV.

User
Posted 18 Nov 2021 at 18:08

Peter 

Good news on the margins and nerves.

Members often suggest and name  pad brands and super markets with pads on offer etc.

Thanks Chris

 

User
Posted 18 Nov 2021 at 19:02
I had huge problems getting my catheter removed. It appeared to have adhered to my urethra. The pain when the nurse tried to remove it was unbelievable ( or maybe I was just being a baby!) She called a doc to help. Doc tried and scraped me off the ceiling. Then suddenly the bloody thing popped out of its own accord and I p****d on the floor in front of the nurse and the doctor. Which was a bit embarrassing but I didn't care as at least the thing was out!!
User
Posted 18 Nov 2021 at 19:30

Music man 

This could have been the reason for the issue with your catheter. I have seen it done but corrected on RARP videos.

" On occasion, catheter removal is not possible due to fixation by one of the anastomotic sutures."

Thanks Chris

User
Posted 11 Dec 2021 at 12:33

Off to see my surgeon for te 6 week post op. review next Saturday. I suppose that  we will be discussing my pathology results (assuming the intra op. Neurosafe analysis was not the final analysis) , how I am doing and plan ongoing etc.
Can anyone put forward any killer questions that may not be obvious to me, or that they may have wished they had asked on a post op. review?

Thanks, Peter

User
Posted 11 Dec 2021 at 13:17

Final histology should give the definitive picture and allow the consultant to predict longer term outcome based on the data. Ongoing PSA’s for the first two years underwrite this to an extent. Other than that I had a few leaks and drips here and there but these improved over time as the surgical site scaring softens over the year post op. Potency can take longer but very individual. 

id say make a list of any points you want to cover as easy to forget them in the heat of the moment. 

 
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