www.incontinentsupport.org

Hi All,
My best friend's husband Don is scheduled for a robotic-assisted laparoscopic prostatectomy next week. The surgeon is very experienced and well-known for his nerve sparing skills and good outcomes. Thankfully, my friend's husband is able to get this surgeon and his expertise. He has been reassured that the likelihood of incontinence and impotence will be minor and if he experiences any incontinence, it will be temporary. That's all he said about it. He was told he may "leak" and may need to wear a pad. Don has questions about what the post-prostatectomy incontinence symptoms are like because "leaking" isn't very helpful. Does that mean he can't hold it and will have urge incontinence? Or will he have stress incontinence symptoms. I told him I will raise the question in this forum. Any and all thoughts will be helpful.

thanks so much,
Diane

My experience with leaking is just that: I leak, often with no sensation that it is happening, sometimes accompanied by bladder spasms. Over the years I have had two prostatectomies/sphincterotomies, which account for my situation. If his experience is similar, he may need to wear protection, hopefully temporarily. He may need to be reassured that this will be temporary, that it is common, and that he is no less manly because of it.

Your friend's husband asks a question that is ever present in our minds. I knew the surgery would go well but there are certain things that are out of the surgeon's control such as impotence and incontinence.
For me, I have a combination of urge incontinence and overflow incontinence that persist. My urge incontinence can be mild or severe such as losing a complete void. This often depends on how far I am from the toilet but sometimes that doesn't matter. I can go immediately to the toilet when the urge hits and sometimes I am fine. Other times, I do the same thing and I will have a complete accident on the way. The other type of incontinence that you don't mention is overflow incontinence. This happens when I feel some discomfort and my bladder spasms. The volume that is released depends on how much is in my bladder to begin with. If I already emptied my bladder, it isn't much. If I didn't, it can be a significant amount. Unfortunately, I don't have much control over this. For this reason, I wear premium adult diapers all the time. I go through several during the day and 1-2 at night.

hope this helps and keep us updated.
If your friend has any more questions, feel free to ask away

Be aware that there are three main possible issues after a prostatectomy beside the just basic healing of the surgery itself...
1) Incontinence (i.e. leaking urine)...
My experience (now 20 months post-prostatectomy) is very similar to what skitennislife said in the post just above. During the day if I know that I will have reasonable access time-wise to a toilet I can get by with a male guard pad inside of a pull-up. Around the house it will be an inexpensive pull-up and pad but if I'll be out and around I'll use a premium pull-up like a Molicare Mobile with a pad. In addition I will always carry at least one pad with me, sometimes two if I think I'll be out for a long time. I generally go through one or two pads and one pull-up a day. I have used a premium tape-up diaper from time to time but that is mostly for an unusual situation like a long car trip or maybe for a big sporting event or concert.

At night I sometimes have a so called "peeing dream" and actually pee in my sleep and therefore I need to wear a premium diaper with a thick cloth insert and PUL pants over that. I have a very small bladder and all of these measures work well for me but be aware that everyones situation is different and what works well for me may not work well at all for your husband's friend.

2) Impotence (i.e. no sperm)...
This is very common and to the best of my knowledge this will be the outcome if the prostate is fully removed.

3) Erectile dysfunction (i.e. can't get/maintain an erection)...
This condition will mostly depend on the success of the nerve sparing surgery. This is a very delicate part of the operation and can't be guaranteed, if the nerves can't be spared a significant level of E.D. will most likely be the result.

Don is recovering well after surgery. He was able to go home on the same day as his surgry. The surgeon said that the surgery was uncomplicated and smooth. He is sore but not in pain which is good. He has a catheter in place and it will be removed in two weeks. He was told to wear disposable underwear while the catheter is in place. Is that normal?

Yes it is totally normal. Very often there is some leakage around the indwelling catheter and the disposable underwear will help to catch that. From my experience some of that leakage can run down the outside of the catheter and out the leg hole of the disposable underwear. You might find that wrapping a small cloth around the catheter inside the disposable will keep that from happening. All of this will take a bit of experimenting to find what works best for him.

That makes sense.
Thats great advice about the cloth to catch any leakage that runs along the catheter itself.

If the balloon at the tip of the catheter that holds it in place irritates his bladder, he may need an analgesic, prescribed by his surgeon, and more absorbent protection.

Don is doing well. He is back to volunteering
His surgeon can't see him for several months. He only saw him for one postop visit. I guess that's what you get with a famous surgeon
The catheter has been out and he is going though a lot of pads
He doesn't know what to do.
He says he leaks whenever he cough, sneezes or strains himself. And sometimes the leak is pretty bad.
My friend is worried because she tells me that he has returned to some activities but won't do others like golf.
I've told him that there are other products to try but he hopes it will get better. I told him that he could use the pads in the disposable underwear but he is stubborn.
This is so frustrating for them.
Any ideas?

If he stubbornly refuses to wear protection, he may eventually be convinced otherwise by repeated public accidents, or, if he is lucky, he may regain control. But discovering adequate protection, and using it, will always be appropriate. Good luck to you and his spouse while he discovers what works.