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@heavyphil

A little background on me: I had robotic surgery done in 2019 by Dr David Samadi in NYC. I chose him because of his vast experience and his early adoption of the robotic platform. Turns out, he is a “celebrity surgeon” - unbeknownst to me at the time - and is frequently on TV discussing men’s health. All I knew by word of mouth was that he was one of the best in the world….and expensive!
He has developed his own robotic approach called SMART, in which he approaches the bladder neck and urethra very differently than most surgeons.
I can’t really describe it all in layman’s terms but his aim is to totally minimize incontinence. I had the same initial leakage, etc after catheter removal and two bouts of bedwetting (humiliating!) but after that, with minimal Kegel exercises on my part, I am totally continent and can start/stop my urinary flow midstream with no effort.
I never realized so many men suffered from this terrible affliction until coming to this forum. I can only conclude that the surgical technique itself is to blame for these urinary problems. Your “inability” to move your pelvic floor muscles is a total smokescreen. Your surgeon probably tells this to all of his patients since it is his technique which is at fault.
NOT saying he did something wrong! He’s just doing it the way most others are - that’s the real definition of “standard of care”. Just do whatever everyone else is doing - even if there is a better way- and you will never have a problem. Digress or buck the trend and you will be punished.
Dr Samadi has made many enemies for his success and maverick ways and has been pilloried in the press for everything from negligence to insurance fraud. He actually addressed these issues with my wife and I during our initial consultation. I told him I was there for only one reason and could care less about finger pointing by others. He told me that he had never experienced such professional jealously before and couldn’t quite understand it.
Sorry to digress…it seems to me that your best option at this point is an artificial sphincter since your own natural one was damaged beyond rehabilitation. Your surgeon and PTs are useless and part of the problem - IT’s NOT YOU! I recommend you find the absolute best surgeon for your reconstructive procedure and pay privately if you have to. It’s your job to educate yourself about your condition and interview your top 3 picks. If you ask any one of them a question and they blow you off or poo poo your concerns get up and leave. You want someone experienced, recommended by others (word of mouth or trusted online reviews) and empathetic most of all. Best to you, Peter…
Phil

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Replies to "A little background on me: I had robotic surgery done in 2019 by Dr David Samadi..."

Thankyou Phil. I really appreciate that.

Apparently my new guy is "a reconstructive urologist, with expertise in management of urethral stricture disease as well as penile deformities and incontinence."

Urethral stricture disease and urethroplasty
Revision hypospadias surgery
Inflammatory disease (BXO) of the urethra and penis
Lower urinary tract reconstruction
Kidney and ureteric stones - Endoscopic removal and shock wave lithotripsy
Kidney bladder and prostate cancer
Vasectomy and vasectomy reversal
Prostate biopsy
Scrotal surgery

So he must know his way around that bit.

From what I've read, the standard approach it to remove the internal urethral sphincter along with the prostate. I've never understood why.

A couple of years ago, I attended a seminar about urinary incontinence and treatments for it. It was a prostate cancer, patient conference but the doctor Jeffrey Brady, MD, FACS, Spent an hour discussing all different treatments for urinary incontinence. He specializes in treating incontinence and is in Orlando Florida.

You can find him quickly on the web. I still have all the slides from the seminar, Including slides of treatment options he discussed? He does a lot of procedures. Something you want in a doctor. He says the AUS has a 92% satisfaction rate.

Treatments options