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Sling (or other treatment/prodedure) for climaturia following RP

Posted by retireddoc @retireddoc, Feb 2 7:08am

I had a RP just over 3 years ago for G9 and subsequently had triple therapy plus whole pelvic radiation for oligo metastatic disease. My PSA had remained undetectable for > 2 years following completion of triple therapy. My MO discontinued my Lupron July 2023. Fortunately, my PSA has remained undetectable.

Although controversial, my JH MO started me on TRT (with help of an endocrinologist) around 3 months ago as my T never came above castration level 18 months after stopping ADT. My libido has returned. Amazingly, I have experienced spontaneous erections ago for the first time since surgery. However, I still have stress incontinence and when I orgasm I ejaculate urine (medical term is climaturia). I have tried emptying my bladder before sex, wearing a ring etc. Nothing seems to fully work.

For anyone that has had the same problem, did you find a solution? I have read about the sling procedure for incontinence. Has anyone had this procedure and did it help? What surgeon did you use? Any other suggestions?

Thanks to everyone and good luck in your journey.

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heavyphil | @heavyphil | Feb 3 9:00am

Hey Doc, congratulations on your positive developments! No small feat making a comeback from all you’ve been through.
You seem like you are on a roll right now; I have not had this procedure but know a few women for whom it did not work. The anatomy is different but I think the procedure is the same.
My question is: how different is urine from semen? I mean, we all love it when we make a mess with the latter - the former, not so much!
Don’t mean to be flip, but why take a chance that an elective surgery might do more harm than good when you are almost fully continent now- except for climaturia?
Would a condom help?

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1 reply
retireddoc | @retireddoc | Feb 3 6:47pm
In reply to @heavyphil "Hey Doc, congratulations on your positive developments! No small feat making a comeback from all you’ve..." + (show)
@heavyphil

Hey Doc, congratulations on your positive developments! No small feat making a comeback from all you’ve been through.
You seem like you are on a roll right now; I have not had this procedure but know a few women for whom it did not work. The anatomy is different but I think the procedure is the same.
My question is: how different is urine from semen? I mean, we all love it when we make a mess with the latter - the former, not so much!
Don’t mean to be flip, but why take a chance that an elective surgery might do more harm than good when you are almost fully continent now- except for climaturia?
Would a condom help?

Jump to this post

The prostate cancer and the treatments/SEs really screwed up what was a great sex life. I've gone through the phases and I'm pretty much at acceptance.

I have some residual stress incontinence and wear a light pad all of the time. I was almost completely continent about a year after my RP but started leaking again after 37 pelvic radiation treatments for recurrent disease. It's manageable.

I very much doubt I would ever have any invasive procedure for incontinence/climacturia. In the big scheme, it's not that big a deal. Not interested in the risks and I've had my fill of surgery and procedures to last a lifetime (whatever is left!).

REPLY
1 reply
heavyphil | @heavyphil | Feb 4 6:04am
In reply to @retireddoc "The prostate cancer and the treatments/SEs really screwed up what was a great sex life. I've..." + (show)
@retireddoc

The prostate cancer and the treatments/SEs really screwed up what was a great sex life. I've gone through the phases and I'm pretty much at acceptance.

I have some residual stress incontinence and wear a light pad all of the time. I was almost completely continent about a year after my RP but started leaking again after 37 pelvic radiation treatments for recurrent disease. It's manageable.

I very much doubt I would ever have any invasive procedure for incontinence/climacturia. In the big scheme, it's not that big a deal. Not interested in the risks and I've had my fill of surgery and procedures to last a lifetime (whatever is left!).

Jump to this post

Boy, we’re both charter members of the formerly robust sex life club…it really does suck!
I looked into all kinds of procedures for pumps, internal prostheses, etc. and when I thought about all this hydraulic hardware that they proposed putting in these already surgically ravaged areas I put that thought quickly out of my mind. I, like you, want no more surgery if I can avoid it.
Just finished my 25 salvage tx plus 6 mos ADT so waiting for all that to wear off. If the out of the blue sexual fantasies ever return to my neutered being I might give Trimix a shot (har har), but if not I will continue, like you, on the road of acceptance and just be glad I am still alive. Peace, Doc…,
Phil

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retireddoc | @retireddoc | Feb 4 7:21am

Just a couple of other points......

I have used Trimix numerous times and it worked very effectively. The idea of sticking a needle in my dick was a little daunting, but not as bad as I thought it was going to be. Downside-it takes several hours for it to wear off so after sex it's a little uncomfortable for a while.

Prior to my RP in 10/21 I used Viagra almost every time before sex for years. I don't know if I absolutely needed it but, better living through chemistry! After my RP my little friend was dead-as a doornail. No erections. My MO told me that the RT to my pelvis would further damage my ability to have an erection. As I mentioned earlier, I began TRT around 2-3 months ago. (I take maintenance generic Cialis 5mg per day since my RP 3 years ago). Around a month after starting the TRT I started having nighttime/morning erections just like the good old days! Didn't think that was going to happen again! Because of issues I am having with my wife currently, I don't know if those morning erections will translate into sex, but I will find out sooner or later. I have read that T is necessary (or very helpful) for the equipment to work. I understand that some men have ED for some months after RP but with time regain function. I began ADT/Lupron one year after my RP so that was a double whammy.

Good luck to you and maybe with time things will start working again.

REPLY
1 reply
heavyphil | @heavyphil | Feb 5 7:20am
In reply to @retireddoc "Just a couple of other points...... I have used Trimix numerous times and it worked very..." + (show)
@retireddoc

Just a couple of other points......

I have used Trimix numerous times and it worked very effectively. The idea of sticking a needle in my dick was a little daunting, but not as bad as I thought it was going to be. Downside-it takes several hours for it to wear off so after sex it's a little uncomfortable for a while.

Prior to my RP in 10/21 I used Viagra almost every time before sex for years. I don't know if I absolutely needed it but, better living through chemistry! After my RP my little friend was dead-as a doornail. No erections. My MO told me that the RT to my pelvis would further damage my ability to have an erection. As I mentioned earlier, I began TRT around 2-3 months ago. (I take maintenance generic Cialis 5mg per day since my RP 3 years ago). Around a month after starting the TRT I started having nighttime/morning erections just like the good old days! Didn't think that was going to happen again! Because of issues I am having with my wife currently, I don't know if those morning erections will translate into sex, but I will find out sooner or later. I have read that T is necessary (or very helpful) for the equipment to work. I understand that some men have ED for some months after RP but with time regain function. I began ADT/Lupron one year after my RP so that was a double whammy.

Good luck to you and maybe with time things will start working again.

Jump to this post

Thanks for the encouraging words, Doc. My surgeon wrote me an RX for Cialis but his team never told me why - or how important it was - for maintaining blood supply to the penis. I assumed it was for sex and after surgery that was the furthest thing from my
mind.
It was about a year post-op that I discovered how important this was; so I think there’s some irreversible damage down there; the few erections I did manage with 100 mgs Viagra gave me one of those dachshund dogs they make out of an inflated balloon and twist in the middle - swollen at one end and pinched at the other. The base was completely shriveled and the rest of it engorged.
Had to whip out the old anatomy book to see Afferent and Efferent blood vessels but still couldn’t figure out how the distant part of the organ got blood, but the base it had to pass thru did not. Maybe Trimix will help that.
Sorry for your conjugal issues, but as an elderly friend who was taking T and HGH once told me: “Wow! I get huge wood in the mornings now!”
“Is your wife happy?” I asked. He gave me a disapproving look and said “Who cares if she’s happy…I’M HAPPY!!”
Enough said😂

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