Long term incontinence after RP

An artificial urinary sphincter is used for more severe male urinary incontinence, defined as pad usage of three or more soaked pads per day.
It also depends (pardon the pun) on the pad weight.
A bladder diary is a big help in quantifying that
Weigh a dry pad, weigh a wet one & note the difference.

Thanks for the information.

This is a question that has been asked many times, and there is a way you can search for the previous answers, one of which was by me. But I don't mind answering it again. I was one of the "failures" going two years with incontinence. Right after surgery, I leaked a lot. Over the months doing kegels and healing, I gradually got better, but drastic improvement didn't occur until I went to a pelvic floor therapist about 8 months post-op. Later on, at my 18-month post-prostatectomy appointment, my surgeon/ urologist asked about my progress, and I told him I was down to one pad per day due to stress incontinence, not urge incontinence. And he proclaimed me cured. One pad per day, he said, is continent from a medical standpoint. I wrote the term "failure" up above because I wouldn't accept one pad per day as a final solution. So last winter I had a Boston Scientific urinary sling implanted and now I feel successful. An AUS can help those leaking more than I was. True there may still be a few drops coming out during a pickleball match or a round of golf, but nothing significant. Many on this site, or other sites like this, will tell you they dried up in a matter of weeks or months. They are the lucky ones; but everyone can improve either with the right exercises or the right surgical interventions.

I am very similar to you (RARP Jan 15 Catheter removed Jan 29)

There is considerable misinformation out there and there are many things that would benefit from further research.
most men get incontinence
the majority get better within a year or so an impressive chart from NIH which indicates that a majority start to turn a corner around 4 o5 months and move towards continence over the next 5-8 months

I have posted this on a different page before. I apologize if I am posting too much but I wanted to respond to your question just from my own personal experience.

I can't stand incontinence
However, I can see some progress lately that is encouraging me. I have both stress and urge incontinence

Lessons learned from me
1. Take the right dosage ( number and type of Kegels per set per day) from whoever you are working with
2. Work on form
3. Learning to relax PFM and resisting the urge to push too much makes sense
I hate incontinence.
There still needs to be more research and study on issues like this ( incontinence in men following prostrate surgery). It is acknowledged even in a recent NIH report, that there is no agreement on the number of Kegels to do each day. However, the good news is that research does support that Kegels help, efficacy is better for those that start prior to surgery, efficacy is better for those that get professional help ( trained PT ) and for those using biofeedback. Research does not seem to support electrical stimulation, emsella chair and other ‘short cuts’. This does not mean they do not work it just means there is a lack of evidence.

I copied the following from the National Library of Medicine. “. Inability to identify pelvic floor muscles or not exercising correctly may be the most common reason for poor outcomes with PFME. “

From https://pmc.ncbi.nlm.nih.gov/articles/PMC8743604/

You also might be interested in this article https://www.kapadiamd.com/posts/the-stages-of-incontinence-after-prostatectomy/ below is an excerpt from the article (cut and pasted)

First, patients may find they can get through the night and remain dry. They may leak once they wake up, unable to get to the bathroom quickly.
The second stage is staying dry through the night, needing to urinate in the morning, and calmly getting to the bathroom to void. They will still leak during the day.
The third stage is getting through the night dry, voiding it in the morning, and making it through the entire morning without leakage.
Then, patients in the fourth stage will typically be able to hold their urine throughout the day until midafternoon and then may have some minor leakage as they get tired.
Finally, some patients in the final stage of returning to continence will only leak when exerting themselves but otherwise stay dry throughout the day.

I hope you see some progress shortly.
I hate incontinence

You may be disappointed, but don't be completely surprised if your control never returns. I opted for an artificial urinary sphincter, which works well, solved my problem and was the best choice for me. I don't even think much about it anymore.

At four months you're getting to a history an area where you're almost completely healed from some of your operation. After four months in my situation, I was in decent shape. I had incontinence for about two- three weeks after the operation. I had plenty of rest after the operation as I had an infection in hospital so I had to stay in the hospital for an extra week- actually it forced me to rest , as im a "have to do something all the time " guy ! HA!! . I don't know if it's Canadian hospitals or what, but I was surprised the food was pretty good once I was off liquids. Majority of nurses were attentive and cute ! ( Cute nurses help me heal too ! HA!! ) I went into the operation in very good shape spot on 200lbs and 6'1" , strong abs and urine control , basically I was going to the gym every second day and hiking with the dogs 10 to 15 km every day. Had operation in end of April . I live outside of Canada 1/2 the year , so I came back early for operation and fitness program continuing . I am a pilot so keeping fit on the road is tough , unless I free book in 5 stars with great gyms and have enough rest Also I went to the sauna regularly- dont over look this element , it helps . . Through a combination of this and my general physical condition helped a great deal the doctor said. Try and keep his fits as possible. Only top quality foods . NO Booze or tobacco . From talking to the boys, everybody holds her urine differently. Some guys really depend on their Prostate for urine control others do not. So its this as well that determines yoru recovery too. Try and get in the best shape of your life, watch your diet, and maybe even get a couple dogs to force you to go for those 10 km walks. You and your dog will benefit from it. I am always here for support. It's not easy to relearn how to hold yoru urine , but it can be done ! Frustration is a key element to fend off Brother ! James on Vancouver Island.

I had RP in November with some spread into the bladder neck. It took 5 months before things got better and I still wear a pad for safety. I was given a 1-month sample of Gemtesa and switched to a generic (chloritine coltrate) when UHC would not cover Gemtesa. I also had physical therapy, although I would have done as well with a list of exercises. I'm at 6.5 months and doing much better.

I think your right- great analysis

Thanks for the advice

Thank you for the advice.