Still Leaking after Robotic Surgery: Thoughts on water intake

Depending on age, extent of surgery, skill of surgeon etc, it is normal to leak a month after surgery. Some men leak for a year or so before becoming completely continent. Some men never become totally continent.

Becoming continent is dependent on multiple factors. Strengthening the pelvic floor muscles is important but not the only factor (we have lost 2 of the 3 sphincters used to hold in the urine; now we have one just like women). Diet, hydration, and training the body to not depend (no pun intended!) on pads are all important. It is counterintuitive that drinking a lot of water will help with gaining continence, but there are 2 reasons this is true. If you start limiting your fluid intake your bladder capacity will shrink as the bladder wall is just a muscle. With diminished bladder capacity you will feel full with only a small amount of urine in your bladder which causes leakage. Also, more water dilutes the urine. Concentrated (yellow) urine is irritating to the bladder and promotes leakage.

I learned all of this and much more from an excellent book recommended by my urologist after my prostatectomy. "Life after Prostate Cancer" Ten weeks to continence by Vanita Gaglani available on Amazon. She is a pelvic floor PT who has treated thousands of men with urinary incontinence. Highly recommended.

Depending on age, extent of surgery, skill of surgeon etc, it is normal to leak a month after surgery. Some men leak for a year or so before becoming completely continent. Some men never become totally continent.

Becoming continent is dependent on multiple factors. Strengthening the pelvic floor muscles is important but not the only factor (we have lost 2 of the 3 sphincters used to hold in the urine; now we have one just like women). Diet, hydration, and training the body to not depend (no pun intended!) on pads are all important. It is counterintuitive that drinking a lot of water will help with gaining continence, but there are 2 reasons this is true. If you start limiting your fluid intake your bladder capacity will shrink as the bladder wall is just a muscle. With diminished bladder capacity you will feel full with only a small amount of urine in your bladder which causes leakage. Also, more water dilutes the urine. Concentrated (yellow) urine is irritating to the bladder and promotes leakage.

I learned all of this and much more from an excellent book recommended by my urologist after my prostatectomy. "Life after Prostate Cancer" Ten weeks to continence by Vanita Gaglani available on Amazon. She is a pelvic floor PT who has treated thousands of men with urinary incontinence. Highly recommended.

Ask your urologist immediately for 8 session of Pelvic Floor Physical Therapy (PFPT). There is actually a subspecialty of physical therapy called PFPT. It is a normal and frequently used therapy for postpartum women who have been stretched out and are in recovery, but it is also for post-prostatectomy men and elderly men who have started incontinence.
On my own first day of PFPT, my therapist said that I was approved for just two session through my Medicare Advantage Plan HMO, but she said not to worry...all it takes is for her as the therapist to write a simple justification for a total of 8 sessions. My Medicare HMO approved it.
The PFPT exercises go well beyond standard Kegel exercises, to include learning how to breathe and use your diaphragm. My PFPT explained that your entire abdomen below your diaphragm to your anus is one giant compartment that works in unison based on pressure and airflow controlled by your diaphragm. You will learn specific exercises and feelings to know that you are using your diaphragm while properly breathing during your exercises. It was actually frustrating for me: I am a natural athlete and never had a problem mastering anything of a physical nature, but my therapist was frustrated. In the earliest of sessions she'd gently say "no...breathe this way, and don't hold your breath." By the end of my eighth session she was exasperated and nearly screaming at me: "NO, NO, you're STILL doing it backwards/wrong...I thought you said you're an athlete!" Let me tell you, learning to breathe the opposite of what nature wants, or to breathe at all was a challenge. Her other admonishment was "YOU'RE HOLDING YOUR BREATH...B R E A T H E!!!" I say this in lighthearted, retrospective jest. You'll likely have no issues with it, but the main thing to know, is that there is a whole world beyond Kegel exercises that a PFPT therapist needs to train you with. Ask your urologist for an order for PFPT.
Urologists are likely reluctant to write orders for it, because it costs them their group practice physician bonus pool money. If you don't know, for the last 30 years or more, physicians have been rewarded with bonus money for NOT referring patients for additional treatments, especially expensive ones. Whether quarterly, semi-annually, or annually, the physicians are rewarded by dividing a pool of money amongst their colleagues in the medical group for under-utilizing what insurance companies are known not to want to pay for. The pool of money is known ahead of time, and it is slowly chipped away at...dwindles...the more physicians write orders for what insurance companies don't want to pay for. There is often one or more people in a group practice, and every hospital has a small staff of former nurses and physicians who do patient chart reviews and assessments to rate the level of care and services given to patients, vs what is expected. Renegade, non-compliant physicians figuratively "get their hands slapped" for over-ordering/over-utilizing treatments and other patient services. This is of course, because hospitals know what they are going to be paid for a patient at the moment the patient is admitted to the hospital. If they know they are getting, say, $10,000 to care for a patient with a certain diagnosis who is normally in the hospital for "x" numbers of days, the hospital loses money if that patient isn/t discharged on time and overstays their "financial welcome." Hospitals like really sick patients (to a degree) because they get more money form them. A patient may be admitted for some type of surgery that will pay, say $20,000. But, if they are a Type II Diabetic with COPD because they smoked all of their life, and they have high blood pressure requiring medicine, and happen to have Crohn's disease of the bowel, then each of those additional conditions, offers added reimbursement on top of the $20,000 for the surgery. It is always a roll of the dice though: sometimes those patients take a real turn for the worse, and DO overstay their financial welcome because all of those other conditions delayed their normal recovery for the surgery. It's a crap shoot for sure. Sorry for the detour, but I think a lot of people do not know that about the finances of hospitals and medical groups contracted with certain insurance payers.
I offer this because you my friend, will be in a progression of diapers, to thicker pads, to thinner "Shields" style pads for the next year, but hopefully less. I am now at 11 months post-op, and I still can't claim 100% continence. I am 95% - 98% continent, but I still have mini-leaks and squirts with certain activities/motions. If you are over 65 years of age, Medicare will pay for most/all of the expense of the diapers (Medicare Plan dependent). Good luck, and hang in there.

I'm 10 month post RARP and I'm still dealing with Leakage. If I stand up too fast urine will go straight from my bladder to Urethra occasionally it will leak all the way out and I will spot my underwear. Usually it just stays in my Urethra until the next time I have to go pee. I get this leakage about once to two times a week sometimes more sometimes I can go a month without it happening.
I stopped dribbling after my 8 rounds of PT.
if it's only been a month since your RARP then your leakage is "normal" but might go away on it's on. I wore thin pads during my PT time and that helped with the dribbling. I suggest you get the PT and cut back on your fluids. One thing to consider is that if you are consuming caffeinated drinks you might cut back on those and see if that helps.

Ask your urologist immediately for 8 session of Pelvic Floor Physical Therapy (PFPT). There is actually a subspecialty of physical therapy called PFPT. It is a normal and frequently used therapy for postpartum women who have been stretched out and are in recovery, but it is also for post-prostatectomy men and elderly men who have started incontinence.
On my own first day of PFPT, my therapist said that I was approved for just two session through my Medicare Advantage Plan HMO, but she said not to worry...all it takes is for her as the therapist to write a simple justification for a total of 8 sessions. My Medicare HMO approved it.
The PFPT exercises go well beyond standard Kegel exercises, to include learning how to breathe and use your diaphragm. My PFPT explained that your entire abdomen below your diaphragm to your anus is one giant compartment that works in unison based on pressure and airflow controlled by your diaphragm. You will learn specific exercises and feelings to know that you are using your diaphragm while properly breathing during your exercises. It was actually frustrating for me: I am a natural athlete and never had a problem mastering anything of a physical nature, but my therapist was frustrated. In the earliest of sessions she'd gently say "no...breathe this way, and don't hold your breath." By the end of my eighth session she was exasperated and nearly screaming at me: "NO, NO, you're STILL doing it backwards/wrong...I thought you said you're an athlete!" Let me tell you, learning to breathe the opposite of what nature wants, or to breathe at all was a challenge. Her other admonishment was "YOU'RE HOLDING YOUR BREATH...B R E A T H E!!!" I say this in lighthearted, retrospective jest. You'll likely have no issues with it, but the main thing to know, is that there is a whole world beyond Kegel exercises that a PFPT therapist needs to train you with. Ask your urologist for an order for PFPT.
Urologists are likely reluctant to write orders for it, because it costs them their group practice physician bonus pool money. If you don't know, for the last 30 years or more, physicians have been rewarded with bonus money for NOT referring patients for additional treatments, especially expensive ones. Whether quarterly, semi-annually, or annually, the physicians are rewarded by dividing a pool of money amongst their colleagues in the medical group for under-utilizing what insurance companies are known not to want to pay for. The pool of money is known ahead of time, and it is slowly chipped away at...dwindles...the more physicians write orders for what insurance companies don't want to pay for. There is often one or more people in a group practice, and every hospital has a small staff of former nurses and physicians who do patient chart reviews and assessments to rate the level of care and services given to patients, vs what is expected. Renegade, non-compliant physicians figuratively "get their hands slapped" for over-ordering/over-utilizing treatments and other patient services. This is of course, because hospitals know what they are going to be paid for a patient at the moment the patient is admitted to the hospital. If they know they are getting, say, $10,000 to care for a patient with a certain diagnosis who is normally in the hospital for "x" numbers of days, the hospital loses money if that patient isn/t discharged on time and overstays their "financial welcome." Hospitals like really sick patients (to a degree) because they get more money form them. A patient may be admitted for some type of surgery that will pay, say $20,000. But, if they are a Type II Diabetic with COPD because they smoked all of their life, and they have high blood pressure requiring medicine, and happen to have Crohn's disease of the bowel, then each of those additional conditions, offers added reimbursement on top of the $20,000 for the surgery. It is always a roll of the dice though: sometimes those patients take a real turn for the worse, and DO overstay their financial welcome because all of those other conditions delayed their normal recovery for the surgery. It's a crap shoot for sure. Sorry for the detour, but I think a lot of people do not know that about the finances of hospitals and medical groups contracted with certain insurance payers.
I offer this because you my friend, will be in a progression of diapers, to thicker pads, to thinner "Shields" style pads for the next year, but hopefully less. I am now at 11 months post-op, and I still can't claim 100% continence. I am 95% - 98% continent, but I still have mini-leaks and squirts with certain activities/motions. If you are over 65 years of age, Medicare will pay for most/all of the expense of the diapers (Medicare Plan dependent). Good luck, and hang in there.

Sorry guys...I wrote an absolute thesis on the subject of Medicare, Medicaid, and private health insurance reimbursement, but it overwhelmed this Mayo blog and wouldn't upload. So I am trying again in a more brief post.
I offered the entire history of Diagnostic Related Groups (DRG's) that came out of a Federal government study at a hospital in New Jersey in 1976 that resulted in 476 Diagnostic Groups for each disease known, each with its own amount of reimbursement, that is known to hospitals and physicians from the moment the patient is admitted to the hospital. This happened because within a very short time after introducing Medicare and Medicaid in 1965, less than 10years later, the Federal government was spending way more on Medicare healthcare and Medicaid (indigent care) than they thought they would (surprise, surprise). They had to reign in the expenditures, so they did the study with the hospital in New Jersey, and came up with 476 disease specific codes with known average length of hospital stays and costs incurred. So...
Simply put: Say a man is admitted for a radical prostatectomy, and the hospital will receive, say, $25,000 for that surgery and admission. If the patient stays in the hospital too long, they have "overstayed their financial welcome." The physician and/or care team did not do a good job of caring for the patient, and they spent more than the $25,000 they knew they'd receive for that admission. So now they have lost money. On the other hand, if they get the patient out of the hospital a day earlier than planned, they make a profit because they still get the $25,000. This form or "prospective payment" came from the results of that New Jersey study in 1976. Prospective payment was phased in over four years: Year #1 75% traditional "fee for service" reimbursement (spend a dollar, get reimbursed a dollar) and 25% DRG payment. Year #2 50% traditional "fee for service" and 50% DRG payment. Year #3 25% "fee for service", and 75% DRG, and finally Year #4 and thereafter, it was 100% DRG payment. The DRG payment was lower than traditional "fee for service" payment, and that is why it was phased in so hospitals could change levels of care, and cut back operational costs that would keep them from being profitable.
Hospitals had difficulty with this, so back in the mid-1980's they started "cost shifting"...increasing their billings to private insurance companies for patients with such insurance, to make up for their Medicare DRG losses. The private insurance companies quickly learned what was going on, and said "no more." That is when "captitated" payment through health plans started to take shape. If a health plan had a certain number of patient enrollees, then each contracted hospital or physician group got a flat amount of money per patient..."per capita." Health plans incentivized physician groups with bonus money to not over-utilize services and care, which quickly became motivation not to do certain types of care, procedures/treatments, and pharmaceuticals. The physicians then got to share in the bonus money if they achieved their goals of managing and under-utilizing their billable patient procedures. Many physicians hated this because it was an unethical temptation and means to provide substandard care for the sake of money from the health plans. It still goes on today no matter the form of health coverage (HMO, PPO, EPO, and group health plans, etc.). Hospitals have physicians and teams of nurses that review patient charts for compliance with "Standards of Care" that each hospital develops to manage the utilization of services for each type of diagnosis. The care for every patient admitted for a certain diagnosis must follow the Standards of Care protocols. Physicians who over utilize services that costs the hospital too much money are reprimanded. BTW...each DRG could be adjusted as follows: That same man admitted for a radical prostatectomy, might also have had high blood pressure, Type II Diabetes, and Crohn's disease of the bowel. Each of these has its own DRG, but they were additive for the admission because that RP patient had to have their high blood pressure, Type II Diabetes and Crohn's disease "managed"/cared-for while in the hospital for the RP. Also, there was/is adjustments for geographic location in the paid DGR amount. Due to cost of living, wages, costs of supplies, etc., it costs more to treat a patient in, say, metropolitan Los Angles, Chicago, New York, or Boston, than it does in Des Moines, Casper, Tulsa, or Jefferson City, etc. So, Medicare reimburses more for such patients in those metropolitan areas. Hope this clears things up.