Healing process following a urinary sling and penile implant

Posted by gabechtel @gabechtel, Mar 11 10:29am

(Non-Mayo Clinic surgery> Two weeks ago I had a urinary sling and penile implant inserted post three-year robotic prostatectomy. While my surgeon assures me all is well, I have doubts.

Vitals are stable, urine is clear and without exudate, no signs of infection. Pain partially relieved by acetaminophen 1000 mg and ibuprofen 1200mg q4-6 hours.

The amount voiding is ~50cc occurring over ~30-45 seconds in an intermittent dribble - there is no steady stream. The urine flows in continuous drops from the urethral meatus, down the side of the penis, and collects in the container. The detrusor muscle and urethral sphincters appear active and control urine flow unless the urgency to void is overwhelming, which is increasing by day.

During the day, the prospect of leaving my residence for more than an hour is almost incomprehensible. Over time, the sensation to void parallels past experiences of an increasing consumption of fluids and no bathroom. The need to void and the abdominal pressure sensation becomes overwhelming. In the bathroom, I can urinate 50-75cc, the pressure is relieved for a 60-90 minutes, then the process repeats.

At night, I can generally sleep 3-4 hours before an acute urgency to void. Two options: I can either void 50cc, return to bed, and the repeat the pattern throughout the night. The second option is an in-and-out cath that results in 250-350cc drainage. The process repeats after 3-4 hours.

Any ideas or behavior techniques to facilitate bladder expansion, reduce the urgency for immediate urine release and begin a normal routine for urination? Thanks.

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jeff Marchi | @jeffmarc | Mar 11 11:42am

There are a couple of drugs that can reduce urgency and incontinence. I take Myrbetriq And get up at the most once at night, Some nights I can wait till the morning. Gemtesa is another drug that works similarly. Ask your doctor about this.

jasonfarmer | @jasonfarmer | Mar 12 8:17am

You had both sling and implant done in same surgery? I am have sling surgery in @ 2 weeks when I asked about getting implant at same time they said no it would be to hard on me. I asked two times just to make sure and got no twice. I hope you get relief really soon

Colleen Young, Connect Director | @colleenyoung | 1 day ago

@gabechtel, how long ago did you have the sling and implant done? Where they done at the same time?

gabechtel | @gabechtel | 1 day ago

The out-patient surgery was done on 02/26 and I am a healthy 72 year old.

It has not gone well but perhaps in another week as I'm seeing the surgeon again tomorrow. The evidence-based literature is supportive of the two procedures being successful when performed simultaneously so I'm probably one of the outliers.

My biggest issue has been with urinary flow and what I perceive as a dysfunctional bladder. Initially, we both thought reducing the size of the implant (at 30% since surgery) would resolve the problem but until late last week, the pain was too great. Now that the pain is more tolerable when touching the valve, I'm more convinced that is not the issue and perhaps medication should be initiated to retrain the bladder. If there is any positives right now, there is no burst of urine when doing squats.

No matter how much fluid I consume, my maximum urinary output is never greater than 100cc. Self-catherization has become the normal, usually 3-4/day. That's easy but a change has to be made. I'm hoping one of the newer medications for bladder functioning will help.

You may have more questions or this could be overkill. In any case, I'm here and will know much more tomorrow.

chippydoo | @chippydoo | 23 hours ago

Sounds like you are dealing with urgency. I took oxybutynin for urgency after blowing on on the radiation table and it worked well. The of course you need to retrain your urinary habits. After months of radiation proctitis and ongoing treatment I am having to retrain bowel habits.

gabechtel | @gabechtel | 20 hours ago

UPDATE: My surgeon is somewhat concerned and he is certainly evidence-based. Our initial concurrence is that the urinary sling is too tight and so we will focus on: (1) slow but frequent high knee lifts to perhaps stretch the sling into a slightly less position, (2) start on Gemtesa 75mg, and (3) continue retraining the bladder to recognize complete fullness. He does not consider the urethral sphincters part of the problem.

Any other behavioral or lifestyle suggestions would be welcome.

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