In December 2000, a biopsy following a rapid rise in PSA showed that I had early-stage prostate cancer; radical prostatectomy seemed to be the best option. The good news is that the operation in early 2001 was completely successful in removing the cancer: Nine years later, my PSA is still below the normal threshold level. The not so good news: The treatment left me incontinent — a common problem experienced by men after prostate cancer surgery. Family physicians I’ve spoken to say that about half of all radical prostatectomy patients have to deal with the effects of urinary incontinence. Hopefully, my experience will offer some useful ideas to other men who find themselves challenged in this way.
Overcoming setbacks
Immediately after the prostatectomy, pelvic floor muscle (Kegel) exercises seemed to be doing their job. After four months I was nearly dry, although emptying my bladder took a long time. My surgeon found a ring of scar tissue building up in my urethra and threatening complete blockage. This was treated by small radial cuts in the scar tissue to increase the orifice size. The procedure was done as day surgery and resulted in much better urine flow. While this may sound like it must have been very uncomfortable, in fact it wasn’t. There was the minor inconvenience of wearing a catheter for five days, but no pain at all.
Ordinary Kegel exercises again improved control — not quite as well as the first time, but enough so that six months later, I was using only about two pads per day. This moderate incontinence improved slightly throughout the next five years, during which time I was becoming less mobile because of a deteriorating hip joint. However, a new titanium hip in 2006 helped to get me more active again. This next period called for even more activity than usual, as I moved house twice in eastern Ontario, ending up in Kingston. My stress incontinence (resulting from exertion of pressure on the bladder, e.g. when you laugh, cough, sneeze, exercise or lift heavy objects) flared up again. It was time to seek help.
A cystoscopy showed that now two rings of scar tissue were building up very slowly in my urethra. Those rings were helping keep me dry but couldn’t be ignored because they would ultimately block the urethra. It took two day-surgery procedures to remove them. Again, there was no discomfort, and the catheters came out after three or four days. But the incontinence became severe. I began to use four or five pads on an average day, six on really active days. I felt that more drastic action was needed.
The first step was to determine whether I was doing the Kegel exercises as effectively as possible. Monitoring the exercises using biofeedback transducers quickly showed that in fact, I hadn’t been doing them properly. During 10 weekly visits to Kingston General Hospital, the nursing staff showed me what I was doing wrong and taught me to use the proper muscles. Learning the proper technique required three 15- to 20-minute practice sessions each day between hospital visits. Progress was slow but measurable. Better mastery of Kegel exercises reduced my pad usage from five or six per day to three or four — definitely a positive step, but still nowhere near what I wanted to achieve or what my surgeon thought was attainable. I had several options: I could continue using a lot of pads; I could have an artificial urinary sphincter implant; or I could choose to have a sling procedure.
Sling technology
Slings have been used for women to treat stress urinary incontinence for more than 50 years, but have only become available for men in the past decade. They are well described in literature addressing lay (nonmedical) people like myself (for example, see: www.amsadvance.com; www.canadiancontinence.ca/pdf/The-Source.pdf). Basically, a sling is a band of tissue (usually synthetic mesh tape) that is surgically placed under the urethra to support it and prevent leakage. The surgery is minimally invasive and initial studies have shown a good improvement rate. I chose this route despite some literature recommending it for only mild to moderate incontinence, because it seemed the most natural and promised the best long-term solution. I didn’t want the inconvenience of having to manually open and close an artificial sphincter. And knowing that artificial sphincters don’t last forever, I also didn’t like the prospect of having to have it replaced as I got older.
Urological surgeons in Ottawa, Toronto and Kingston guided me through my decision, and I had an AdVanceTM male sling inserted in May 2009 in Kingston, by Dr. Stephen Steele. The procedure required an overnight stay in hospital and involved very little discomfort. Sit on something soft for the first week and don’t do any heavy lifting for a month and that’s about it!
Not all men may be eligible to have a sling implant or enjoy the same results as I did, but for me, the outcome has been thoroughly satisfactory. Improvement was immediate. I’m completely dry at night, as well as some days when I’m stuck passively in front of my computer most of the time. And even when I’m more physically active helping out in my daughter’s carpentry business
or digging in the yard, I generally use no more than one pad per day.
On a final note, I’d like to express my appreciation for the good advice I received from all the medical staff involved in my care, as well as the valuable support and tolerance of my wife and family.
Phil Read is a prostate cancer survivor living in Kingston, Ontario. Since retiring from his career in the field of energy and the environment, he has been an active volunteer with the Canadian Cancer Society.
