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1 26th May 20:25
jesse
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Posts: 1
Default PVP and incontinence (bladder ejaculation)


We know that lasing at the bladder neck can cause retrograde
ejaculation. Can PVP cause incontinence? In particular, does lasing in
the bladder neck cause incontinence? Does anybody have experience of
this, one way or another?

Jesse
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2 26th May 20:25
fgomsan
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Posts: 1
Default PVP and incontinence (urinary bladder ejaculation prostatectomy)


Dear Jesse,

Lasing the bladder neck can cause retrograde ejaculation. Men have two
urinary sphincters, one is the bladder neck, the involunctary
sphincter, and the other one is below, at the prostatic apex, the
volunctary or external sphincter.

The bladder neck contracts during ejaculation to avoid the backflow of
***** into the bladder. If it is damaged during surgery, it may not be
able to avoid this backflow of ***** and retrograde ejaculation ensues.

Continence after prostatectomy relies on the external sphincter, as the
bladder neck is usually damaged with prostatectomies. This sphincter
suffices to have perfect continence.

Trying to preserve the bladder neck during PVP could result in
preserved ejaculation but also could cause obstructive voiding.

I usually try to focus on deobstructing the patient and to provide him
with a long term unobstructive voiding and thus I lase the bladder
neck. Excessive coagulation on the bladder neck could cause a bladder
neck stricture, although the chances are extremely low. There is no way
of preserving the bladder neck in a patient with a median lobe. When
you remove the median lobe, the bladder neck is totally opened.

I hope this helps,

Fernando Gómez Sancha
http://drgomezsancha2.blogspot.com
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3 26th May 20:26
pete
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Posts: 1
Default PVP and incontinence (stress bladder sphincter ejaculation throat)


Dr. Sancha...You have stated twice now (once previously also) that the
internal sphincter or bladder neck is involuntary, and it seems you are
saying that it is "only" used to contract during ejaculation to prevent
retro.

Let me ask you about the following (as I have said, I had TUIP in 1995, and
TURP 2005).

After the TUIP I had stress incontinence (from coughing, clearing throat,


retired early - lol). Naturally, he said he did nothing wrong and did not
sacrifice the external sphincter. Later on I asked another uro about this,
and he said the bladder neck was another "valve", but didn't explain any
further (when I asked why I had the stress incontinence after the TUIP).

After the TURP last year, I have about the same amount of stress leakage as
before, but it seems to be worse at night (ie I will dribble or leak
sometimes while in bed when I turn over, etc - I don't even have to cough or
clear my throat).

So, assuming neither of the surgeons compromised my external sphincter (for
the TUIP or the TURP), why did the work they did in way of the bladder neck
cause my stress incontinence, and now my additional dribbling in bed. It
seems to me that the bladder neck also contributes (as a "valve") in holding
back urine (not just as a valve that prevents retrograde ejaculation).

Is my assumption valid (or "am I all wet" - no pun intended - lol), and the
bladder neck only prevents retro, like you said. If it only prevents retro,
then the surgeons must have done something to my external sphincter (even
though minor, and not enough to cause a worse type of incontinence - I know
there are four classifications of incontinence). I have been curious about
this for many years now. Thanks...Pete fgomsan@gmail.com wrote:
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4 26th May 20:26
fgomsan
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Posts: 1
Default PVP and incontinence (bladder sphincter)


Pete,

Of course the internal sphincter contributes to continence, but the
vast majority of patients are continent when they rely on their
external sphincter. TUIP uses electrical current that can damage the
external sphincteric inervation. Cutting the bladder neck usually does
not cause incontinence, neither does TURP, except in a limited number
of patients.

Maybe the reason is that the electrical current used damaged somehow
your external sphincter's ability to hold urine, maybe the muscle tone
in your sphincter is not able to hold urine, maybe you experiment
involunctary bladder contractions that overcome the sphincter
pressure... It is difficult to know what causes this incontinence in
your specific case.

Bests,

Fernando Gómez Sancha
http://drgomezsancha2.blogspot.com
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5 26th May 20:26
pete
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Posts: 1
Default PVP and incontinence (stress kidney bladder sphincter)


Thank you Dr. Sancha...I don't think it is the non surgical possibilities
you mentioned, because I did not have the stress incontinence (nor the
increase in bed dribbling) before the surgeries, and I don't believe in
coincidences as a rule (there is no doubt in my mind that the initial stress
incontinence in 1995 was caused by the TUIP). But you did answer my
question about the internal sphincter contributing to continence, so I will
definitely assume that the surgeries have resulted in the types of
incontinence I described, whether it was electrical current damage to the
external sphincter, and/or some kind of damage to the internal sphincter (ie
the bladder neck). Since I don't have any luck with my medical problems, I
am probably one of the limited number of patients you mentioned, that might
have incontinence problems from cutting the bladder neck :-) .

I did the nightly drinking test (per your suggestion to my kidney post) for
two consecutive nights, and will report back to you via a new post (I have not forgotten)...Pete
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