Hi DL0808,
This the best description of the surgery that I have heard.
I may have misunderstood but Dr. Krambeck led me to believe that during the surgery the laser would “nick” the bladder neck muscle in several places. That is what causes the stress incontinence. A strong bladder neck is sphincter stops stress incontinence.
Thanks for the description.
This the best description of the surgery that I have heard.
I may have misunderstood but Dr. Krambeck led me to believe that during the surgery the laser would “nick” the bladder neck muscle in several places. That is what causes the stress incontinence. A strong bladder neck is sphincter stops stress incontinence.
Thanks for the description.
Loading...
This is news to me.
So the bladder neck is the internal sphincter ?!
And stress will cause it to open!
So the bladder neck is the internal sphincter ?!
And stress will cause it to open!
Loading...
I did a lot of internet research on bladder sphincter and inner sphincter. The muscle in the bladder neck works “automatically” to close when lifting preventing leaking. During my 6 month follow up Dr. Krambeck confirmed that it was damaged. She also said it could heal over time. During that time the outer sphincter takes on all of the work to keep the patient continent. That is why the kegel exercises are so important to build the outer sphincter.
At about 6 weeks out two of us had to move a heavy piece of furniture. I didn’t leak, I gushed. Today I am working out, lifting, and have very little or no leaking. My concern is as I grow older and my muscles weaken will I have incontinence return. I guess I will find out.
At about 6 weeks out two of us had to move a heavy piece of furniture. I didn’t leak, I gushed. Today I am working out, lifting, and have very little or no leaking. My concern is as I grow older and my muscles weaken will I have incontinence return. I guess I will find out.
Loading...
I am glad that I am talking to a knowledgeable person on the subject.
"bladder sphincter and inner sphincter"
------ are they different?
"During my 6 month follow up Dr. Krambeck confirmed that it was damaged"
---- how did she know?
"bladder sphincter and inner sphincter"
------ are they different?
"During my 6 month follow up Dr. Krambeck confirmed that it was damaged"
---- how did she know?
Loading...
More: from lingeman's 2010 paper:
"To our knowledge no patients were treated with a urinary sphincter or male sling but 2 patients received urethral collagen injections."
--- does it relate to ur situation? have time to explain what does this means?
"To our knowledge no patients were treated with a urinary sphincter or male sling but 2 patients received urethral collagen injections."
--- does it relate to ur situation? have time to explain what does this means?
Loading...
Thank you for your compliment but let me say I AM NOT A DOCTOR. I read a lot and I can make mistakes in interpretation.
The terms bladder sphincter and inner sphincter are used interchangeably so you need to search both.
I am assuming that it is a normal occurrence with classic HoLEP. The modification that Dr. Miller makes, I believe, preserves the bladder sphincter. I can’t elaborate any more than that. The day after my surgery I asked Dr. Krambeck about my inner sphincter. Her answer was, “I took it” and then ran off. I did not have a chance to ask her to elaborate.
Let me backup and tell you that Dr. Krambeck is an excellent surgeon in the technical sense. She is highly qualified.
The terms bladder sphincter and inner sphincter are used interchangeably so you need to search both.
I am assuming that it is a normal occurrence with classic HoLEP. The modification that Dr. Miller makes, I believe, preserves the bladder sphincter. I can’t elaborate any more than that. The day after my surgery I asked Dr. Krambeck about my inner sphincter. Her answer was, “I took it” and then ran off. I did not have a chance to ask her to elaborate.
Let me backup and tell you that Dr. Krambeck is an excellent surgeon in the technical sense. She is highly qualified.
Loading...
This is a paper that is given to Dr. Krambeck’s patients at the time that surgery is scheduled.
I have never had bulking shots. From my reading they are temporary and thus would have to be repeated.
Right now I am nearly continent. The stress incontinence is almost nonexistent. It happens once and a while when I am lifting at the gym. I am generally good during the day. I will dribble after voiding so I need to patient and not rush away from the urinal. The other time that I might have a drip is when I twist at the pelvis and then it only a drop or two.
For me the greater issue is the retrograde ejaculation. I have little or no intensity so the lack of ejaculation is a problem. I realize at 73 I should not worry about it and I am in the minority. My situation is extreme. My prostate was 214 grams and the surgery removed about 100 grams. My Uro says I have a wide spot in the urethra, I think of it as a mini bladder.
Back to my surgery like is said I am 73. I was scheduled for 2.5 to 3 hours. In reality it lasted about an hour including morcilation. I am nearly continent after 6 months. I hate to think what the recovery time would be if the surgery had gone the full 3 hours. I am blessed in that respect.
I may have missed it but what are your stats; age and prostate size?
If you are interested in some articles that I have found useful PM me and I will send some URLs. This bulletin board does not permit me to post them.
I have never had bulking shots. From my reading they are temporary and thus would have to be repeated.
Right now I am nearly continent. The stress incontinence is almost nonexistent. It happens once and a while when I am lifting at the gym. I am generally good during the day. I will dribble after voiding so I need to patient and not rush away from the urinal. The other time that I might have a drip is when I twist at the pelvis and then it only a drop or two.
For me the greater issue is the retrograde ejaculation. I have little or no intensity so the lack of ejaculation is a problem. I realize at 73 I should not worry about it and I am in the minority. My situation is extreme. My prostate was 214 grams and the surgery removed about 100 grams. My Uro says I have a wide spot in the urethra, I think of it as a mini bladder.
Back to my surgery like is said I am 73. I was scheduled for 2.5 to 3 hours. In reality it lasted about an hour including morcilation. I am nearly continent after 6 months. I hate to think what the recovery time would be if the surgery had gone the full 3 hours. I am blessed in that respect.
I may have missed it but what are your stats; age and prostate size?
If you are interested in some articles that I have found useful PM me and I will send some URLs. This bulletin board does not permit me to post them.
Loading...
"I took it" is a VERY SCARY answer. That means that one of the two sphincters was resected and gone for good. No wonder u had no control. But ur previous answer seemed to imply it would heal over time, correct? Or the itnernal sphincter is gone forever?
Wiki: "The internal urethral sphincter is a urethral sphincter muscle which constricts the internal urethral orifice. It is the junction of the urethra with the urinary bladder surrounding the membranous urethra. The muscle is made of smooth muscle, so therefore it is under involuntary control."
Wiki: "The internal urethral sphincter is a urethral sphincter muscle which constricts the internal urethral orifice. It is the junction of the urethra with the urinary bladder surrounding the membranous urethra. The muscle is made of smooth muscle, so therefore it is under involuntary control."
Loading...
No I don’t think it was respected. Rather during the procedure to remove the prostate tissue surrounding the bladder neck the laser nicks the bladder sphincter. It should grow back slowly, I hope. Dr. Krambeck seemed to think it would but only God knows when.
Loading...
Thanks for sharing ur experience, which I found very illuminating. But I don't follow some of ur replies.
What paper? The 2010, 1000 HoLEP paper that I cited?
What is a bulk shot?
I agree that retrograde ejaculation does not cover other aspects of sexual health. They are covered in the MSHQ(?) questionaire, but is not offen reported. I also agree that 214 gram prostrate is an extreme case. It requires either open prstrastactomy or HoLEP . HoLEP is the obvious choice.
One hr of total operating time to enucleate 214 gram is an unbelievable short time. The papers that I have read for average prostates(70-80 grams ?) quoted a total time of one hr. This suggests Dr. Amy has extraordinary skill and u were lucky to have her.
And congrats, u seem to have regain ur internal sphincter function, which u mentioned controls stress incontinence.
Thanks for offering papers u found important. Love to read them. If I have the name of the papers, I could google them.
Loading...
Yes the paper that you cited.
The bulking shot can be collagen that is injected into prostate and or around the urethra to take up space left by the surgery. it can also be other material.
Actually FLA-BPH can handle it without side effects but it may not be covered by insurance and thus very expensive. In Europe they are developing the “en block-no touch” technique for HoLEP. Most reports emphasize how easy it is to train doctors. I have found a paper that indicates patients do not automatically have the negative side effects, it is a fifty fifty chance. Another technique that is in trial here in the US is PAE. Both FLA and PAE are used by interventional radiologists, thus urologists don’t usually talk about them.
Dr. Krambeck said that the prostate basically fell apart. I would have to look up her exact words. She is a very talented surgeon.
I am going to ask Dr. K’s nurse if the internal sphincter is healed or if the external sphincter has take over?
I will go through my url collection and send ones that may be useful. It may be a while I have some other things that I to do.
The bulking shot can be collagen that is injected into prostate and or around the urethra to take up space left by the surgery. it can also be other material.
Actually FLA-BPH can handle it without side effects but it may not be covered by insurance and thus very expensive. In Europe they are developing the “en block-no touch” technique for HoLEP. Most reports emphasize how easy it is to train doctors. I have found a paper that indicates patients do not automatically have the negative side effects, it is a fifty fifty chance. Another technique that is in trial here in the US is PAE. Both FLA and PAE are used by interventional radiologists, thus urologists don’t usually talk about them.
Dr. Krambeck said that the prostate basically fell apart. I would have to look up her exact words. She is a very talented surgeon.
I am going to ask Dr. K’s nurse if the internal sphincter is healed or if the external sphincter has take over?
I will go through my url collection and send ones that may be useful. It may be a while I have some other things that I to do.
Loading...
Replying to DL808 and Buster. For what it's worth, my urologist told me the internal sphincter is really only for blocking semen from entering the bladder and directing it out during sex. It's primary function is not continence. That is the job of the external sphincter. It is standard to have the internal sphincter removed during HoLEP, hence RE results in all HoLEP surgery. The amount of damage that then occurs to the external sphincter will have a direct impact on continence.
In my case, my prostate was very long (as well as large at 150cc), required a 3 hour surgery, and hence I am still battling dribbling and leaking after my 8th month. Improvement has occurred, but very slowly. I am still crossing my fingers that eventually I will regain full continence, but figure it's going to be a good year.
In my case, my prostate was very long (as well as large at 150cc), required a 3 hour surgery, and hence I am still battling dribbling and leaking after my 8th month. Improvement has occurred, but very slowly. I am still crossing my fingers that eventually I will regain full continence, but figure it's going to be a good year.
Loading...
Wiould be interested in learning more about "en block-no touch” HoLEP if u have info.
I thought HoLEP is "en block" technique as the adenoma is decided into only two or three big pieces then push off to the bladder for morcellation removal. Curious what does "no touch" mean.
I thought HoLEP is "en block" technique as the adenoma is decided into only two or three big pieces then push off to the bladder for morcellation removal. Curious what does "no touch" mean.
Loading...
Sorry that I am ignorant about what the itnernal sphincter is. Is it a band of circular (involuntary) tissue situated immediately below the bladder neck? If so, narrowing the diameter to zero thus shut off the urine. Thus it functions as a valve. Involuntary, hence related to stress incontinence as mentioned by Buster. This part makes sense to me as well as the dr. miller's technique.
If that band of tissues is removed by HoLEP that valve is gone. In the short term, the tissue will not grow back as it will take years for tissue to regrow if it does regrow. I found this is very confusing.
" It is standard to have the internal sphincter removed during HoLEP. "
---- are u positive about this? Where can I find more info?
If indeed the internal sphincter is the circular band of tissues, it does look like it will be removed by HoLEP, which acts like a bulldozer to push all the adenoma, which includes the circular band of tissues, to the bladder for morcellation.
"urologist told me the internal sphincter is really only for blocking semen from entering the bladder and directing it out during sex. It's primary function is not continence"
--- the urologist is Dr. Das? If so, his view on RE may not be correct. This somewhat worry me as there have been many papers explaining the cause of RE for all technologies, not just HoLEP.
If that band of tissues is removed by HoLEP that valve is gone. In the short term, the tissue will not grow back as it will take years for tissue to regrow if it does regrow. I found this is very confusing.
" It is standard to have the internal sphincter removed during HoLEP. "
---- are u positive about this? Where can I find more info?
If indeed the internal sphincter is the circular band of tissues, it does look like it will be removed by HoLEP, which acts like a bulldozer to push all the adenoma, which includes the circular band of tissues, to the bladder for morcellation.
"urologist told me the internal sphincter is really only for blocking semen from entering the bladder and directing it out during sex. It's primary function is not continence"
--- the urologist is Dr. Das? If so, his view on RE may not be correct. This somewhat worry me as there have been many papers explaining the cause of RE for all technologies, not just HoLEP.
Loading...
My understanding DL is that the internal sphincter simply gets damaged to the point that it is "removed", not that it is an intentional part of the surgery, but a result of what occurs during the procedure. Since RE is 100% certain in HoLEP this explanation just seems to make sense. And since if the only thing that is left is a damaged external sphincter (to varying degrees in different patients) and in most cases continence is regained, it must be that it is able to recover sufficiently over time (and kegels of course to firm up the whole area).
The discussion regarding the internal sphincter was with my local urologist, I never had this conversation with Dr Das. As I noted previously, I would discuss this with Dr Das when you see him.
Most of us here (like me) are not MDs and don't claim to be. You seem to have done some exhaustive research (kudos to you). I would take these detailed concerns to Dr Das, and not depend on us here for that level of expertise. Until then, I wouldn't get overly worried based on response here. Let the expert address them. Just my 2 cents.
The discussion regarding the internal sphincter was with my local urologist, I never had this conversation with Dr Das. As I noted previously, I would discuss this with Dr Das when you see him.
Most of us here (like me) are not MDs and don't claim to be. You seem to have done some exhaustive research (kudos to you). I would take these detailed concerns to Dr Das, and not depend on us here for that level of expertise. Until then, I wouldn't get overly worried based on response here. Let the expert address them. Just my 2 cents.
Loading...