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Medical Forum / Diseases and Disorders / Prostate BPH / March 2006PVP and incontinence
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 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 semen into the bladder. If it is damaged during surgery, it may not be able to avoid this backflow of semen 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 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, etc), and I was a little upset to say the least, and wrote the uro a letter and was not a happy camper (part of the reason I took an "early out" and 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 > Dear Jesse, > [quoted text clipped - 26 lines] > Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com 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 > Pete, > [quoted text clipped - 11 lines] > pressure... It is difficult to know what causes this incontinence in > your specific case. 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 > Bests, > > Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com |
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