To all who may care...I have pasted one of my old posts from 3/06 regarding
my incontinence, that may be beneficial to Norm, and others who were not in
the newsgroup then.  And it may be of use to Ed and others, as a repeat
also, if you happen to remember it :-) .  I have also pasted Dr. Sancha's
reply, and my reply back to him...Pete

Here is my previous post -
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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 - ).  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 mistaken, 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

Here is Dr. Sancha's reply -
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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

Here is my reply back to Dr. Sancha -
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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  .

Pete