Saturday, October 20, 2012

Doing a bit of my very own science!

[TMI] [Science] Caution: What follows deals with subjects that may make some people uncomfortable.  Various body parts and their function are discussed in plain language.

Update 31 Oct 2012: Added a new specimen and a bit more history. Inline below.

The general consensus among urologists about why some men leak after having their prostate removed and other men don't is that they don't have any idea.  I asked Dr Cavernosa about it and he said it was a frustrating topic.  He said he would sometimes think "I did a really good job on that guy and he leaks like a sieve."  Other guys who got exactly the same `reatment did fine.  Some guys leak, some don't.  Nine out of ten times the leakers get better with time.  Sometimes biofeedback can help.  But some don't improve and require additional work to restore continence.

I am just over four months out from a robot assisted radical prostatectomy and I still leak quite a bit.  I've been working with a biofeedback nurse who coaches me on my "kegel" exercises and hooks me up to a machine every couple of weeks to measure my "progress" and, to be fair to her, there has been some progress just lately.  But it has been maddeningly erratic with repeated alternate improvements and relapses. 

I have developed a theory about why I personally have leaked for so long and why I seem to be getting better.  It also explains the on-again, off-again nature of my improvements.  I have a dab of evidence which I will get to in a minute, but first the theory.

The Theory:

Because the cancer had grown near, but not into, my urinary sphincter (which the doctor and I wanted to keep) he had to cut things pretty close.  This meant that there were sutures very near to the sphincter and they irritated it.  These sutures should have dissolved fairly quickly but because I reduced my fluid consumption to minimize the leaking (Depends cost money) my urine was a bit concentrated and some of the minerals crystallized on the exposed parts of the sutures, slowing the rate at which they dissolved and making them stiffer and more uncomfortable.  In the last few weeks these encrusted bits of suture have been breaking off and being expelled with my urine.  They come loose at one end first and, for about a day, the loose end protrudes and pokes at the sphincter making my uncomfortable and leakier than ever.  Then the other end comes loose and I am better until the next suture starts making trouble.

The Evidence:

June 14th: I have my prostate removed.June 26th: Catheter comes out I leak like a sieve.
Aug 25th: I start biofeedback training.
Sept 12th: I notice a small amount of blood in my urine after doing my Kegel exercises.  Dr. C advises a three day break from the Kegels.
Oct 11th: While taking a shower I  notice a 5mm long piece of something on the tile. (How did it get there?  Did I mention that I leak?) It looks like a bit of uncooked Ramen noodles.  I discard it.
Oct 11th and 12th: My leaking is much reduced.  I am encouraged.  I wonder if the improvement is related to the object.
Oct 13: My leaking is worse than ever.  Then just before bed I notice another bit of material in the commode.  I retrieve it.
Oct 14th: Leaking better again.
Oct 16th: Find a bit more in one of my used pads.
Oct 17th:  Start radiation therapy (IMRT).  This will somewhat confound my reporting of urinary symptoms since the radiation can cause irritation.  Buy a fine-mesh tea strainer.  Keep it in my pocked and pee through it whenever I go.
Oct 18th and 19th: Feel like a bit of an idiot peeing through my tea strainer, especially at the state fair.
Oct 20th: leaking is definitely worse.  Nothing in the dratted strainer.  Discouraged.   Then at about 3:00 pm I catch a 5mm bit of suture in the strainer.  Feel better immediately.  Leaking lets up.  Take photos of my bits of suture and write a blog posting.
Oct 25th:  Catch a small piece in my tea strainer.  About the size of the piece from the 16th.  Shaped like a russet potato.
Oct 26th through 31st: Incontinence gets worse.  Develop constant urge and a prickly irritation (similar to urinary track infection).  Nothing in the dratted strainer.  Unable to comply with bladder instructions for IMRT.  (I am supposed to arrive full for the ultrasound fine-positioning.) Discouraged.  Worried that problem is the radiation.
Oct 31: (About 9:00 pm) Catch a 6mm piece of suture in the strainer.  More comfortable immediately but still rather leaky. Specimen has an encrusted cuff at one end and bare suture material at the other.  Cuff and bare portion are both approximately 3mm.
Nov 2: (11:00 am ish),  Catch a rather small (2mm) piece of lightly calcified suture.  The end of a piece of clear suture material is visible sticking out of one end.  


Here are my photos:

 My collection (photographed in a plastic bag).  From left to right (starting with the bit that looks like grass)
1) a fleck of mostly-dissolved suture from Oct 13th,
2) today's sample (Oct 20)
3) half of the Oct 13th sample,
4) the Oct 16th sample,
5) the other half of the Oct 13th sample

 Closer shot of Oct 13th (top two) and October 16th (bottom) pieces.

 Angled shot that shows the thickness of the calcification (or whatever sort of cruft it is) that has accumulated on the Oct 13th sample.  (The hole is where the bit of green suture material came from)

October 20th  sample appears to be a knot.

October 31st specimen has a tail of bare suture material.  This one made me uncomfortable for a week.  My theory is that it came loose at the calcified end and stuck out of the sphincter wall like a thorn.  (Sorry about the photo: light was so-so.)


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