DEAR DR. ROACH: I had a DaVinci prostatectomy 11 months ago. I can sit or stand for hours with no problem, but then sitting on the floor to play with my dog causes me to leak. I realize that getting on the floor or any other bending squeezes my bladder, thus causing a leak. So does a cough or a sneeze. I sleep all night with no leakage, although I do urinate two or three times a night. I have done Kegel exercises, but have been told to cut back so I donβt overtire the muscle. Do you know of any procedure by a doctor or anything I personally can do? My doctor says, βJust wait β it takes time,β but Iβve experienced no further improvement since about six months post-surgery. β K.F.
ANSWER: Incontinence in men following prostate surgery is a common problem, even in robotic (DaVinci is a robotic system) surgeries. In a large study, about half of men after prostate surgery will have some incontinence two months after surgery, but this decreases to 15 percent at one year. At two years, only 7 percent of men felt that incontinence was a moderate or big problem. A separate study showed that urinary function continues to improve for up to four years after surgery. So I agree with your doctor that time is likely to improve symptoms.
Pelvic floor exercises have been proven in multiple studies to benefit incontinence symptoms. I am surprised that you are getting advice to cut down, but I would listen to the advice of the therapist helping you, who must have vastly more experience than I do.
If you continue to have symptoms, there are drug treatments and surgical treatments, the most effective of which is probably the artificial urinary sphincter. However, since only 1 percent of men after prostate surgery will require it, I do counsel patience, although I recognize how frustrating it must be for you.
DEAR DR. ROACH: I am a 77-year-old man in good health. An issue has been gnawing at me for going on close to three years. When I am sitting in the driverβs seat and traveling more than 100 miles, I develop a pain that starts in my right buttock and radiates down to my knee and foot. β D.W.
ANSWER: Whenever I hear that a pain is βradiating,β I think of nerve pain. The fact that the pain begins after sitting for a long time suggests that the nerve is being compressed. Unfortunately, the only advice I can give that I have found consistently effective is to avoid excess pressure. This may mean getting out of the car before the pain starts and walking about to relieve the pressure. Sometimes a more comfortable seat or cushion can help.
