Aging Dads: Incontinence Issues Part 2– A Urologist Weighs In

Dr. Leonard Plaine, a highly respected, recently retired urologist at NYU Langone Medical Center, was a logical choice to double-check my last week’s “Aging Dads: Incontinence Issues–Part 1” post. He has treated men’s urological issues for many decades and I especially wanted his “take.”

Dr. Leonard Plaine weighs in:

1.  The links are well-chosen. They provide the important information men need. But he wanted to make a point about human nature, saying “Many people are not motivated to do Kegels regularly.” And that’s a good point. Some people certainly are; but what about those who have good intentions but won’t follow through? Is “Know Thyself” the key?

2.  Harvard’s Prostate Knowledge article,“A patient’s story: Overcoming incontinence,” is excellent–very complete– a piece every man wondering about incontinence issues and prostate surgery should read.

Coincidently, it was timely. Dr. Plaine had been consulted by a former colleague, earlier that day, about the advisability of his patient’s having the artificial sphincter procedure for overcoming incontinence. Dr. Plaine’s opinion raised an important caution. It involved radiation.

His former colleague’s patient had successful prostate surgery several years before and carried on life as usual. Then his PSA rose and another doctor ordered radiation treatments, which the patient had. Incontinence followed. The artificial sphincter procedure, detailed in Prostate Knowledgewas being contemplated. Dr. Plaine said once tissues in the area needed for the sphincter have been subjected to radiation, they are compromised–reducing the likelihood of a problem-free solution. In fact, he would not recommend the artificial sphincter procedure in that situation.

This prompted me to phone the friend mentioned in Part 1, whose husband had radiation after prostate surgery, was living with incontinence issues, and was considering the sphincter procedure. She said her husband consulted 2 doctors. One surgeon–according to her–was ready to do the sphincter procedure; her husband’s surgeon (who did his prostate surgery), on the other hand, was very hesitant–said chances were my friend’s husband “wouldn’t be happy.”

Lastly, I learned two new terms: “urodynamics ” and the “Cunningham clamp.”
The first is the sophisticated study of how the bladder works and helps diagnose reasons for incontinence. When ordinary answers aren’t the answer, urodynamic testing may be recommended. Mayo Clinic explains “urodynamics” testing in the preceding link.

The second, “Cunningham Clamp,” (see update below)* is what Dr. Plaine calls–an “old fashion” device, meaning it has been around for years, to control incontinence. Although he said he hasn’t heard much about it recently, he thinks it’s good daytime option to adult underwear, pads etc.

With hopes that some of the information in these last 2 posts will help older dads age well……..

5/2015 Update: the acquaintance mentioned in part 1, tried the Cunningham clamp for a while and, as I recall, didn’t like it. Will check on specific reasons and add those at a later date. He decided on the sphincter surgery, which took place 3 months ago after his surgeon said the tissue looked fine for the procedure. I understand he’s happy with the current result. I don’t think there was a discussion about the possibility of a later problem with the tissue. This is obviously a question to ask of the surgeon if contemplating the procedure. Note: This should not be construed as medical advice; only one person’s experience that can provide a framework for discussion.

Check out: “Newsworthy” (right sidebar). Links to current information and research from highly respected universities to help parents age well.

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