Mets Day 391: Another Uro's opinion on incontinenece

Today I met with Dr. Phillips, partner to Drs. Hendricks and Fraizer.  Dr. Phillips specializes in solving incontinence issues.  He used to do RC's and build neobladders, but stopped doing that several years ago.  He was very familiar with problems with nocturnal incontinence with neobladders.  He sketched out diagrams to explain why neobladders had a propensity to leak at night.

We had a long discussion about my options, which we identified as follows, in order of least to most invasive:

1.  Do nothing, and hope my nocturnal incontinence gets better by itself.  Not interested, thanks.

2.  Try medicine.  We discussed Duloxotine (Cymbalta), but he said that he believed that another medicine, Imipramine (Tofranil), had a better likelihood of helping.  He said he'd prescribed Imipramine for his patients who had their prostate removed and had enuresis, but had not had a large track record of use with neobladder patients.  He suggested that I try it, and that I would know in a few weeks whether it was making any difference.  He candidly admitted that he had no idea if it would work, but said it was worth a shot.  "It certainly won't hurt," he said, noting that he was starting me off at 25 mg, a relatively low dose. 

3.  Use a clamp.  This was a new one for me.  I had a mental image of a binder clamp on my penis (ouch!), but he said that there was a product called a C3 penile clamp that was designed to help with incontinence.  I'm skeptical.  It looks uncomfortable (despite the title), but Dr. Phillips said that many of his patients had found that they worked.  It's going to take me little while to get used to the idea . . .

4.  An Artificial Urinary Sphincter, or AUS.  His discucssion was identical to Dr. Wright's:  implant it, wait 6 weeks, then activate it.  He was candid on the pros and cons, and recommended that I try options 2 or 3 first.

5.  Remove the neobladder and switch it to an Indiana Pouch or an ileal conduit.  This is major surgery.  He said that changing it to an IC was straightforward, but changing it to a pouch would mean taking out the neobladder and then taking another chunk of bowel to make the pouch, which would increase the odds of bowel problems.  I'm not too excited about that either.

I think I'm going to try the medicine option first.  I've been taking Cymbalta for 5 days, so I'm going to continue with that for a couple of weeks and see if there is any effect (so far, I haven't noticed any difference).   Then I'll give the Imipramine a try.