Prostate surgery in March, still using pads in July, and the physio has discharged me

Operation was the second week of March. Started the exercises about ten days after the catheter came out, as instructed, and I have done them religiously ever since, which anyone who knows me will tell you is out of character.

Four months on I am down from what I was, which was frankly grim, to two pads a day and a bad afternoon if I do too much. Last week the physiotherapist discharged me. Very nice about it, said I was doing everything right, said there was nothing more she could add and to keep going with what I have got.

And I came out of that appointment feeling like I had been quietly told that this is it. Nobody said that. But nobody said anything else either. So which is it: is four months too early to be drawing conclusions, or have I had the treatment and this is the result? And is being discharged from physio the same as being told there is nothing left to try, because it certainly felt like it in the car park.

Not my situation, but I want to pick up on the car park thing because I think it is the real question in your post.

I was discharged from a completely different pathway last year and I read it as a verdict for about six weeks. It was not. What it meant was that the person in front of me had run out of things she could add, which is a statement about her toolkit, not about my prognosis. The person who could tell me what came next was the consultant, and it took me an embarrassingly long time to work out that nobody was going to arrange that conversation for me.

Ask your urology team, not the physio, what the plan is now. They are the ones with the operation notes and the timeline.

Two pads down from grim in four months sounds like a lot of movement to me, for what a stranger's opinion is worth. Sorry the appointment felt like a full stop.

Gerry, I am going to answer this with the evidence as it actually reads rather than as clinic pages usually summarise it, because in this particular area the two are quite far apart and you deserve the real version.

Start with the uncomfortable part. A Cochrane review covering 50 trials and 4,717 men found no evidence, from eight trials, that pelvic floor muscle training with or without biofeedback was better than control for men who already had urinary incontinence up to twelve months after radical prostatectomy: 57 percent still incontinent in the intervention group against 62 percent in the control group, a risk ratio of 0.85 with a 95 percent confidence interval of 0.60 to 1.22, graded moderate quality. That interval crosses one, which means the result is compatible with a moderate benefit and equally compatible with no benefit at all. The same review pooled a more prevention-shaped analysis with a much more encouraging answer, 10 percent incontinent at one year against 32 percent, but it records that this was not supported by the pad test data in the same review. The authors' own conclusion is that the value of conservative management here remains uncertain and the evidence is conflicting. The European Association of Urology does recommend offering the training to men having radical prostatectomy to speed recovery, and the strength rating attached to that recommendation is Weak. Note the verb. Speeding recovery is a claim about the shape of the curve, not about where it ends. The EAU recommends no course length at all, and the only timing it gives is a description of common practice, which is starting about seven to ten days after the catheter comes out. So your "ten days after, as instructed" was the ordinary thing.

None of that means you wasted four months. A weak recommendation means the balance of benefits and harms is uncertain and that preferences should drive the decision, not that there is no reason to do it, and the harms of supervised training are low.

Now the timeline, which is what you actually asked. Most men have transitory incontinence immediately after the operation and reach complete continence within roughly two to three months. Continence keeps returning progressively for about a year, with reported continence rates at twelve months ranging from 68 to 97 percent across studies, and further improvement recorded up to two years. So four months is a long way from the end of the published curve.

The reason those ranges are so wide is the definition, and this is the single most useful thing I can hand you. A meta-analysis of 51 studies of robot assisted surgery found that at twelve months 4 to 31 percent of men were incontinent, mean 16 percent, on a strict no pad definition, and 8 to 11 percent, mean 9 percent, if a single safety pad counted as continent. Same men, same operations, near enough double the rate, entirely from where somebody drew the line. And in the UK ProtecT study, which used the widest definition available, any use of absorbent pads, pad use in the surgery group went from 1 percent before treatment to 46 percent at six months, and by year six 17 percent of that group were still using pads, splitting into 9 percent after nerve sparing surgery and 15 percent after non nerve sparing. So when somebody quotes you a continence rate, the useful question is not whether the number is high but what counted as continent inside it. Only you can say which of those definitions describes your life.

On the discharge. Being discharged is not the same as being told nothing further can be done. Those are different sentences and only one of them was said to you. Continued leakage after a completed conservative course is a specific result, and it is the specific result that opens the next conversation, which is with your urology team rather than with a physiotherapist. Mo is right about who to ring. Men's pelvic health after prostate surgery has the figures above with their definitions attached, and when physiotherapy is not enough sets out what that next conversation covers and the four questions worth taking into it.

What I cannot tell you is whether four months is early or late for you, because that depends on your surgery, your notes and an examination, none of which I have. There is no clean line at which leaking after this operation stops being expected, and anyone who gives you one is guessing.

One thing that is not a pathway question and does outrank it: being unable to pass urine at all, a fever with flank pain, a wound that opens, or unexplained visible blood in your urine are same day contact rather than something to raise at a review.

Rang the urology nurse specialist on the Monday after that post, which I would not have done without this thread because I had it filed under "not worth bothering them".

She was unbothered by the pads at four months, said much what Bethan said about the year, and has put me down for a review in the autumn with a proper conversation then if it has not moved further. She also asked how many pads and how wet, which nobody had asked me before and which I had to guess at, so I am now keeping a tally like a man counting his own laundry.

The car park feeling has gone. It turns out that what I needed was not more treatment, it was somebody to tell me where I was on the map.