For me, prostate cancer brought many fears and worries to the fore in addition to fears for the possible consequences of cancer and my mortality. As I availed myself of the tremendous amount of information on the Internet, I found that my main fears centered on the possibility of impotence and incontinence.
Impotence resulting from prostate surgery is caused by the severing of the nerves which control one's ability to have an erection, while incontinence results from the removal of one of the two sphincters during surgery and the cutting and sewing together during the operation. Today, nerve saving (or nerve sparing) surgery is widely practiced, but it can take a man over a year to become potent again. There are various devices available to help achieve an erection, including Viagra. Control of the bladder is another story.
During surgery, a catheter is inserted and is left in place for (up to) three weeks while the remaining sphincter learns to cope with its increased workload.
Five months prior to the radical prostatectomy I underwent hormone treatment to shrink the prostate, and one of the side effects was the loss of my libido. Until this time sex had always played an important part of my life, but during the hormone treatment I came to the realization that life without sex was not that bad. My relationship with Myrna, my wife, became the best in our thirty-six, some times stormy years of marriage.
My first objective was to come through the operation without too much pain and to survive the three weeks of the catheter. Survive might sound strong, but the thought of having a plastic tube stuck into my penis was almost as frightening as the post catheter fear of not having control of my bladder and being swathed in diapers for the rest of my life.
My first experience with a catheter was in the early 1990's, after a hernia operation. Several hours after the operation I complained to the nurse on duty that I was in pain and couldn't pass water. I was ready to climb the walls with pain, when the surgeon made a unexpected ward round. He took one look at me and shouted for morphine and a catheter. What happened after that, turned out to be one of the most pleasurable moments that I have ever experienced. To this day though, I am not sure what was more enjoyable, the morphine or the fact that the catheter allowed me to empty my bladder. After 10 years I can still remember that very relaxing feeling. On one hand, I can understand how people can become addicted to morphine. On the other hand, it meant that my first encounter with a catheter was a positive one although it was only in place for 12hrs, most of which time I spent sleeping.
My next and I hope last encounter was in February 2001, after my radical prostate operation. The build up to the operation took almost 4 years. When first diagnosed as having cancer in the prostate I was not happy with the urologist who was attending me. He told me that I would have to be operated on immediately. Statistics that he provided showed that there was a 10% chance of me retaining my potency and a 90% chance of retaining control of my bladder. These figures frightened me. Secondly, after reading up more about prostate cancer and speaking to other people in the medical world, I realized that my cancer count was very low. I also discovered that, in such instances, in many countries a" wait and see" program would be instituted. I opted for this method. Thirdly, I turned to alternative medicine, changed my eating habits, lost a lot of weight and felt more energetic -- better than I had felt in the preceding 10 years
During the following 3 years I more or less stuck to my new lifestyle and read every thing I could on prostate cancer. In May 2000, after a medical check up, my PSA was found to have doubled. (Prostate-specific antigen is the test to establish whether there are any problems related to the prostate, including cancer.) This indicated that something was wrong in the prostate. I could not believe it! For almost 3 years the PSA had been stable, even dropped! and now it had doubled! I had another test, which unfortunately confirmed that the PSA had doubled. There was no choice but to return to standard medical methods and treat the cancer. I found a urologist with whom I could communicate, went through batteries of tests and discussed the various therapies available. Finally I opted for surgery.
Early on the 26th of February 2001, I checked into the urology ward. The first thing I noticed were the bags that most of the patients were carrying around with them. These bags were attached to their penises and were known as catheters. Would I be so casual and at ease with my bag? I noted that there did not seem to be a 'standard' way of wearing this accessory. Some carried the bags in their hands, others had them hooked onto the pocket of those awful hospital gowns. Many of them were full of a reddish liquid while others were a piss-yellow. I now realize that I had resigned myself to whatever awaited me and would make the best of the situation.
I had been in a similar position in 1982 during the war in Lebanon while driving through a captured town in a covered jeep. I found that to overcome the reality of the situation, I had placed myself 50 meters above the jeep, watching those idiots in the jeep, almost powerless to defend themselves, driving through a hostile city surrounded by enemies whom they could not see. Once again I was sitting somewhere above, watching myself, resigned to my fate.
I knew that within 24 hours, I might be joining the "club." Let me explain: one of the fears of cancer in the prostate is that the cancer has escaped from the confines of the prostate and spread to the surrounding areas. In this case the surgeon would not remove the prostate nor insert a catheter. He would sew the man up and order hormone and other treatments to try and control the cancer from spreading and causing, eventually, a miserable and painful death. In one of the books I had read, the author tells how, on coming around after surgery, he immediately felt to confirm that the catheter was in place and was ecstatic to find the tube protruding from his penis. It confirmed that the cancer had been confined to the prostate. I felt no fear of the cancer spreading, but on coming around, found myself reaching for my penis for that comforting confirmation that the cancer was out of my body. The catheter was in place and a new phase of my life had begun.
That first night after surgery I dreamt that I was drowning in piss. The following morning I woke up to find that I was lying in a bloody liquid. During the night, the bag had worked loose from the catheter and I was lying in the resultant spill of bloody urine. That was my first disillusionment about my 'comforting attachment.' However, there is always an up side to everything. Two young, good-looking student nurses were sent to bed-bath me: not that I could appreciate their touch! I enjoyed the new experience of being sponged and pampered.
The handling of the bag soon became a subconscious action. For example, when lying on the bed, I hung the bag on the bed railings and of course had to remember when getting out of bed to attach the bag to my gown. I suffered no pain after the operation and was walking around the following day. As the bag filled up, it became heavy and I soon learned where spare bags were kept so that I would not be carrying the extra weight. The nurses changed bags three times a day, but I did it at least six times daily. The patient's progress was judged by the color of the urine in the bag. In other words, discharge from the hospital could only be considered when blood no longer showed in the urine. What a relief I felt on the fourth day when I woke up to a clear bag. However, after exercising, there was the reddish hue in the bag again and I realized that exercise at this stage was out of the question. More than anything I wanted to go home.
On the morning of the sixth day, after ward rounds, the chief surgeon said I could go home. I phoned Myrna to buy a leg bag to attach to the catheter and to come and pick me up. Now I was faced with another problem. I was not going to walk around the streets with the piss bag in hand or hooked to my trousers. Myrna was picking me and my catheter up at the main entrance to the hospital (there is no parking near the hospital) with the leg bag. How to manage? I solved the problem by scrounging a large safety pin from one of the nurses and pinned the bag to the inside of my trousers. At home I would attach the leg bag.
The leg bag has straps for attachment to the leg, and a tube, which you plug into the protruding appendage dangling from your penis. At the bottom of the bag is a tap whereby you can drain the urine when it fills up. The nurses suggested that I use a standard bag whenever I lay down.
The catheter created an unexpected problem the first time Myrna and I lay down together. For years before going to sleep we would cuddle for a few minutes, which meant turning inwards. The bag was lying on the floor at my side of the bed and the connecting tube made this move very uncomfortable for me. While in hospital, I had not encountered this problem as the bag was hooked on to the bed, thus allowing more freedom of movement. Another obstacle to overcome and a change of habit.
I soon settled down to a routine of changing or emptying the bags. When going to lie down, I would walk to the bedroom dragging the bag on the floor behind me. My daughter had been in India and had photographed a guru with a rock suspended from his erect penis and I pictured myself building up the muscles to do similar feats. We went to a party and I found it amusing when swinging my leg, to watch the expression on the faces of people who heard the sloshing (from the urine bag) - which of course was covered by trousers-and not didn't know where the sound was coming from!
After three weeks of "wearing" the catheter, it was time to take it out. Then I had frightening thoughts about the extent of control I would have of my bladder. Would I have any control at all? My fears of incontinence after the operation made me determined to create as much control as possible. For two months prior to the operation I had being doing exercises to strengthen the sphincter muscles. On my discharge from the hospital, I was told to bring adult diapers on the day that I would have my catheter removed, as there could be a steady uncontrollable flow of urine. After the relatively easy time I had had up to now, I felt confident that I would have some sort of control, so decided to find the thickest sanitary pads available and took them with me on my return to the hospital to have the catheter removed. The nurse who removed the catheter raised her eyebrows and mumbled something about me being an optimist, when she saw me putting the pad in place. Well, optimist or not, after three days I was down to using only two pads a day. Furthermore, after a week, I was using one a day. After two weeks, I was using one ultra thin panty liner a day.
I cannot say that I was sad or depressed to part with my catheter. It is now six weeks after the operation; I have control of my bladder. The next hurdle is: will my potency return or will I use Viagra or other potency aids?
© Lenny Hirsch 2003
After his radical prostatectomy, Lenny Hirsch's PSA rose measurably.
Read more about how he's come to terms with sex
after surgery and how he's reached into himself after marital seaparation to find new friends and go on with his life in a new job while organizing the first prostate cancer support
group in Israel:
Making Out: Sex After Prostate Surgery and Separation
Tomorrow Will be as Good As Today
Living with Cancer
Israel now helps organize two active support groups, one in Tel Aviv and a Haifa
support group :
You Are Not Alone (YANA).
Meetings 6 pm, last Thursday of every month, companions invited
Meetings in Hebrew and in English, if required.
Israeli Cancer Association, Bldg. 5
Contact: Lenny Hirsch, phone
Tel Aviv: 0528300467
Haifa and the north 0544570595
For a list of support groups around the world:
prostate cancer activist news